Signs Metformin Is Working (or Not Working)

When people start taking metformin, it may take some time before any positive change in blood sugar or weight is noticed.

If you’ve recently added this drug to your daily routine, you may want to see results, and fast.

In this article, we’ll explore how you’ll know if metformin is working or not, and what you can do about it.

Why do people take metformin?

Metformin is the first-line treatment for prediabetes and type 2 diabetes.

The American Diabetes Association recommends Metformin for people who:

  • prediabetes aged 25-59
  • HbA1c 6% or more
  • BMI 35 or more
  • fasting plasma glucose (at least 8 hours of fasting) 110 mg/dL or more
  • previous diagnosis of gestational diabetes
  • diagnosis of type 2 diabetes.

Taking metformin regularly can help improve insulin sensitivity, reduce appetite, lower blood sugar and HbA1c, and even help people lose some weight when used in conjunction with a healthy diet and regular physical activity.

Metformin side effects

Experiencing the side effects of any new drug, including metformin, is extremely common. Most of these side effects are minor and go away within a few weeks of taking the medicine.

The occurrence of side effects is not in itself an indication that metformin is working.

Watch out for the following symptoms and see your doctor if any of them get worse or don’t go away on their own after a few weeks:

  • Nausea
  • Vomiting
  • Diarrhea
  • Decreased appetite
  • Weight loss
  • Low blood sugar (especially if you are also taking insulin)
  • Metallic taste in the mouth
  • Heartburn
  • Flatulence
  • Gas
  • Constipation
  • Stomachache

Seek emergency medical attention if you’re experiencing severe nausea and low blood sugar and can’t stop anything to treat it.

Find out more in our guide Metformin side effects: what you need to know.

Symptoms Metformin works

There are a few signs that metformin is working, and the drug’s effects may build up over time, so don’t worry if you don’t see immediate results.

Lower blood sugar

If you regularly check your blood sugar at home, you may notice that your blood sugar levels are consistently lower when you start taking metformin, especially after eating when you may be used to elevated levels.

Lower HbA1c levels

If you don’t check your blood sugar at home, you can contact your doctor’s office after a few months of taking metformin and order a glucose test (A1c test), which measures your average blood sugar over the last three months.

Your average blood sugar level should be lower after several months of metformin use. If not, discuss alternatives to metformin and/or lifestyle changes with your doctor.

You can also measure HbA1c at home with a simple test kit that you can buy at your local pharmacy or online.

You’ve lost some weight

In addition, you may notice that you lose some weight, especially if you take metformin in combination with a healthy diet and increased physical activity. However, weight loss is often small and may be inconsistent.

Signs Metformin is not working

If you’ve been taking metformin for a month or more but notice the following symptoms, it may mean that metformin isn’t working and you may need to increase your dose, work with your doctor and experiment with combination medications, or look for an alternative medication.

Watch out for the following signs.

Your blood sugar remains stubbornly high

If your blood sugar continues to rise after meals, or you routinely wake up with high blood sugar despite taking metformin, the metformin may not be working and you should contact your doctor.

The easiest way to track your daily blood sugar is if you have a glucometer at home.

Your HbA1c level has not improved

If your baseline HbA1c was higher than you would like, but after taking metformin for some time (usually 3 months after starting treatment) your HbA1c level has not improved. This is a sign that metformin is not regularly lowering your blood sugar.

It’s important to be aware of the symptoms of high blood sugar. They include:

  • Increased hunger
  • Increased thirst
  • Blurred vision
  • Increased and frequent urination
  • Tiredness
  • Lethargy
  • Body and headache
  • Fruity breath smell
  • Weight loss (which may be mistaken for the effects of metformin, but is also a sign of dangerously high blood sugar levels)

You are not losing weight or gaining weight

Metformin does not cause weight loss in everyone who takes it, but many people experience a slight weight loss (less than 10 pounds) after taking the drug for several months.

However, if you eat healthily and exercise regularly in combination with metformin, but your weight is not budging or you have gained weight, you may need to increase your dose or look for an alternative. This may be a sign that you should contact your doctor.

Frequently asked questions

How long does metformin work?

The drug takes time to build up in your system, and often the doctor will start with a low dose to avoid unpleasant side effects.

Don’t expect a miracle within the first week of treatment, but after just a few weeks you should start to notice a drop in blood sugar, especially after meals.

However, any weight loss and improvement in HbA1c levels may take several months on full-dose metformin.

How long should I take metformin before giving up?

Do not stop taking metformin until it has had a chance to work fully in your body, which may take up to a month (or more).

Never stop taking a prescribed medication before talking to your doctor. Giving up on any medication can cause unpleasant side effects, so weaning under the supervision of a doctor is crucial.

How can I maximize the benefits of metformin?

Metformin itself is not a miracle drug. To get the maximum benefit from the drug, it is best to combine it with a healthy diet and regular physical activity.

Work with your doctor or Registered Dietitian (RD) to develop a meal plan and a set of healthy activities that you can fit into your lifestyle.

The Centers for Disease Control and Prevention (CDC) recommends that most adults aim for 150 minutes of moderate activity per week, or about 30 minutes (or more!) per day (such as walking, jogging, swimming or cycling) plus 2 days per week of muscle-strengthening exercise such as weightlifting.

What are the alternatives to metformin?

If metformin really isn’t working for you, there are alternatives. Some people with uncontrolled blood sugar levels may be best suited to start insulin therapy.

Other people may opt for an SGLT-2 inhibitor such as Invokana, Farxiga, Jardiance, or Steglatro.
Other alternatives to metformin include GLP-1 receptor agonists such as Bydureon, Byetta, Ozempic, Adlyxin, Rybelsus, Trulicity or Victoza.

Some people may choose to take oral medications, including sulfonylureas (SFUs) and DPP-4 inhibitors such as Tradjenta, Onglyza, Nesina, Januvia, or thiazolidinediones (TZDs).

Finally, if you’re experiencing low blood sugar or aren’t feeling well on metformin, you may be able to go off the medication completely without starting anything new. Talk to your doctor to find out more.

To go

Metformin is an inexpensive and accessible drug that millions of people take to better control their blood sugar levels. However, it’s important to keep track of any side effects you experience and take notes to see if the prescription drug is working for you and your health goals.

Don’t sit and suffer in silence if metformin causes unpleasant side effects for more than a few weeks or if you don’t see the results you were hoping for. There are alternatives that may work better for you and your health goals.

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