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.

Type 2 diabetes occurs when the body's cells stop responding to insulin appropriately. As a result, levels of glucose, or sugar, in the blood rise too high.

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.

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Metformin may cause digestive problems.

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:

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:

  • weakness
  • 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.

Certain people taking metformin may also have a risk of kidney damage. A 2018 study suggests that metformin may reduce kidney function in people with both chronic kidney disease and type 2 diabetes.

Does metformin cause hair loss? Click here to find out more.

Other considerations

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.

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Regular exercise and losing excess weight can help reduce the need for metformin.

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.

Click here to find out more about how the different ways people can approach treatment for diabetes.

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:

Learn more here about the symptoms and complications of diabetes.

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A doctor can offer advice for stopping metformin safely.

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.

Prandin (repaglinide)

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).

Canagliflozin (Invokana)

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:

Dapagliflozin (Farxiga)

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.

Empagliflozin (Jardiance)

People can use this alone or with other drugs, such as metformin. It reduces blood sugar in a way that does not involve insulin, and may also help to reduce body weight and blood pressure.

It can help protect cardiovascular and kidney health, and it does not increase the risk of bone fractures or amputation, according to a review published in 2018.

Actos (pioglitazone)

This lowers blood sugar and, it can reduce the risk of a heart attack or stroke, but it can have adverse effects.

These include a higher risk of heart failure, weight gain, bone fractures, and edema. Edema is swelling due to fluid accumulation. If it occurs on the lungs, it can make breathing difficult.

It is not usually the first choice for people with heart failure.

    Herbal options

    People are using a growing number of medicinal plants to treat diabetes.

    These include:

    • 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.