How Does Metformin Work?

Key Takeaways

Metformin is an antidiabetic drug that decreases glucose production in the liver and makes cells more sensitive to insulin.
Metformin may also be used to treat gestational diabetes (high blood sugar in pregnancy) and polycystic ovary syndrome (PCOS) (a condition associated with fertility problems).
Metformin reduces its absorption in the intestines, so the liver makes less glucose, and you use insulin hormone more effectively, leading to lower blood sugar levels.

Metformin is usually the first-line treatment for Type 2 diabetes. Historically, it is one of the most commonly prescribed drugs to treat Type 2 diabetes mellitus, a condition in which there are high blood sugar levels and increased insulin resistance. By lowering blood sugar levels, this diabetes medication, along with diet and exercise, significantly reduces the risk of many chronic health conditions.

Metformin may also be used off-label to treat gestational diabetes (high blood sugar in pregnancy) and polycystic ovary syndrome (PCOS), a condition associated with fertility problems.

Please continue reading to find out how metformin lowers blood glucose levels.

What does metformin actually do in your body?

The antidiabetic drug metformin reduces blood glucose levels in several different ways:

It decreases the amount of glucose absorbed in the stomach and intestines, reducing how much sugar enters your body.
It activates certain enzymes and reduces the glucose your liver produces.
It increases insulin sensitivity in muscle cells and helps your body use insulin hormone more effectively.

Note that, unlike insulin and certain other diabetes medications, metformin does not increase insulin secretion from the pancreas.

What happens to sugar when taking metformin?

When taking metformin, your body absorbs less sugar (glucose) from your dietary intake, your liver makes less glucose, and your muscle cells use insulin hormone more effectively to absorb glucose from the blood. All this leads to the lowering of blood sugar levels.

What are two ways that metformin works?

Two ways metformin works are by decreasing liver gluconeogenesis (glucose production in the liver) and acting as an insulin sensitizer (making cells in the body more sensitive to insulin).

What are the advantages and disadvantages of taking metformin?

Advantages

Metformin therapy helps to control blood glucose levels and lowers the risk of cardiovascular disease, kidney problems, and other health complications in people with Type 2 diabetes mellitus.

Metformin is less likely to cause hypoglycemia (low blood sugar) than some other diabetes medications. However, the risk of low blood sugar is still a precaution with metformin therapy. All diabetic patients should be educated on the signs and symptoms of low blood sugar and how to manage it. Also, metformin is less likely to cause weight gain and may actually lead to moderate weight loss. Keep in mind that metformin is not approved as a weight management drug.

Disadvantages

Metformin can cause side effects, with the most common side effects being bloating, gas, stomach pain, stomach upset, heartburn, diarrhea, constipation, headache, metallic taste in the mouth, flushing, and muscle pain.

The good news is that metformin is also available as an extended-release formulation, metformin ER. Compared to regular metformin (metformin IR or immediate-release), the extended-release version of metformin releases the drug slowly into the bloodstream, making it more tolerable since it is less likely to cause gastrointestinal disturbances.

More serious side effects of metformin therapy include lactic acidosis (too much lactic acid in the body) and a serious allergic reaction with skin rash, hives, itching, swelling of the tongue, lips, or throat, and difficulty breathing. You should tell your doctor immediately if you develop these symptoms. You seek emergency medical care if the symptoms are severe.

Is metformin still the first-line therapy for Type 2 diabetes?

Historically, metformin is the first-line therapy for Type 2 diabetes. However, metformin is known to cause gastrointestinal side effects, in addition to metformin’s risk of lactic acidosis and kidney injury. The risk of lactic acidosis with metformin is relatively low and typically occurs in individuals with underlying health conditions. As a result, metformin may not be the “best” drug for every single diabetic patient and healthcare providers may look into other alternatives to choose the best diabetes regimen for their patients.

Additionally, many new diabetes medications have been approved over the past few years. While metformin may remain the first go-to medication for someone with a new Type 2 diabetes diagnosis, there are many reasons why healthcare teams may recommend a metformin alternative, such as:

Your blood glucose levels are well controlled with lifestyle changes (a healthy diet and regular exercise), and you no longer need to take diabetes medication.
Metformin is not working adequately to keep your blood glucose under control.
The adverse effects of metformin outweigh the beneficial effects (you are unable to tolerate metformin due to a common side effect, or you are at an increased risk of more serious side effects).
There are cost issues, especially if you cannot take metformin immediate-release and you have problems with insurance coverage for metformin extended-release.
In addition to diabetes, you have other health conditions such as heart disease. Therefore, different types of diabetes medication may be beneficial for you.
Despite rigorous diets and exercises, you cannot achieve adequate weight loss. In these cases, other diabetes treatments are also very effective in weight management in addition to their anti-diabetic effects.
You develop kidney disease, and metformin is no longer safe for you.

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