Metformin is generally a safe and effective treatment for type 2 diabetes. However, it can cause side effects, and some people may want to look at other options.
Certain lifestyle factors can increase the risk of type 2 diabetes, including:
- being overweight or obese
- engaging in low levels of physical activity
- eating a poor diet
Metformin is an oral medication that helps manage the effects of type 2 diabetes. In people with prediabetes, the drug can also help prevent or delay the onset of the condition. Doctors prescribe metformin to nearly 120 million people worldwide.
In this article, we look at the side effects of metformin and why a person with type 2 diabetes might want to stop taking it. We also look at the risk of not taking metformin and some alternative options.
Metformin is an effective treatment for type 2 diabetes. It helps lower blood glucose levels by:
- making the body’s cells more sensitive to insulin
- slowing the release of glucose stored in the liver
- slowing the absorption of glucose from food in the gut
However, metformin has a number of potential side effects. Some are common, while others are rare.
Common side effects of metformin include:
- digestive problems, such as diarrhea, vomiting, and flatulence
- a vitamin B-12 deficiency
- slight weight loss
A person should talk to a doctor before stopping metformin treatment. Taking the medication with food reduces the risk of digestive problems.
Around 30 percent of people taking metformin in the long term experience vitamin B-12 deficiency. Symptoms can include:
- shortness of breath
- nerve damage
Is it safe to eat grapefruit while taking metformin? Find out more here.
Less common side effects
In some people, metformin causes blood glucose levels to drop too low, and the medical term for this is hypoglycemia.
Hypoglycemia is more likely to occur if a person is taking insulin as well as metformin.
There is also a very low risk of developing a condition called lactic acidosis, which results from a buildup of lactic acid. This condition can be life-threatening.
Exercise can reduce insulin resistance and improve type 2 diabetes symptoms. However, some research suggests that taking metformin in the short term may reduce the positive effects of exercise on insulin sensitivity.
Due to the side effects of metformin and other antidiabetic medications, a person may prefer to manage type 2 diabetes through lifestyle changes.
Even people who experience no side effects may wish to avoid the long-term use of medication.
Many people with type 2 diabetes find that they can manage their condition through lifestyle changes alone. These can include:
- Making dietary changes: A 2017 review found that changing the diet may significantly reduce type 2 diabetes symptoms and prevent complications.
- Losing weight: In a 2018 study, almost half of the participants reversed their type 2 diabetes and came off antidiabetic medications following a 12-month weight loss program.
- Exercising regularly: A 2014 study suggests that a single exercise session can help to improve symptoms of type 2 diabetes temporarily.
Stopping smoking and reducing or avoiding alcohol can also help control symptoms.
When a person chooses to stop taking metformin, or any other antidiabetic medication, there is a risk of symptoms becoming worse.
It is, therefore, essential that people manage their symptoms through sustainable lifestyle changes involving the diet, weight management, and regular exercise.
If left untreated, high blood glucose levels can lead to complications, such as:
- impaired vision, or diabetic retinopathy
- kidney problems, or diabetic nephropathy
- nerve damage, or diabetic neuropathy
- heart problems
- sexual health issues
- foot problems
Learn more here about the symptoms and complications of diabetes.
Speak to a doctor before stopping metformin or any other antidiabetic medication.
A person can stop using this drug safely if they are able to manage their type 2 diabetes effectively through sustainable lifestyle changes.
These should involve:
- the diet
- weight management
- regular exercise
A doctor will often use certain criteria to determine whether it is safe for an individual to stop taking metformin.
These criteria include:
- having a fasting or pre-meal blood glucose level of 80–130 milligrams per deciliter (mg/dL)
- having a random or after-meal blood glucose level of under 180 mg/dL
- having a hemoglobin A1c result of under 7 percent
A doctor can give advice about choosing the right diet and exercise plans. They can also help set realistic goals and provide monitoring and support.
If necessary, they can refer a person to a dietician or another specialist.
People who do not like the side effects of metformin can ask their doctor about other options.
This works quickly to lower blood sugar levels, but it can lead to weight gain in people who have not used similar drugs before, and a loss of blood sugar control, which may lead to hypoglycemia.
It might also interact with other medications.
People with severe kidney problems may need to start with a lower dose than other people, according to the Food and Drug Administration (FDA).
This drug lowers blood sugar and reduces the risk of cardiovascular disease, but it can also increase the risk of needing an amputation in people with:
- peripheral vascular disease, which affects the blood vessels in the hands and feet
- neuropathy, or nerve damage, which can lead to problems throughout the body, including the feet
This lowers blood sugar and reduces the risk of atherosclerotic or cardiovascular disease, so it may be suitable for people with diabetes who have a risk of this type of complication.
It is not usually the first choice for people with heart failure.
People are using a growing number of medicinal plants to treat diabetes.
- Bitter gourd (Momordica charantia)
- Fenugreek (Trigonellafoenum-graceum)
- Gurmar, or cowplant (Gymnemasylvestre)
- Neem (Azadirachtaindica)
These are traditional remedies for diabetes that people have used for a long time, and research suggests that some may help to reduce blood sugar.
However, researchers note that there is not enough information about how they interact with other treatments.
A person should not change drugs or use herbal medication to treat diabetes without speaking to their doctor first, as it could be dangerous.