Metformin, the Liver, and Diabetes

Most people think diabetes comes from pancreas damage, due to autoimmune problems or insulin resistance. But for many people diagnosed “Type 2,” the big problems are in the liver. What are these problems, and what can we do about them?


First, some basic physiology you may already know. The liver is one of the most complicated organs in the body, and possibly the least understood. It plays a huge role in handling sugars and starches, making sure our bodies have enough fuel to function. When there’s a lot of sugar in the system, it stores some of the excess in a storage form of carbohydrate called glycogen. When blood sugar levels get low, as in times of hunger or at night, it converts some of the glycogen to glucose and makes it available for the body to use.

Easy to say, but how does the liver know what to do and when to do it? Scientists have found a “molecular switch” called CRTC2 that controls this process. When the CRTC2 switch is on, the liver pours sugar into the system. When there’s enough sugar circulating, CRTC2 should be turned off. The turnoff signal is thought to be insulin. This may be an oversimplification, though.

According to Salk Institute researchers quoted on RxPG news, “In many patients with type II diabetes, CRTC2 no longer responds to rising insulin levels, and as a result, the liver acts like a sugar factory on overtime, churning out glucose [day and night], even when blood sugar levels are high.” Because of this, the “average” person with Type 2 diabetes has three times the normal rate of glucose production by the liver, according to a Diabetes Care article.

Diabetes Self-Management reader Jim Snell brought the whole “leaky liver” phenomenon to my attention. He has frequently posted here about his own struggles with soaring blood sugars that were not controlled by 75/25 insulin, pioglitazone (brand name Actos), nateglinide (Starlix), and glyburide (Micronase, Diabeta, Glynase, Prestab). All the medicines were overwhelmed by his liver’s dumping glucose.

The best tool medicine has found for controlling the liver is metformin. Metformin has been known for decades; it has been the first-line oral diabetes medicine in the United States since the 90’s. But until recently, we really haven’t understood how it works, so it has usually not been used to best advantage.

Metformin prevents the liver from dumping more glucose into the blood. Scientists used to think it worked by telling CRTC2 to cooperate with insulin (in other words, reducing insulin resistance.) But new studies have found that metformin actually works by bypassing CRTC2 and directly telling the liver cells to hold the sugar.

So if your CRTC2 switch is busted, you need some metformin in your blood at most times, to prevent the liver’s dumping glucose. Jim discovered this one night when he forgot his dinnertime metformin and took it at bedtime instead. In the morning, he had very little dawn effect; his morning sugars were much better. Working with his doctor, he figured out that taking 500 milligrams of metformin at 10 PM and another 500 milligrams at midnight kept his sugars down until 5:30 AM.

It seems that for people whose leaky livers are the main factor in their sugar levels, taking 500 milligrams of metformin four or five times a day might be optimum. But everyone’s different, and it takes some work (with your doctor) to find what pattern works best for you.

Metformin takes a couple of hours to fully absorb, and lasts about five hours in most people. (Half-life in the body is about six hours.) There is also an extended release form that can be taken once or twice a day.

What causes leaky livers in the first place is not really known. It seems that people with fatty livers may be up to five times as likely to develop diabetes, so liver fat, which is loosely associated with abdominal fat, may be part of the story. But thin people can have leaky livers, too, so there’s more to it.

It might help to learn when your liver tends to dump sugars. This might require frequent monitoring for a while. Jim has a continuous glucose monitor, which enabled him to get his regime right. According to him, if his sugar goes low, or his metformin level goes low, or sometimes after eating (for some unknown reason), his liver will dump glucose into his bloodstream, as he can see on his monitor. The only thing that stops it is having enough metformin in his system. (I’m sure Jim will correct any mistakes I’ve made in the comments section.)

People without diabetes sometimes take metformin for weight loss or for conditions like polycystic ovary syndrome (PCOS). It’s one of the best, most affordable and most successful chemical medicines ever invented.

When the dose is too low, however, it may not seem to work at all. Bottom line is that many people with diabetes may not be getting enough metformin or not getting it at the right times. You might be one of them, especially if you have a dawn effect, especially if you’re already on a basal insulin.

There is a lot more to learn and say about these topics, but I want to hear from you first. Does any of this ring a bell for you? What have been your experiences?

Want to learn more about this popular diabetes drug? Read “Diabetes Medicine: Metformin,” “Metformin: The Unauthorized Biography,” and “Metformin Smelling Fishy? What You Can Do,” then take our quiz, “How Much Do You Know About Metformin?”

Learn more about the health and medical experts who who provide you with the cutting-edge resources, tools, news, and more on Diabetes Self-Management.
About Our Experts >>

  • calgarydiabetic

    I remember taking 1500 mg of metformin in the beginig of my diabetes and it did nothing. could be that just was not enough. Now I pop some along with tonnes of insulin and it does seem to do some good. Jeanne Wagner has great success with it at 2800 mg/day. Many people cannot take it because of GI upset or like me makes me feel DEAD tired.

  • Caroline Comings

    Greetings, The cytomegalovirus switches the kidneys’ bloodpressure raising activities into overdrive: RAA system renin-angiotensin-aldosterone.
    Does your research indicate the possibility that this hyperactivity of the liver might too be caused by a virus?
    Best wishes.

  • Anne

    My metformin prescription says to take
    with a meal. If I forget to take my
    my dosage at dinner time which is usually
    when we eat out, the next morning there
    is no difference in my blood sugar level.
    I had been eating nuts, seeds and whole
    grain products. I had some female surgery
    in June and my GYNO told me to stay off
    of them. I have been losing weight since
    then, not really weight but inches. All
    my clothes need altering again.

  • Bill

    There is nothing worse than going to bed at 115 blood sugars and fasting next morning test at > 200. It just seems unfair.

  • Krishna Kumar

    I am a Metformin user. I find that if I take Metformin about an hour before my dinner time, my morning glucose levels are much better. I am not sure why; it seems to be contraindicated by this article.

  • Doris J Dickson

    Don’t forget … in insulin dependent diabetes even if a patient is releasing a lot of unwanted glucose, it can be dangerous. It’s not like metformin is selective. If someone goes low in the middle of the night and they are taking metformin there’s a good size risk of the liver NOT doing it’s job when it is needed.

  • jim snell

    response as follows:

    Using CGMS and by careful testing:

    a: If BG is low at night AND no snacks after dinner ( 5 to 6 pm); checking bg at 3:00 am and 6 am should smoke out liver if its is doing the nmonsense – 150 at 3:00 am and 238 at 6:00 am is liver overloading body. Metformin willl stop
    by taking 500mg dose at 10:00 pm and 12:00am midnight. Single large dose does not work.
    i have used this since may 2010 and bg dropped from 13.3 to 6.9.

    krishna kumar:

    i have found taking one hour before meals most effective and stops any spurious liver dumps when gut/intestine ends and drops glucose output. any turbulance in bg dropping can cause sympathetic liver dumps to 278 or higher.

    i do this.

    doris j. Dickerson:

    very good and interesting comment but :

    i run on cgms with alarms set.

    i ensure any loose insulin is worn off before i go to sleep (other than lantus)

    i make sure bg is 122 to 133 when i go to sleep and it usually can drop to 110 to 119 when asleep.

    during day i run a 500 mg dose one hour before every meal. i have not seen any spurious liver dumps i used to get once or twice a week since running this dose approach.

    one needs to check dose upt tp strength on standard met. for me 2.5 hours up. lasts up to strength 2 to 2.5 hours and 20 minutes to clear system. data sheets show 1 to 3 hours at strength.

    i see no benefit from any residual met hanging around.

    each time pill comes up to strebgth; i watch body bg drop as liver cut off and as it exits system; i can see bg gradually crawl up to ceiling.

    single large dose useless once a day while paking smaller doses around clock gives consistent results.

    teva er and regular teva useless while most met standard generics work.

    its a shame that ada and endo’s doing nothing or it seems that way to resolve liver leaks.

    after 30 years and a stroke and numbers all over map; mess is cleaned up; liver leak stopped, actos and starlix and 75/25 insulin all booted out;
    on tight mediterranean 1200 calorie diet and 1 to 2 miles walking, issues stopped – I did not say cured. Feel way better.

    Insulin was NOT key medicine but metformin telling liver to shut up is. I now take 3 to 4 units of humalog lispro and now in 30 years I have predictable numbers that one can track with handheld if desired.

    I realize that this is not the 23 century with Dr McCoy’s magic wand and the computer processing power of the starship Enterprise processing data and helping fix patient; but we can offer an electronic pak of CGMS and some chemical analysis that new type 2 insulin resistant patient wears for 2 to 3 days and then brings in and data is processed and Doctor gets full picture on all key orghans from gut, liver, pancreas, kidneys, thyroid so doctor can than apply medicine tool kit to adjusting patients system better as well as getting diet and exercise instruction to enable his hunter gatherer old gene super eficient digestion system not to overwhelm body with overage of glucose constantly in this day of plenty and marginal exercise.

    The order of Merlin, divinening rod and educated gueses in this day in age remind one of when Dr. McCoy is wandering around a 20th century hospital and runs into a lady – when asked says she is in there for dialysis. McCoy says – what the devil is this – the dark ages – here take this pill and call me back if any trouble. Of course – later in show women is magically cured.

  • donna

    This has been a very good read. I found comments that answered so many questions.


    I don’t take metformin but would like to see if you have an idea that can help me understand why my readings take about 4 hours to fall back to the reading before eating. I take 31 units of Lantus daily, in the morning, 5 or 6 units of Humalog depending on my early morning reading. my mornings readings range from 106 to 130, average.
    I work hard to keep meals within diabetics range.
    I take synthroid, for an inactive thyroid gland,
    any suggestion will be greatly appreciated.

  • Tony Kumar

    Metformin use has also been linked to longevity (1) and a general reduction in incidence of cancer (2). It makes sense if it reduces blood glucose levels without a large increase in cellular uptake of glucose. Actos, on the other hand, increases cellular uptake by improving insulin resistance and has recently been implicated in increasing the incidence of bladder cancer. Personally, for this precise reason, I have reduced my dose of ActosPlusMet from twice daily to once daily and replaced it with Metformin alone. I have not noticed any changes in my blood glucose readings from dropping Actos.


    (2) Metformin and cancer: Doses, mechanisms and the dandelion and hormetic phenomena
    Cell Cycle, 2010, vol. 9, no6, pp. 1057-1064

  • Sapphyre

    I knew years ago I had some liver damage caused by being on pain killers for so many years. I was told I have Type 2 Diabetes and the Doctors say that from all the neuro damage I have in my body including having a minor heart attack and then recently in the hospital for mini strokes, I never took the seriousness of taking my metformin, I would go weeks forgetting to take it and I am bad about taking my insulin shots. I have so many pills I have to take, I had lost 65 lbs and still battle highs and lows of my sugar. My insurance company will not pay for me to get a one on one training about how to care for this issue, all I know about it is it runs high in my family from my grandmother, mother, myself and 1 of my daughters. I feel like there is no help for me because I have read so many things and everything is different that I have got to the point where food to me is something I dont want in my life, I usually go all day without eating anything until dinner time and then I eat less then my 5 year old grandson, I never even finish what I am eating. I like this story about the Leaky Liver. Even when I was told I was diabetic and I had to go on med and 60 units of insulin that was all that was explained to me. I am still clueless as to what I am suppose to do.

  • Hala

    Years ago, I used to take Metformin (1,000 mg in the morning when I wake up and 1,000 before going to bed)for PCOS and lost weight. I did great on it all around but my doctor at the time took me off of it because he said that my liver panel tested too high. My weight came back with a vengeance! I have been off of it for 10 years.

    I want so bad to be on Metformin again! Now I have a new doctor and we are going to see what to do for my PCOS and maybe I will be on it again.

  • Mike Moore

    I used to be a metformin user. I took it for several years for my Type II diabetes. Last year I became anemic and also had knee replacement surgery. While in the hospital they determined the cause of my anemia was from taking the metformin so they took me off of it and now doing just long and short acting insulin. One of the things that I notice is that from the time I get up in the morning until I get a shower and get dressed and ready to go downstairs to eat breakfast (usually 1.5 hours), my blood sugar level can go up 20 to sometimes 50 points in that period. I’m wondering if what you’ve described is what is happening with me regarding my liver dumping sugar into my system. I’ve even taken insulin right at getting up and it doesn’t seem to have the same effect on my blood sugar levels as it does at other times of the day. Is it really true that metformin can make you anemic?

  • David Spero RN

    Thanks everyone for these comments and questions.

    Mike, you’ll have to ask your doctors to explain why they think metformin caused your anemia. It can lower vitamin B12 levels, which can cause anemia, but other than that, it’s not a commonly reported adverse affect. They could be wrong.

    Hala, perhaps you can go back on metformin. They probably didn’t think the metformin was hurting your liver, just that it’s not safe to take metformin with a bad liver. So perhaps retesting and restarting is possible.

    Sapphyre, I’m sorry you are having such a bad time. It certainly sounds like metformin could help you, IF you take it regularly. Since you don’t have access to diabetes education, perhaps you could join a diabetes support group? They often help.

    Mildred, maybe you could start taking Humalog before each meal. Or perhaps metformin would help. Diet changes are also possible, but it would be helpful to work with a dietitian or somebody on that.

    Caroline, the virus theory of liver dumping is interesting and quite plausible, but I don’t know anything about it. If you find out more, please let me know.

  • John

    I have only been on Metformin since I was diagnosed with type 2 diabetes about 10 years ago. It has been doing a very good job of keeping my blood sugar under control. My last A1C which was in July was 5.8%! I do not watch my diet as closely as I should but I REALLY watch my sugar intake. My doctor also told me that in order for Metformin to work the right way YOU MUST TAKE IT WITH YOU FIRST BITE OF FOOD OR IT WILL NOT WORK!

  • virginia

    i am type 2 diabetic and my dr prescribed metformin and i was put into the hospital and was told that metformin was shutting down all my organs they took me off of it and put me on glypicide and my body returned to near normal function so for some i do not think metformin is good just my experience with it i have also heard from others metformin was working great for them i guess it just was not right for me



  • marciejoy

    I’ve been on varying doses of metformin er for most of the 11 yrs that I’ve had type2. Taking it at bedtime seems to work best for me, no matter what the dosage.

    I read a very interesting little article about the different generic brands of metformin ER and how they don’t all work the same. Some people had better control with the Teva brand,some could cut their metformin doses, and some had worse side effects from it than with the other brands they’d been taking. I’m not sure that it’s readily available, as I’ve picked up mine from two or three different places and have never had it. I don’t know if/how/where you can choose which generic brand to get, but I think I’ll call the different pharmacies around here and see.

    The article is at:

  • marciejoy

    Mike — As already mentioned in my above post, I’ve been on metformin for 11 years. I had read in two or three places that it can lower your B-12 level, so I’ve been taking an oral supplement. Same with Co-Q-10. You might consider this approach.

  • linda

    I take metformin 1,000 in morning 1,000 before bed my morning bs are still in the high range 129-160 and they go up and down like a yo-yo at nights depending on what and how much i eat. they aren’t much better than before i didn’t take them. I am not thirsty and my sores heal rather fast even though dr. said i was diabetic. the only thing is my bs sugar levels weren’t that high until my dr. put me on Hydrochlorothiazde for blood pressure. wondering if this med. can be causeing the high bs levels? i also take 2 other blood pressure meds. and chorestroal med. since i went to, to 2,000 mg on metformin i get bad heart burn dr. gave me meds for this also.

  • Denise

    I’m not sure what liver dumping is? To read all the other comments, y’all sound like medical professionals. In 1980, my gallbladder was removed. As a result, my liver has been dumping bile (at times to be quite embarassing). All of this has been happened without being diabetic.

    I have now been Type II (after 2 gestational pregnancies) since about 2000. I was initially put on metformin that I took twice a day (500mg in morning, 500mg before bed). My readings were not urgently out of line but doc wanted to get a handle on it.

    I do not have high blood pressure, high cholestrol, anemia, or anything other than being diabetic. I was progressed to actos (whoa, big time vertigo issue on first dose).

    After a sever bout with edema (I gained 60 lbs in one month) it was discovered that I not only had a GYN issue resulting in a complete hysterectomy (with 4 units of blood given before the surgery to put color back into my face and more during surgery). I am now waiting to get this extreme weight gain down to replace a defective aortic valve (that I was born with but never was treated for). Hard to exercise when you can’t get your heart beating to hard or breathing becomes an issue.

    My current diabetes meds are Lantus 70 every 12 hours, 1.8 shot of Vitoza in morning, and Novolog with each meal. I also take Lasix for the heart issue AND I am manic depressive and take lamectal, clonopin and paxil for that.

    I gotta believe that ALL this medication and surgeries have affected everything about my diabetes. HELP.

  • Maria Huff

    I asked my new dr to change my advandia to metforman in January and have gotten along very well with it I take 500mg every 12 hrs . I was having chest pain and weight gain while taking advandia my previous Dr would not change my RX. I did discover that I had to do a NO FAT diet for about 3 months after starting the Metforman. I still am very careful about fats , also the information that came with the metforman says not to drink alcohol at all so I stay with that also .

  • Jewel

    I come from a family of diabetic’s. My younger sister is the only one insulin dependent with a pump.. I take 500 mg of metformin 2x’s a day. one with my morning meal and the other with my evening meal or around 6:30. My sugars have been under control, but it seemed to take a week or so of the pattern in order to keep it under control. I don’t seem to have the real highs or real lows that I had before. However, I have learned always check my sugar before taking the medicine. If it is 100 or less, I do not take the medicine. Thanks for the info

  • Ernestine York

    Now that you mention it, I realize that my sugar count in the mornings is lower when I have not taken my Metformin immediately after supper, but forgotten until later in the evening and sometimes just before going to bed. I’ve been on 1000mg of Metformin – doctor wanted me to take that in the mornings with one 10mg GlyburideXL and then take another 100mg at supper.It lowered my blood sugar too much, so I cut out the morning Metformin and only take it if my blood sugar is really high at lunch and then only take 1/2 a pill (500 mg)which works wonderful.
    Thank you for your article. It really helps me.

  • Angie S

    Metformin was the first medicine the doctor tried me on and it made my blood pressure sky-rocket! I take two different meds for high blood pressure and it did’nt seem to stay down at all while taking metformin. I am now taking Amaryl and it’s not keeping by blood sugar down where it should be. It’s always higher than it should be in the mornings.

  • Dick

    I used to take Metformin for my diabetes but my endocronologist put a stop to this since it may harm my kidney. NIH website also puts out a warning on this point. So what is the effect of Metformin on kidney?

  • Morris

    A key and a comment/question:

    The key is that while metformin is the most commonly prescribed and often the most effective drug for diabetes, it does not work for everyone. A couple of people have mentioned that it did not work for them, and the reason is that diabetes can stem from a couple of underlying conditions. If indeed the problem is with how the liver responds to blood sugar levels, then metformin can be hugely effective. But if the problem really is elsewhere, then other drugs and/or insulin might be more effective. When I started 8 years ago, I rapidly got up to the max met of 2550 mg/day and my blood glucose had come down but not yet to normal until I started taking Glipizide XL. When I then quickly got down to below a 5 A1c we started cutting back the metformin gradually, over the course of a year, and my blood glucose never went back up. For me the liver clearly was not an issue, but my pancreas was. 7 years later I still don’t take met, have reduced the Glipizide, and still maintain around 5.0, but if I skip a dose, I jump about 20-30 points the next time I test…

    The comment/question is that I have read before the point made here, that WHEN you take the met can make a huge difference; and in particular that a nighttime dose sometimes can lower morning numbers. But for a huge number of people who try that, it fails to have that effect. The more common wisdom is that met works by building up to a level in your body, and that each day’s pills maintain that level, and that in fact it does not matter much when you take them. That is why when people start met, it can take a few weeks to even a few months to really kick in and start being effective, and also why when people stop, the effect is often not noted for a few weeks also.

    So that is pretty different than the idea that dosage timing makes a big difference. My guess is that both theories may be right, but for different people, that how our biologies react is not identical. I haven’t heard of any research that might help identify which outcome is most likely for an individual based on a blood test or genetic marker, but suspect that in time it will become more predictable, so that instead of playing trial and error, the tests will say from the get-go what is likely to be the most effective treatment regime…

  • gary

    what the effects of metformin on the kidneys? My Dr. just took me off metformin becuse it was causing damage to my kidneys.

  • jim snell

    Good points.

    Type 2 diabetes Insulin resistance is not a uniform disease caused by a single common organ/hormone misfiresame that cause blood glucose control mucked up but by a multi-organ-multi hormone complex system. That is key critical point.

    That is whay a careful scan of key organs and hormone signalling on a 24 hour/48 hour basis with a compact portable analysis loaner system is needed to catch the data.

    Single lab test while catching out right failure is not tracking action through empty stomach, eating, digestion cycles, exercise and all going on.

    Metformin appears most effective if ones liver leaks and that has been confirmed with monitoring bg throughout full 24 cycle and especially at midnight.

    For those whose liver and its buffering – emergency glucose functions work correctly, then value of metformin may be greatly reduced.

    For those whose livers may benefit may need larger doses. John Hopkins study did say that they believe there are conditions that metformin will not help and for those, they had a proposed test that could identify those and dose size that works. For me; 250 mg has no effect; 500mg appears to work.

    In my case; my Doctor has recommended that I ensure my BG does not go sub 100 and trigger any of the liver dump functions that for me dump in uncontrolled amounts of glucose. For me that has required metformin to keep liver messing up picnic.

    Judging by writing to this web site and others, most folks livers are working reasonably well and they can avail themselves of the livers extra glucose add functions without blowing up average bg and destroying – rotting out body.

    This whole field is just now getting attention and release of some of the additional powers of metformin as well as type 2 diabetes insulin resistance stopping and cure thoughts.

    So far, the most happening right now showing any real gains surrounds lap band, bariatric bypass surgery, small intestine liner, starvation/reduced carb diets and hearty exercise.

    The bigger problem is that as body ages, the degredation of the human body may not be uniform across the major organs namely stomach, intestine, pancreas, liver, kidney and thyroid such that a Doctor may have to adjust these as one ages.

    In my case, while insulin was not fix, yet due to aging my pancreas was down and needs a small boost of meal bolus and basil insulin assists but for this body liver was they key pest at this time.

    After 30 years of too much insulin not really fixing anything, my body booted out the excess of 26 units 75/25 humalog, starlix ( and the dam glyburide) and that other charmer actos.

    ENergy intake – Carbs ingested in daily diet and respecting old hunter gathere gene set digestion system and its supper efficient capability grabbing extracting every possible calories out of food and guarding against excess quantities of super grains, rice, starches and getting sufficient heraty exercise are also part of the whole puzzle.

    A terrible dis-service to all type 2 diabetic insulin resistance types is the unfortunate treating as a simple monolithic disease for which adding tons of insulin will fix.

    Today we are starting to see a tool kits of meds dealing with glp-1, gpp-5 , leothyroxin, metformin.

    The Salk institue felt that the effects described by Dave Spero’s article on Metformin suggested we should be able to create new drugs to better do the effects found on metformin that is still not properly described in many other web site data other than Diabetes Self-management for which I send my deepest thanks.

    My other read as a layman that not fiixing serious liver leaks will overide any diet efforts to stop rot and body – eyes, kidneys, et all and body will be condemmed to rot out.

  • jim snell


    Without knowing your whole situation, drugs and meds on, it is impossible to comment on what your good doctor has done. Your kidney’s may no longer able to handle the metformin load.

    In my case:

    my kidney doctor zeroed on the actos and wanted that dog out now. that said I did the followiing:

    a) diet set to 1200 calories adn watching items that may acerbate.
    b) remove actos.
    c) remove excess insulin whne body on low diet booted out 75/25 insulin, starlix.
    d) got 1 to 2 miles exercise.
    e) took vitamin supplements to make up for any loss.
    f) used met to get a1c from 13.3 to 6.9

    AFter lab tests every 3 months since May 2010;
    kidneys stabalized and all key numbers stable and in spec.

    My read was that actos and excess body glucose were source of rot for me on kidneys. Their gone/under control and kidneys now stable.

  • leonard

    i have been taking metformin for 12 years, started off with 500 to 1000 then 2000, then 5 mg Glipizide twice a day, my sugar started yo yoing, the Glipizide would drive it down to fast, sweats and dizziness , like wanted to pass out. stated getting weaker with no energy. started going into depressions and neuropathy got worse, had to quit job, balance was getting so bad. i read how metformin effected your b 12 levels i started getting b12 shoots at lab once a week my energy level came back up for 2 to 3 days. so cut half metformin down to 1000 at evening meal, my depression lifted and suger level dropped and is stable. started reflexology for feet and shoulder.
    i guess we have to get touch with our bodies it will tell if some is good or not.

  • jim snell

    Leonard: Thanks for sharing!

    Your experience and comments bear out my suspicions and method of taking pills is that super size doses only provide massive dose over the pill lasting time of 1 to 3 hours and providing serious side affects . Taking smaller doses spread around the clock provide a more even dose without hammering body.

    i am unclear who in the drug industry thinks because you put in huge dose, the human body then spreads these doses conveniently around clock.

    Absolute bull and I have had this discussion with a safety officer of some heart pills.
    He even suggested to take bigger single dose. When I told him that does not work and I do not want to hammer my body – oh well spread around clock.

    I have verified my metformin as well a heart medicine and found only way to get even proper control was thru the normal small dose spread around clock. Spent 2 weeks checking hour by hour.

    my honest take (at least for me) is that single large doses are useless and waste of money and drugs. One can build a skyscrapper on initial large dose in one’s body with short duration interval or take smaller – normal doses spread around clock at proper intervals ensures more even continuous dosage. My results and success come from spreading the dose at regular intervals.

  • Nancy

    I am on glimepiride and metformin. I have been on several different diabetes meds during the last 15 years or more. With some I have had adverse effects and had to stop taking them(Actos, DPP-4 enzyme inhibitors and most insulins). However,the Somogyi effect was the worse in the past when I was on insulin. I would wake up out of a sound sleep around 4:00 AM and could not get back to sleep for an hour or two. My blood glucose kept rising.
    I then got back to the current meds and the effect of Somogyi is almost gone. Now I can sleep through the night. But my morning BG is still about 50 to 70 pts. higher in the morning than at bedtime. After reading this article, I have decided to try changing when I take the metformin and to take one 500 mg with my bedtime snack. If it does any good I should know in a week.

  • David Spero RN

    More great comments and questions

    Vicki — Janumet combines Januvia with metformin. You definitely could take Januvia and metformin separately, which might save money, although Januvia is still pretty expensive. You and your doctor might need to come up with another plan. Metformin itself is extremely cheap, and you may not be getting enough of it.

    Virginia’s and Gary’s experiences show that metformin is not for everyone. However, the evidence shows that kidney damage from metformin is unusual. It can happen, though. If your doc says met is too dangerous for your kidneys, ask him what evidence makes him think that. Perhaps ask your pharmacist, too. No medicine works for everyone.

  • thea

    I have had PCOS, now I’m in menopause, such a releif in its own way. Regarding this particular blog I think you are on something here. I work nights and sleep days and I find that when I get home I still feel full from my lunch from 5 hours before, the odd time I have taken meformin before bed and find I sleep better and when I wake my belly isn’t so bloated feeling. I also find my bs #’s are more reasonable. I’m also now taking something (can’t remember the name of drug)for my liver in regards to lowering my cholestrol (the bad one), seems its a hint over the normal range.
    Thank you for this info, it seems to ring true with my own accidents.


  • jim snell


    I believe your excellent article hit the super lode on these issues and certainly provided excellent comment and feedback.

    As the lady early on said: your blog answered many questions.

    Ah men to that and thank you.

  • M. B.

    First time in my life I am understanding what metformin actually does. I knew it interacted with my liver and reduce the conversion of other bodily masses (starch, fat and what-not) into glucose for energy, but “how”, was a mystery until now.

    While I was on oral medication, my pill regiment was to take 1000mg metformin tabs, twice a day. BUt at the same time, one of my old endocrinologists scared me by saying my liver size is larger tha that of a normal person of my age and size. So, I was keeping a tight control over what I eat and take that is making my liver function outside its natural ways. So, when I went from oral medication to insulin regiment, I kept taking metformin upon my doctor’s advise. But one day my prescription ran out and my doctor apptmt was a week away. And I got distracted to call the nurse for a new prescription. With the insulin regiment that I was on, I noticed, lack of metformin did not make any changes in my glucose levels. So, next week I asked my doctor if I can stop taking it. He said we can try. And I am not taking it for the past 2+ years. As long as my insulin injections are timely and sufficient, I am good.

    On the other hand, I am battling with weight problem. And one of the comments made in the article as well as my ex-wife (who is a morbidly obese person) had one of her doctors prescribing her the metformin pill as a help for weight loss, making me think about my decision. Later in the week, I have my second appointment with my endocrinologist and I will run this by him to see what he will say.

    I would like to hear from others who are in the same or similar situation like myself.


  • jim snell

    There is a mistaken idea here about metformin timing.

    If one needs to shut down dawn effect of liver over loading glucose; then taking metformin at 10:00pm and 12:00 am will for some shut down dawn effect from 12:00 am through 5:30 am.

    If one has spurious liver dumps during falling glucose output at end of digestion from gut/intestine; then taking met pill one hour before meal usually ensures met a strength in blood and liver stalled out from doing a spurious dump even though BG at fingertips can be between 140 through 210.

    In all cases the timing of met and when to take should be per Doctor’s instructions.

    The timing was established from hard data from CGMS watching BG and activity and effects of metformin timed to ensure up at strength at optimal time. At all times dosgae and taking of metformin must be per your Doctor’s direction and advise.

  • jim snell

    weight loss and metformin:

    prior to shutting off liver dawn affect that dropped a1c from 13.3, i was on tight diet of 1200 calories and exercise and could not lose an ounce for 2 years.

    After metformin used to shut down dawn effect and same calorie meal program and 1 to 2 miles walking every day – finally lost weight from 330 to now 260 and still dropping.

    ones liver can overload diet and cause massive weight gain. For me; metformin shut down the over sugaring of my body. Exercise and 1200 calorie diet did not change prior and after metformin timing optimization.

  • Diane Fennell

    Hi Linda,

    Thanks for your question. According to WebMD/ “If you have diabetes, hydrochlorothiazide may affect your blood sugar levels. Check your blood sugar levels regularly as directed by your doctor. Your doctor may need to adjust your diabetes medication, exercise program, or diet.”

    I hope this helps.

    Diane Fennell
    Web Editor

  • Ferne

    This is all very confusing. I have problems with side effects of taking medformin. One medical person said that could be fixed by injecting insulin. Then another said to take medformin at the end of my meals not at the beginning. Those simple instructions took care of the problem. Hard to know who to believe.

  • Carol

    Thankfully I just stumbled upon this website which I find full of very good info. I have been type2 for about 12yrs and on metformin for about6yrs. Not one Dr has explained what it actually does or when to take it. It has just been left up to me. (Of course I keep a very tight control with all tests remaining constantly good. a1c around 6.6-6.9. The later shook me up and I got back on track. Didn’t know the term morning dawn but I do have higher readings at that time. 115-144. I will try these 2 things: taking 500m at bedtime with snack, and taking met with first bite of food throughout the day.

    Thank you all for your input and I will report back. Hopefully my info will help someone else.

  • Kim

    Very interesting read, I appreciate everyone’s input.

    Sypphyre – Here in Florida our local Extension Office – University of Florida IFAS extension provides classes on diabetic education and they are free. Maybe in your county the local extension office does it as well.

    Thank you for providing this space to help us all understand this disease.

  • David Taylor

    I have stumbled on this discussion quite by accident after Googling “Glycogen”. I have been looking for someone on the same line of thinking as me for a long time and hopefully you, David, are that person. Lucky you that I live in UK!!!

    All the above seems to be about Type2, but thats not the end of the story. I have been Type1 for 63 years and now have a pump.

    I have been teling my diabetes team about this “phenomenon” for over 5 years now and they simply tell me to counter the “sugar” with more and more insulin. I actually counter it by reducing my insulin requirement by 10% for a few days and the glycogen effect gradually disappears. How long depends on how long the Glycogen has been being produced. Now that I have found the solution to the problem my “highs” last about 12 hours only.

    Its taken me a long time to find out this remedy and my team simply look at me and my charts with disbelief. The breakthrough came by injecting 3units insulin and retesting after 1 hour to find the sugar level had increased; perversely I ate 40 grams carbohydrate and found the sugar level went down. My team said I simply pee’d it away!!

    In my case it appears that what I call my “hypo floor” varies. So far as high as 100. When this floor is reached my BS spikes upward dramatically fast and treating with insulin merely accentuates the problem.

    It is my belief that this liver dump occurs when my BS reaches my hypo-floor and creates a “false BS reading” around 50 higher than my true BS level. Eating carbs to raise my “true BS level” stops the liver dump and the BS lowers to a normalish level.

    I recently postulated that i believed that glycogen was the cause of Type2. How strange?

    If you want to further this outside of this discussion I expect you can access my email address.


  • Cristian

    I can understand every word,because I am really suffering from liver dumping, every night when I am going to bed, .I have no blood sugar and I am monitoring since 6 months all the day whatever I am eating, I am under max levels,my problem starting in the evening ,after a heavy or light dinner ,my blood sugar is going to approx100, but in the ti me of bed my bs. Start to go up ,in the morning it comes to 130 135if I eat light 126 if I had havier dinner ,the problem is not over here ,I have my breakfast ,and than immediately my blood sugar goes up to up to 225 before it start to go down after 1 hour,to be normal after 2 hours ,and than in lunch and dinner it never goes up more than 140 during the 2 hours. to face this I am trying to shorten my night and at 5 am I am having my breakfast and than going imdtly to have fast walking in treadmill for 1 hour. ,taking my bs every 20min I have it max 145, than I am swiming. 40 minutes .my blood sugar after completing this process goes down to 90 and stayed normal till night bed time.

  • joyce

    I am presently on metformin 500mg to1000mg and it makes me stay in the bathroom. my doctor suggest that i take immodium to help control the stool. However, by reading your articles there are somethings that I am going to try. I blood glucose is usually high in the morning around 147 but the minute I empty my stomach the readings begin to drop below 120.

  • Cynthia Astle

    David, I can’t tell you how much your article has helped me! I was diagnosed last October with Type 2 diabetes and since then have been following a carb-restricted diet with daily exercise. I’ve lost close to 40 pounds, but my blood sugar hasn’t stabilized.

    What’s more, I discovered within the past two weeks that exercise makes my blood glucose RISE. That’s when I began to investigate this “liver dump” phenomenon. I saw my Dr. yesterday and he was surprised to get my results. We took blood for a new A1C, and he said that he may prescribe metformin based on those results.

    After reading your article, I’m convinced that my diabetes is a combination of factors. I had my gall bladder removed in 2006, and I had thyroid cancer in 1997, so my thyroid was removed and I’m on levothyroxine. I’ve been insulin resistant all my life; my whole family is. I wish I could get that “all systems” monitor, but I’m already on high-risk health insurance because of my high blood pressure, so I doubt my insurance would cover such testing.

    In any event, your article has really educated me and I’m going to forward it to my doctor. Thanks so much!

  • Pam king

    Dear Sirs,
    I am type 2 Diabities and i was taking 2 850 mg twice a day now they cut me back to 2 500 mg a day. I still have the sweets when i eat about 1 to 2 houres after i eat it starts it last about 2 hours.i sweet real bad and my body will get real clamming and then I get week. but then it goes away. could you tell me whats wrong…. Thanks Pam king.and God Bless….

  • David Spero RN

    Pam, I don’t know if your sweating and weakness is a side effect of the metformin, or if the metformin is taking your sugar too low (hypoglycemia.) Hypos in response to metformin would be unusual, but perhaps it is possible.

    What does your doctor say about this? If the metformin is causing it, it might not be the drug for you. Maybe our readers have some other ideas, but I think you should ask your doctor again.

  • Toni

    Can exercise cause your liver to dump sugar? My bg goes up when I exercise rather than down. I’ve tried taking Metformin before exercising, and after, with no noticeable difference in my bg. I can test at 98 before exercise, and at 160 afterward.

  • John Sykes

    I have gotten my A1C down to below 6 and my daily glucose averages to under 110 with weight loss, exercise, supplement and 2550mg of metformin taken 850mg at breakfast, 425mg at lunch, 850mg at dinner and 425mg at bedtime. I still get a liver dump with pre-breakfast readings of 120-150 which take till well after lunch to settle down to 90-110 bgs.

    Recently, my cardiologist halved my morning Plavix to 35 and my aspirin 75% down to 81mg which I take at night. Now my glucose readings have jumped up with higher dump readings taking longer to drop. If this keeps up I will be running a 120ish-130ish bg daily average of about 6 readings.

    My research just showed me that more aspirin will probably cause lower bg readings and that plavix might do so. I am tempted to add the aspirin back in.

    I am also tempted to completely swap my metformin schedule to see if that affects liver dump.

    I would appreciate any help or further comments.

  • Lazaro Gonzalez

    I take 1000 mG metformin with 5 Mg glyburide and my insulin is about 120 at 600 am before I eat and heart meds of Effient 10 Mg, Lisinopril 5 Mg, Corvedilol 25 Mg, Asprin 325 Mg. I then measure the sugar again at 12:00 pm and it is at 151. I then take Humalog 75/25 quickpen 4 units and eat lunch. i then measure again at 6:00 pm and the sugars at 117. I then take Humalog 75/25 quickpen 3 units and eat dinner. I then measure at 6:00 am then next morning and start all over again. The Metformin does the job in the morning, and when I take the insulin twice a day it allows full absorption of sugar and stop the CRTC2 from producing sugars I guess. I take the the three med every day. I thought it was the pancreas not producing insulin but it is the liver producing too much sugar release, because metformin work together with insulin treatment. Though close monitoring of sugar is recommended to combine the two meds. I am have high neuropothy pain at night and the level sugar helps a whole lot.
    hope this helps someone else with the same issues.

  • mira

    hello docter.
    my father 40 year old .he is the one businessman and also manage one hotel.he has diabetes at 160 point..we regular checkup the diabetes..and i want to know simply that what type of care should be take for him..what type of fruit and food match him at this stage..what type of exercize suit him…..pleaze give me best guidance at minimum time .i am waiting for ur positive response……..

  • Judy Stanley

    I was diagnosed with Type 2 Diabetes around 2004 and I took my metformin 500mg in AM and 500MG at dinner time. Everything was great I never needed Insulin unless I had to take Prednisone then I took Humalog when sugars were high. Recently my Husband passed away and my Diabetes seems to have gone crazy. I was switched to Lantis 10mg at night. In the middle of the night about 4am my stomach starts to growl and drive me nuts. Sometimes my sugars are fine sometimes they are high 160-which is high for me. I know I can’t be hungry because I had dinner and have really been watching my sugar intake. No sodas unles diet,lots of water and vitamin water. I have breakfast about 9am usually hot cereal and my pills. I can’t seem to eat very much at one time. So I wait about an hour after breakfast to see if my stomach has stopped growlly etc. I check my sugars and they are fine 120 but the hunger etc is still there. I am waiting to see my Endocrinologist which is going to take a few weeks. Now that I understand the the liver might be causing the problem. I will see my primary care and discuss this situation with her again.
    If anyone has any information about this type of problem please let me know.
    Posted by judy 11-24-12

  • wilma


  • jim snell

    Re: Krishna Kumar

    taking metformin 1 hour before meal helps – There is a reason and it is not properly discussed nor understood by all the experts.

    It has to do with timing of the digestive track.

    Using cgms, I found by experimentation, taking metformin 1 hour before meals usually ensures met is up to strengh in blood 2 hours after meal ingestion and blocks the liver form doing false liver dumps because some sensor in gut tells brain – glucose going low ( yet fingetip blood is 140 to 200) as glucose generation in gut is falling.

    I have found this approach stops a bunch of false liver dumps as gut is emptying. And why by golly – average BG stays under much better control.

    There neads to be much better testing and understanding of the power of met given much of the “experts” are fixated on insulin sensitivity rtaher than excess glucose cut off in the liver caused by direct signalling of the metformin.

  • Zela Charlton

    I have been a diagnosed diabetic for 30 years. I have ‘progressed’ through all the stages , slowly and now am on insulin; 4 units Novorapid before meals, 20units Lantus at night.
    My ‘contro;’ is very uncertain and i cannot work out diet or dosage.
    I recently had a ‘tummy bug’ and now feel slightly nauseous much of the time. I feel that my liver area gets swollen at times.
    I am wondering if the addition of metformin to my regime might help ?

  • jim snell

    Well on jAN 6, 2013; here is latest findings ( not theories) that metform works to block liver glucose release and directly bypassing the ampk chain:

    Science News
    … from universities, journals, and other research organizations

    Most-Used Diabetes Drug Works in Different Way Than Previously Thought
    Jan. 6, 2013 — A team, led by senior author Morris J. Birnbaum, MD, PhD, the Willard and Rhoda Ware Professor of Medicine, with the Institute for Diabetes, Obesity, and Metabolism, Perelman School of Medicine, University of Pennsylvania, found that the diabetes drug metformin works in a different way than previously understood. Their research in mice found that metformin suppresses the liver hormone glucagon’s ability to generate an important signaling molecule, pointing to new drug targets. The findings were published online this week in Nature.
    For fifty years, one of the few classes of therapeutics effective in reducing the overactive glucose production associated with diabetes has been the biguanides, which includes metformin, the most frequently prescribed drug for type 2 diabetes. The inability of insulin to keep liver glucose output in check is a major factor in the high blood sugar of type 2 diabetes and other diseases of insulin resistance.
    “Overall, metformin lowers blood glucose by decreasing liver production of glucose,” says Birnbaum. “But we didn’t really know how the drug accomplished that.”
    Imperfectly Understood
    Despite metformin’s success, its mechanism of action remained imperfectly understood. About a decade ago, researchers suggested that metformin reduces glucose synthesis by activating the enzyme AMPK. But this understanding was challenged by genetic experiments in 2010 by collaborators on the present Nature study. Coauthors Marc Foretz and Benoit Viollet from Inserm, CNRS, and Université Paris Descartes, Paris, found that the livers of mice without AMPK still responded to metformin, indicating that blood glucose levels were being controlled outside of the AMPK pathway.
    Taking another look at how glucose is regulated normally, the team knew that when there is no food intake and glucose decreases, glucagon is secreted from the pancreas to signal the liver to produce glucose. They then asked if metformin works by stopping the glucagon cascade.
    The Nature study describes a novel mechanism by which metformin antagonizes the action of glucagon, thus reducing fasting glucose levels. The team showed that metformin leads to the accumulation of AMP in mice, which inhibits an enzyme called adenylate cyclase, thereby reducing levels of cyclic AMP and protein kinase activity, eventually blocking glucagon-dependent glucose output from liver cells.
    From this new understanding of metformin’s action, Birnbaum and colleagues surmise that adenylate cyclase could be a new drug target by mimicking the way in which it is inhibited by metformin. This strategy would bypass metformin’s affect on a cell’s mitochondria to make energy, and possibility avoid the adverse side effects experienced by many people who take metformin, perhaps even working for those patients resistant to metformin.

  • Margaret Hart

    I have been taking metformin for approximately 20 years. I started with 500 mg twice a day with food. I did not always take the medicine as required, or follow a healthy diet and exercise plan. Consequently my doctor increased my metformin to 1000 mg twice a day. Because of my unhealthy actions I developed high blood pressure and high cholesterol, and I am taking medication for that: quinapril, amplodipine, pravastatin, and hydrochlorathiazide. I also have arthritis so I take tramadol as needed for pain. Two years ago I lost 50lbs by exercising and eating right. The doctor put me on 850 mg twice a day. I have had at least five doctors in the past 20 years. A few days ago I took both doses of metformin within 30 minutes of each other, I forgot I had already taken one. I was driving from church and I became very sleepy. I pulled into a parking lot and slept from 30 to 45min. A phone call woke me up. I drove home and slept hard for about 5 hours. How long will the metformin stay in my liver and have I done any damage to myself? I am 69 years old.


  • Indira

    I was recently diagnosed with diabetes and is on the starvation diet and now the BGL are normal. However I have noticed even with the strict diet my FBGL some times are higher, this happens randomly. I have looked in e dawn phenomenon and if this is happening frequently should I ask for medication when I visit my Dr Next time?

  • Nk

    Hi there,
    I have been taking metformin for last 6 months and my BG levels are just about as much as I started, I have been asked to increase my dinner time metformin to reduce my morning BG, but it only seems to go higher even further when I doubled my dose.

    I think metformin is not working for me.

    Your theory does make some sense to me and i will try and see if that controls my breakfast time BG.
    My day time glucose is fine, most evenings it comes to 7. But morning time readings are always more than 10-11.

    I hope this will help me

  • David Spero RN

    Hi NK,

    Yes, it sounds as if metformin isn’t working for you. But try checking your morning glucose at different times, and try the metformin at different times. You might also check your blood glucose at 3 AM to see if you are dropping low, then rebounding in the morning. If that is what is happening, a midnight snack can help.

    Or there may be some other problem. You should keep your doctor informed of what’s happening.

  • Patricia

    I have had type 2 diabetes for some time,, and I am on metformin, and I figured that’s all I need I Have had four pregnancy’s and each one I didn’t have the diabetes, just border line, then with my last child I had it pretty serious and my age really didn’t help it non, he is now five years old and I still am fighting it and really didn’t care at the time apparently and then my doctor said if I don’t get it under control with excersize that I would be put on insulin and I don’t want that, so I went to a nutrition class and I learned a lot about my diabetes and apparently I have a leaky liver, my numbers are high in the morning and then I started a carbohydrate diet and my numbers went down, still high in the mornings so now I am on the slow release metformin, and I am told that this will help with my high’s in the morning,,, I do hope so,, I have lost weight and carbohydrate diet has helped my allot thank you for the information that you have given me and it is nice to find that other’s like me are having to do this as well,,,, sincerely P.J.

  • Linda

    This explains my delima. I take 1000 mg metformin twice a day. When I first get up at 6:30 AM and again at bedtime, usually around 9:30 PM. At bed time, I also take lantus. I can take my blood sugar any time of day up until 7:30 PM and it will be under 170. Then suddenly it will shoot up to 250-300. When I get up the next morning, it will be back to 100.

    I guess I need to take my metformin around 6 PM so that it is in the bloodstream before the glucose numbers go up. I thought the 24 hour insulin was only lasting 21 hours. This information helps. Thanks!!!!

  • Phil

    I have the dawning effect. I am on an Insulin pump using Novolog. I like tight control where BG is 80-90 fasting. For 2 years this was the case until recently. I also take Symlin 120 mcg. With meals or snacks over 240 calories. I take Metformin 1000 mg. XR twice daily with meals. My fasting BG rises 50-60 points every night. I adjust temporary basal rates and can control it to some extent but not as much as I want. The doc gave me Byetta to try only at the evening meal to see if my fasting BG comes down. It made me kind of nauseated but went away. I ate at 8 pm and by 11 pm my BG was 94 at 1 am it was 72 and by 5 am it was 128 at which point Zi took 1.4 units Insulin as a corrective dose. By 8 am fasting it was 123 not much change. On another meter the BG read 133 at which point I took another. 1.9 units of Novolog as a corrective dose. I take an average if 120 units of Novolog daily and don’t want to keep increasing it. I don’t know why the fastings are starting to go higher but they are. If my am fastings are good my numbers are good all day but if not they are all high all day. Last A1C was 5.7 6 months ago and it was 5.2 6 months before that. So there is something going on, I just don’t know what. But before taking insulin I had fasting BG about 180-190. The pump got it stsight but it is starting to go back up. Basal rate at 10 pm is 2.75, at midnight 2.45, 3 am was incrrased to 3.3 units/hr. What can I do to get the fasting BG back to 80-90 upon rising in the morning?

  • MollyAnn

    I have early morning high sugar, stays high till noon then drops from noon till 5 or 6 pm. I found some help. I have ‘Dawn Phenomenon’. I found 2 ways to stop the high sugar in the mornings. Per the Dawn Phenomenon articles, the liver starts to shut out 4 hormones from 2 to 8 am. Each persons timing differs, for example mine starts about 6 am. However, if I wake up and move around, it will trigger the process to start earlier. It’s after I get up to move around that that the liver starts so that could be 4 or 5 am and just going to the rest room. But after 6am it starts to shoot out the hormones anyway. So for me to keep this from happening and which causes the glucose to rise caused by the liver and not by eating, I must prevent it. To do this, the minute I was up I must get straight up, take my Glucophage with a lot of water, cook an egg and 1/2 piece of bacon and eat it quickly. The liver shoots out the hormones and the glucose quickly you only have minutes to do this and its rising as you do it. But within minutes after the egg and bacon is eaten it will stop shooting out and I check my sugar what ever it is then will be the same 3 and 1/2 hours later. Don’t think this is the end, after much testing of this it works fine but I must then take my Glucophage again before 10:30 and eat more protein or it will start again shooting out but not as fast and as bad. after this I am ok for the day. I avoid bread fruit etc until after noon then at 2pm on can eat that also and it continues to stay down. If I don’t do both these and the liver shoots out this, my sugar rises fast until noon and no medicine will work to get it down till after noon. The dawn phenomenon articles will tell you to eat protein and fat early for this to work but they don’t help with the times and urgency of the eating early. You can do your own test early to see when yours starts. I can get up with sugar of 72 and If don’t do this will be 175 in 20 to 30 min’s in one hour will be 230 or more and in 2 hours 275. … the second help I found was vegetables, I stopped doing the above and went on vegetables and 100% fat free beef or chicken broth and found that after the 4th day sugar was down to 145 or less in the mornings and continues as long as I eat vegetables and broth only. … I found a happy medium, its to do the egg and bacon at 6:15 am and then eat vegetables for other 2 meals, then I can also eat fruit and carbs after noon till about 5 pm and then avoid them after that time. God is the one thru prayer that led me to the dawn phenomenon and he let me know it was to be and egg and bacon. It worked from day one. …. If I go for days without eating green vegetables it won’t work as good. Oh yeah when I ate the veg’s only I wasn’t taking any sugar meds and it worked fine. … now for the cinnamon, it really does help lower the sugar but you must continue to take it. .. and I had my hormones checked and they found they were very low. I have a cream to put on my skin, when I use these hormones correctly they help keep my sugar down and just the opposite when I don’t use them correct the sugar is higher that day. … Last eating a variety of foods and at each meal works best. so eat the protein and fat for 6am and then protein, non bread veg’s and nuts for 11 am lunch then protein, vegs and non bread vegs nuts and fruit for 2 pm snack and 5 pm dinner. use protein or vegs and nuts after that. hope this helps its nice to have low morning sugars ….. even if it means getting up earlier than you want to…

  • David Spero RN

    Hi Phil,

    Your case report is way too complicated for me to safely give advice. One thing I would think about is changing your times for the metformin, and possibly changing from XR to regular. That sometimes fixes dawn phenomenon.

    I encourage you to talk to a diabetes educator about the details of your treatment.


  • Rebecca Sinha

    I have the problem of my liver releasing to much sugar. I have to take a little metformin and acarbosa with a bedtime snack even if my blood sugar is 70. And I also take 750mg of metformin between 4 and 5 am or my blood sugar will be to high in the morning. I also take metformin and acarbosa with every meal, and I follow a low carbohydrate diet to keep it in control. This routine allows me to to keep my blood sugar levels when I get up and before meals between 70 and 99, only once in a while will it be a little over 100. It took me several years to get it the proper doses of meds and my diet right to keep it where it should be. The diet also stops my post meal blood sugars from going up to high. I believe this is vital to avoid the potential diabetic complications from to high blood sugars. It takes a lot of work to get it right but it can be done.

  • jim snell

    Neat, Rebecca. I also time my metformin doses to achieve similar effect and control. Thank you for sharing.

  • mark

    Is there really a difference between generic metformin and the brand name Glucophage? I’ve heard the brand name is far better. Plus, I was taking Lantus for 9 months and about the 6-7 month mark I started having weird side effects such as extreme dizziness, stomach bloat, nausea, dry heaving and tiredness. I also gained 15 pounds. I stopped taking it cold turkey and all those symptoms went away, my energy levels went up and I lost the 15 pounds. Lantus, which is synthetic, is bad news. I would rather take my chances with Metformin and diet alone.

  • kendra

    have been taking metformin for years. because of this I have developed fatty liver that has now turned into cirrhosis. I have been diabetic for over 30 years. I am now 58 years old and my liver is not functioning because of the medicine taken for my diabetes. . I will need a liver transplant within the next two years. metformin is not the wonder drug that everybody thinks it is.

  • David Spero RN

    Hi Kendra,

    I’m sad to read of your liver problems. The government’s LiverTox Web site says metformin “is an exceedingly rare cause of…liver injury.” It almost never happens. You drew a very bad number in the lottery.

    I hope things get better. There are a number of things you can do to help your liver. Some of them are on this Web site.

  • John

    have been taking metformin 500mg in the morning plus glyburide 5mg for a long time and my sugars have been normal with the last 2 weeks. My blood sugar has spiraled out of contol. it has been 225 or more in the morning and 210 or more in the evening. My doctor has me taking 500mg 3 times a day with breakfast lunch and dinner and blood sugar is still gigh over 200 with sweating and diareah I dont understand the change I also have alot of burning and numbness in hands legs and feet I am wondering if i need more Metformin to control susar levels or if it just stop working or how long it will take before my sugar levels start to drop below 210 I have valot of shaking too help

  • David Spero RN


    If metformin suddenly stopped working, something must have changed. Sweating and diarrhea don’t necessarily go along with high blood glucose levels. If possible, please ask your doctor to investigate what’s going on. You might have an infection or some other change.

    I suppose it’s also possible you have a bad batch of metformin. Might want to take it into a pharmacist to check.

  • Jawwaad Ali

    I take metformin in the morning and night I still urinate frequently at night I probably go to the restroom 5 to 7 times at night to urinate? What do I need to do to control this? During the day I urinate frequently I was told that sugar was pouring in my urine

  • David Spero RN

    Hi Jawaad,

    There are many reasons for frequent urination. High blood glucose is certainly one of the main ones. Can you get that checked? If glucose is causing your frequent urination, you need to get that down. Metformin alone isn’t doing it for you.

    In case blood glucose isn’t the problem, many other causes, and their treatments, are listed at this Web site.


  • Jenny

    Interesting posts. I took metformin after reading an article about how the liver works and affects fatigue and/or brain fogs/depression brought on by poor food choices. It actually helped me lose weight perhaps but the main reason I took it at about four in the afternoon was to fight tiredness that I thought might have been brought on by overloading my liver with bad foods. Being less tired helped prevent me from overeating in the p.m.
    I was careful to drink more water while using metformin as I have read that it can lead to kidney failure. My question is whether it helps cleanse the liver or whether it forces it to work properly while we change our diets.

  • Lisette

    After reading this article I am confused.
    Another article that you posted states:
    September 13, 2013
    Metformin and Impaired Thinking
    Diane Fennell
    According to new research from Australia, the
    oral diabetes medicine metformin is linked to impaired brain function, but supplementation
    with vitamin B12 may reduce some of the
    cognitive effects. Metformin is the most widely used diabetes drug in the world, with over 61 million prescriptions for the medicine filled
    in the United States alone in 2012.
    So how can you say that metformin is good for anyone.

  • David Spero RN

    Hi Lisette,

    Every drug and herb that has benefits also has side effects. Relatively few people report the brain fog you mention. You will have to decide for yourself if metformin is worth it for you.

    Jenny, I haven’t seen anything about metformin as a liver cleanse. I think it just helps the liver store glucose like it’s supposed to.


  • jacqueline buckner

    Hello my name is jackie and I was diagnose with type 2diabetics and Im current taking metroformin twice a day but this morning woke up at 6am with a blood sugar of 260 cant figure out what I did wrong I did eat a little halloween sweet on last night



  • David Spero RN

    Hi MaryAnn,

    Norco has acetaminophen (Tylenol), and three tabs at a time, four times a day could be hard on the liver. I don’t know whether this contributed to his diabetes. I didn’t find any studies making this link, but perhaps it could happen. It wouldn’t be “THE cause,” but might be a contributing factor.

  • Barb


    Thank you so much for your informative article. This may be a long post, as I have much to explain and ask. 🙂

    I am an LPN, who stopped working in the medical field to persue music, and have been happy with that choice. In 1997, I was diagnosed with Type 2 diabetes, after entering the ER with Severe Ketoacidosis and a BSL of over 700. They put me on insulin, I had a horrid reaction to it. Later when I saw my GP, he explained that from what he saw, my body was still producing insulin, and all I needed was Glipizide to control with proper diet.

    Being a Musician means sometimes you don’t have health insurance, and my meds were sporadic at best, once my reg doc retired in 1999. I ended up in the ER in 2000 again, but something was different. The Attending looked at my hairy face and male pattern baldness and diagnosed PCOS with insulin resistance. He added metformin to my regiment at 250 twice a day.

    Now, again, I’ve had a real problem with getting meds. Sometimes my only recourse was ER’s and believe me that sucks. Over the years though, I’ve noticed a pattern…

    My BSL would rise and STICK. In other words, even when doing EVERYTHING right, as in Low Carb diet, Regular Meds, and proper exercise, I’d see numbers in the 200-300 range AFTER Glipizide… Now one thing I’ve always seen, is that it would be say, 210… I’d take 10mg Glip and eat… It would go UP to say 300… Then go back DOWN to 220 or so…

    Now, here’s the thing… The times would be odd… My dose of metformin always brought it back down to “normal” ish numbers like 120… Then when that was gone it would start up again, and NO amount of Glip would lower that part of it. It was like I never took it!

    Now of course, the lack of proper management led to severe depression… Being a nurse I KNOW the risks, complications, etc… For several years I’d given up completely… Eating high sugar foods, no meds to speak of… I’m talking TEN YEARS. My mind was like, well, it seems meds or no meds, diet or no diet, this ain’t gonna stop, so whatever, just let it go. However the nurse in me was always trying to think of alternatives. I tried Bitter Melon, Gymnema, Chromium, when I couldn’t get meds.
    Still the same pattern where it seemed like there was an overabundance of sugar in my system.

    In 2010, I did see a clinic where the doc upped my metformin AT MY INSISTANCE, after checking my Liver to make sure it would be ok. Helped a little, but still… SAME pattern. I got frustrated again, and when the meds ran out, I stopped.

    Three more years of eating like a 20 year old at thanksgiving, in the deep south… LOL.. NO ketocidosis, NO hospitalizations for extreme thirst, dizziness, etc… You know, the whole “NCD” thing… 🙂 I still felt good enough to function. DO NOT lecture, I gave em enough, but depression can do that… 🙂

    Now here’s the happy ending… I know WHY.

    2 weeks ago, I finally got hooked up with a GREAT Medical practice that charges only 89 bucks a month and offers FULL medical maintenence of any problems, NO copays, no deductables, it’s not insurance, its concierge membership. The doc was amazing, he drained an abcess I Had due to Hydradentitis Superativa (complication of PCOS I’m told) and gave me the regular dosage of Met and Glip, told me to “clean up my numbers” and come back in 2 weeks to see if this works.

    The first day was GREAT… I saw 119, 88, and even 73 after Glip and Met… But the next day, I ate NOTHING in the morning, as is my habit, and it skyrockets back up to 200s! Here we go again, I thought… I guess i’m gonna be on insulin, I’ve ruined my body, I’m stuck for the rest of my life as a type 1… Right?


    I Knew how Glipizide worked, but I wanted to know more about Metformin, and how it’s linked to PCOS… I found your wonderful blog, and read it through. Suddenly it made sense!!!

    Now mind you, I had eaten NOTHING all day, and my BSL was slightly over 200… So I took an extra dose of 500 Metformin, and waited… I tested my BSL about 50 times that day… I had to see what it was doing hour to hour… (These are actual readings off my meter that night) 204… 188… 167… 155… 147… 131… 126… 118… 107… 101… 97… 89!!! BINGO!!!

    Two hours after the dose (Metformin ONLY, No Glip) it DROPPED LIKE A ROCK!!! I took the 500 at around 4:30… By 8pm it was 89!

    I ate a light low carb meal, and took NO Glipizide with it, made sure it had enough carbs to cause a noticeable rise… (Cheeseburger with a potato roll bun and 1 tbsp Ketchup)… Watched it go up to about 143, then drop back after 2 hours to 114. SO… It would appear my Pancreas did indeed clean up the food, wouldn’t it? 🙂

    Took my final nightly dose of Metformin and went to sleep. Woke up with a BSL of 119! First time I’ve seen that in years!

    The next day I took the morning metformin, at 10am… Didn’t eat. Shot up to 200 something… 12 noon I took 500 more. Dropped again to 108 by 5. Ate dinner, no glip, didn’t rise higher than 140. Was back down to 121 by 2 hours post meal.

    Today… Normal morning. No food… 500 Met. Went out the the pharmacy, got a splitting headache. Noticed it had again shot up. Took the Second 500 and ate a low carb meal… 177… It’s dropping again. 🙂

    So here’s what I’ve concluded so far… Time and my Doc will verify…

    1- My main problem is LIVER DUMPS, NOT INSULIN RESISTANCE.

    2- I appear to dump in the AM Upon not eating for 2 hours… I guess my liver senses that I haven’t fed my body so it goes ballistic. 2 500mg Metformin at the intervals described by Jim (2 Hrs apart) seems to clean that right up, shut it down. Tomorrow morning I’m going to eat early while the sugar is normal(low carb high protein) and see what that does to the dump.

    3- I’m theorizing here that perhaps my Pancreas is over taxed from all the dumping by the Liver, and will eventually adjust once I get that problem under control. I’d love it if I only need a little Glipizide or none at all. I’m betting that’s going to be the case since I’ve seen that taking only ONE with a low carb dinner can sometimes crash me. Taking none and there’s no rise but a little.

    So far, I feel like there’s hope for me, for the first time in literally DECADES. I will be seeing my GP and going over all of this with him next week, we will do the Bun, Creatnine, LFT, all that stuff, as well as Hormone levels to deal with the PCOS. Probably a progesterone BCP for that too, he said.

    Love to hear your thoughts on this, Please no warnings about treating myself… 🙂 Sometimes you have to prove you know what works for you, and that is all i’m doing. 🙂 I know the risks, am well within the “Recommended Metformin Dosage”… So far, the end has justified the means, I’ve had numbers under 200 most of the day for the last few…

    My doc said do what I normally do, and show him a lower a1c (first was 12.5) in 2 weeks… Let’s see if I can!

    Any thoughts on the morning dumping? That’s what I’m most curious about…

  • Barb

    Also want to share with you guys who have Mac/iPhone/iPads…

    There’s this GREAT App called “Diabetes Pilot” that makes monitoring everything you need fun and easy! The thing actually has a food database containing everything sold in stores and all fast food chains… Down to the Carb!

    It has customizable settings and you can input Glucose levels, Foods, and even BP/Pulse readings. You see it all laid out so it’s super to note. You can set your own “high” level (mine’s at 140) and anything over that is displayed in Red.

    I suggest anyone who has any type of management needs get this, even if you’re just looking to lose a few pounds, it has weight settings as well, and food nutritional info.

    It’s 11.99 in Itunes App store. Got it for a Birthday gift from a Fellow Nurse friend, she KNEW my detail oriented, anal OCD ‘nursey” brain would adore it, and she was RIGHT!

  • JmmyS

    Re: LPN Barb post Jan 11, 2014.
    Dear Barb – Like you, I believe my type 2 is caused primarily by liver dump (dawn phenomena). I’m taking extended release (ER) Metformin 500mg 1x in the morning with breakfast. My AM pre-breakfast numbers range from 125 to 200. My numbers during late day, afternoon and evening are in the normal range. Questions for you. (1) Would you see any advantage or disadvantages between using regular Metformin vs ER Metformin for mitigating dawn phenomena (if so, please explain)? (2) What and when are you eating to help mitigate dawn phenomena? (3) What Meds (type/dosage/frequency) are you taking to mitigate dawn phenomena?

    Thanks for sharing!

  • jim snell


    As one who has been following/fighting this issues I have the following comments:

    Research by Salk and others suggests it takes a
    minimum level of metformin in the blood to tell liver to shut up. That level apparently varies from person to person.

    Standard met gets processed and takes 2.5 hours on average to achieve sufficient levels from a dose of metformin.

    For me ( using cgms) it takes a solid 500mg dose to work. 400 and under are useless.

    Extended ER metformin have a delayed response due to binders in Pill that slow the release of metformin. Yes they can work but one needs to get to a minimum does in blood to signal liver to shutup. My experience says to me it may take bigger doses of ER to achieve similar responses as good standard metformin.

    Many of the generic metformin standard work well, some put out sub standard levels in blood and fail.

    There are a bunch running around claiming it takes weeks to achieve useful levels. Nonsense; I have seen doses work on every sufficient dose taken on a CGMS. I have seen NO advantage to residuals and remaining met in body as many claim. I simply see every sufficient dose work according to the drug timing charts watching the liver get told to shutup and stop dumping in excess glucose.

    On top of that and due to that response; doses taken around the clock are far more effective and useful rather than this single mega dose that upsets the system, enhances the bowl issues and a general nuisance.

    Best wishes and good luck.

  • SMorgan

    It is well-known that when people follow a ketogenic diet (VLCKD) and get into what nowadays is called [dietary] ketosis, the glycogen stores in the liver must get depleted first before that state can be reached. Maybe not “zero”, but definitely highly depleted. In this state, there is nothing substantial to be dumped regardless of what “signalling” is or isn’t happening.

    It seems that some diabetics are unable to achieve this and no matter what they do or eat, their livers apparently still have plenty and keep on dumping it uncontrolled. Why can’t these people have a low enough level of glucose from diet to empty the liver of its stores?

  • Paul smith

    I take slow release metformin twice a day and only get problems if I leave to long a gap between eating so I have small but regular meals and no added sugar I am ok with natural sugar in small quantities but have a bad reaction when I am given processed sugar I discovered this when round a friends having a curry they could see a change in me I went pale and asked if I was alright I told them no and then it was revealed that sugar was added to the curry as a cheat like so many people do today I find this very interesting though because if my sugar levels do go down I suffer for it so perhaps I need a stronger dose of metformin but when I was first on it taking 1800 mg twice a day that used to make my head bad I couldn’t think on reducing my dosage it was like a fog had cleared.

  • Harry Linden

    Metformin works for me too – but with the diarrhea side effect. I run about 220 without it, and a 500 cap takes it down to about 145.

    Unfortunately, it averages about 2 hours to return to over 200.

    Atkins diet, no carbs or sugars.

    Reason for this post – through trial and error, I found out what works: walking.

    Last night for example, after a light dinner at 4PM, went out at 6PM for a walk. My sugar was at 218 at 6PM, and after a 3.2 mile walk, in one hour, it was down to 160.

    My average drop in sugar from a 1 hour / 3 mile walk – is about 60 points on the average – with no drugs(such as metformin).

    If I exercise more, like 4 hours a day (2 + 2), my sugar level runs right at 150 – no drugs (and no diarrhea).

    No walking for the day, regardless of diet:>200 easy.

    I am fortunate to be retired, so I can do what is needed to fight this problem. 4 hours of walking a day, healthy diet and no metformin.

    Works for now …

    PS: I beat diabetes 4 years ago by losing over 70 pounds (245>170). My doctor was proud of me, probably uses me as an example to share with other type II patients.

    Thought it was over, and then gained 50 pounds back (227 this morning). II came back with a vengeance. Bottom line: obesity is taking many of us down – we have to drop the weight to beat this thing.

    I have two friends who have lost a foot apiece feet due to this type II diabetes. Both were obese, not to an extreme – but apparently to the extent that not enough blood flow reached their lower extremities.

    Don’t totally rely on the pill – get rid of the fat, make that lifestyle change.

  • Ken Napier

    Wow liver dump is an weird thing. I have been a diabetic for over 15 years and not one person ever talked about liver dump. I have been on every med on the market. I am now taking Invokana 300 mgs and amaryl and just this week added back metformin cause I could not get control of them numbers. One dose of 500 mgs of metformin brought them numbers in check. I did quit metformin after going on Invokana. My fault not my doctor !!

    Invokana covered me for the most part but kept getting them high spikes and FBS was out of this world. I done what the author said instead of taking the 1000 mgs of met in the am and 1000 mgs in the pm I started taking 500 mgs every six hours. My numbers are almost that of a non diabetic !!

    Also please know I am not over weight I am 5’10 164 lbs and workout a great deal and an avid runner. Exercise is not always the answer it really helps but there are other problems in our bodies that cause diabetes.

    I suggest we all read this forum one more time so that the things that you read are ingrained in your mind and talk with your doctor about what you see that’s working for others. As most say not everyone is the same and might not have the same results.

    Bless all of you and hope that some day we have what should be a cure instead of a way of life.

  • Susan Coleman

    I realize this is a very dated post but it seems to address what I am experiencing as a newly diagnosed (pre) diabetic. The dx seems to depend upon who I talk to.
    I am also a cancer patient and was taking 500 mg Metformin even before this dx came I to play. My elevated numbers happen during the night when I am not eating. Lately, I have been taking four 500mg ER at night with little effect. So, based on this post, I should have more. I am committed to keeping tight control because even slightly high BG skews my PET scans.
    Do you have some current research about this approach that I can show my doctor?
    Thank you!

  • William

    Does Glucophage (name brand) control blood sugars better than Metformin (generic)?
    I take 1000 mg AM & PM of Metformin, plus I inject Victoza 1.8 ml after supper.
    The past few months, my sugar levels have spiked!
    260-280/PM Take 1000 mg Metformin and 5 mg Glyburide ——- AM sugar 89-100
    Take 1000 mg Metformin AM —– by 2:00 PM sugar levels 190-210
    I watch my diet, but I am very perplexed by these sugar levels.
    I learned I was a type II diabetic after having a heart attack 16 years ago. Two stents later,COPD,Sleep Apnea and HBP, I am very thankful to be here.

  • Glenda Davis

    I am on metformin and have notice that in the morning is when my sugar levels are higher am I taking it to early in the evening? I take 500 twice a day.

  • Ernest H. Harris, Jr.

    In Years, How long can a person take Metformin ?

  • Mumsies

    Glenda, Go to Jenny Ruhl’s Diabetes 101 website and see her pages in regards to dose timing. You will get information much faster as this page is not apparently being monitored on a regular basis any longer- at least from my experiences.

  • Mumsies

    Indefinitely as long as it is working for you.

  • David Spero RN

    Glenda, you might be taking your metformin too early. Or not taking enough. Try taking it later and see what happens.

    Ernest, you can stay on metformin indefinitely, unless your liver enzymes start to go up. Your doctor should check your liver once a year.


  • Pavar

    Your blog is very interesting as I recently read an article about the production of sugar by liver and kidneys.


    I have testing only Fasting blood glucose levels once in a month. I used be always below 130.

    Recent development:

    The monthly test showed a gradual rise of 5 points. When I consulted my Doctor, he told me to test also my PP blood glucose. This surprised me!In the month of June PP was just 73 (low) In July it was 74. In August it is 133. what makes the Fasting Glucose high? Shall try the METFORMIN AT BEDTIME (10pm?)

  • Vinod Kumar Yadav

    Why we cann’t prepared vaccines or any parenteral formulation of those drug used type-2 diabetes excepet insuline.

  • elsa

    I’m type 2 diabetic. When my sugar levels get too low my stomach gets bloated and kind of painful

  • Bonnie

    how long does it take to see results while taking Metaforim?

  • floris

    good day i haven’t insect my self for 3 days insulin was up bud i getting from my diabetic accession to day will it harm something my sugar level is 17.9 what can i do to drop it quick


  • patricia

    metformin or any other diabetic medication..but especially metformin cause me to have persistent lingering headaches all day and everyday…For the the last 5 of 7 years since my diagnosis. i did not even know it was the metformin because initially, there was no headaches. i had been to neurologists and lab techs trying to find and underlying cause. i stop taking every med wether it be vitamin or not….but i continued to take my diabetes medication cause i needed it….one day i ceased that cause i did not want to live anymore…i would feel that bad…the next day….no pain…no anything…i continued headache and pain free until my endocrinologist appt…we, him and i, had been working with different meds, cause i thought the glyburide that was with the metformin might have been causing the headaches…every other drug gave me a slight headache and did not bring my sugars down…when the were pretty controlled before. i even thought maybe the reason for the headaches were due to the fact that i was on meds but was not really a diabetic because my sugars would run so low, after meeting with my endo and my a1c rapidly rose it was clear i needed to be on something…he put me on metformin by itself and thats when i knew…as soon as i took it immediately got a headache that put me in the bed for the rest of the day. i refuse to take anymore… my endo insisted that i need to be on something..and nothing else worked but the metforim with glyburide. so he put me on insulin(20 long-acting lantus and 5 short acting before meals novolog)…no headaches..but my sugars sometime are not low enough…i just do not know what to do anymore….i forgot to add that i had my gall bladder removed prior to my diagnosis and always thoght it factored in some way….i know i need to lose weight but when you feel bad can you?

  • Melanie

    Hi there
    I am currently using MR30mg X 4 in the morning but its not bringing my sugar levels down it stays at 17-18, this is the 5th tablet I am using and have strange side effects like fast heart beats or skipping sometimes wakes me from my sleep, fog headed, heavy chest feeling,stomach burning sensation (reflux using topzole 20 and very tired throughout the day. Tried metformin and had bad tummy runs every day, tried a different brand and that again made me constipated with headaches constantly.I want to try the Glucophage and try it 3 x times per day and see what happens I really don’t want to go on insulin.

  • Chaitra Pallavi

    i have been diagnosed with type 2 diabetes since 2 my fasting blood sugar is below normal and hba1c is 5.6….still my dr has advised me to take 500 mg of sustained release metformin…do i really need it?? i am a controlled hypothyroid on fomg of thyronorm,taking 50mg sertreline for depression and vit D level at 6 for which i am taking replacement….
    do i need diabetic medication??or can i control it just like now ,with food and exercise…

  • Cathy G

    Please help!
    I am diagnosed as pre-type 2 diabetic and I have been riding between a 6.4 to 6.8 A1c for 3 years. Recently that went up to 7.2. My kidneys went into stage 3 failure. I have changed my diet drastically making sure NO processed sugar or bad carbs gets into my body. (I was eating 90% crap including sugar before the change) I am losing weight, which is great, but now the metformin I was taking makes me need to urinate constantly. Even when I have no urine in my bladder. It did NOT do this to me before. I tested the theory by stopping the metformin for two days. WITHOUT it my morning fasting BS was 135, WITH it 110. Is it possible just the change in diet and the lost pounds changed my bodies reaction to Metformin?
    Thanks for your time!

    • Kathleen Morgan Smart

      Deena.please do not change or quit taking your mess without talking to your doctor. This is serious.

  • me

    Ala really works. Get the r ala along with your Dr u can come up with a plan. This my dose along with diet and walking 600mg of ala one 300mg in am with food and one half of a 500mg met Forman then same at dinner and prayer prayer gives peace and walk if u can’t walk do some squats u need to use the sugar your liver puts out the but as always discuss this with your Dr ala and met Forman are powerful together my b.s. went from 200 to 120 fasting and learn when u should eat and what keep a diary everyone is different

    • Dena

      Wth is ala??????

      • chuck

        Alpha lipoic Acid

  • Tracy

    I just started taking Metformin and my daily morning blood sugar has jumped from a steady 120-122 to 154-159 with Metformin. I thought it was supposed to DECREASE my sugar not increase. I don’t know if I should keep taking it or not.

  • Tracy

    What is a normal blood sugar? And why would Metformin make it higher?

  • Tracy

    One more clue I use to urinate 4-5 times a night and now maybe only 2 times a night could that be why my BS has jumped 30 points?

  • bonnie campillo

    My husband was diagnosed 8 months ago an they said he’s had it for awhile he used. to weigh 185. an now today he weighs 135 an eats well an he’s slow he has memory loss an falls asleep all the time even at wheel driving he sleeps 24/7 he looks like he went from 57 to 80. yrs old an he can’t donothing any more I’m worried.

    • Dena

      I also have memory loss bad I am only 53…I try to loose my weight but cannot. Need 50 lbs gone. Always falling asleep! Feeling the same :/

      • musings2

        How about sleep apnea as a reason for falling asleep – the weight can be causing some of the problem. There is a Resmed device to help you sleep through the night if this is the problem (apnea). Then with more energy you can work on weight loss. “Always falling asleep” is a medical emergency in my view. My husband used to nod off driving until we got him the sleep aid from Resmed (this is not an advertisement for it, by the way). It’s like night and day (instead of night all the time!)

    • chuck

      Could your husband have LADA diabetes ?
      Improving your insulin metabolism can somehow turn you into type 1 late in life.
      ihave a friend that this happened to.

    • Yuri Cowsar

      I’ve been taking metformin 1500 per day, 500 per meal for about 3 months, lost from 253 to 230 by following a low carb diet. When I eat any sugar like a non diet drink or ice cream (by way of confession) it is almost immediately obvious, big mistake. Doc says getting my weight down another 30 – 40 lbs and exercise, 150 minutes/week of fast walking, or jogging is critical for my health. Not hitting the exercise target yet but getting closer. Metformin helps curb my appetite especially for bad carbs and sugar but that affect has a trade off based on taking it before meals not after or during where earlier also means nausea sometimes. In spite of this it has been very effective for me so far.

      I had some trouble getting used to Metformin due to the nausea, Doc said take med closer to meal or after a few bites until I can gradually take it earlier. That helped a lot, and taking the occasional antacid when nasea starts. My Doc had pre-diabetes and headed it off with diet and exercise where I waited too long and was already Type-2. We both were susceptible from heredity standpoint (we are brothers).

    • Mel Smith

      Sounds like he could be suffering from OSA, Obstructive Sleep Apnea. This causes increased blood sugar, memory loss, day time tiredness, increased blood pressure, slows metabolism and oxygen saturation in the blood. Simple test for the condition is available and if his neck size is greater than 17inches this is also a good indication of the problem.

  • Dena

    Thank you I will try this also!!! I take chrm. picolinate but my sugars are still in the 300’s all the time..I don’t want to go on insulin! :/

  • Don P

    The only problem I have with taking 750 mg ER Metformin (twice) & 8 mg of Glimepiride (5 mg in the morning and 3 mg for dinner): I have to take the meds at least 2 hours prior to eating to work better at controlling my glucose. Last night I took the dinner med just before I ate and it took over 3 hours to bring down my glucose to near 140. And then, my glucose continued to plunge to 65 right before bed. I got out an 8 oz. apple juice and drank it. I didn’t bother with taking my evening Lantus shot. I awoke this morning to 101 fasting glucose.

  • Mel Smith

    I am having tests for sleep apnea. One of the effects of stopping breathing at night is an increase in blood sugars to create the ‘fight or flight’ response to this effect. Could this be the reason for the increased readings in the morning? I will post any significant results if I think they can be of help.

  • paula

    i take 1000mg metformin and 10mg glipizide before.breakfast and again before dinner. i drink a health drink every morning consisting of blueburries, spinach/kale, ground flax seed, table spoon of dark hersheys cocoa, small banana, unsweetened coconut milk and now store bought egg whites. i need to eat a snack a couple hours later or my sugar will drop which is fine. dinner seems to be the problem. i take my meds and eat dinner about 15min to half hour…sometimes right after taking them and usually a decent size meal like tonight i ate deep fried swai deep fried cauliflower and deep fried mushrooms all in sunflower oil. now to me that sounds like a unhealthy meal, but we have that meal mayb once a month cause i usually oven bake my fish. anyway, my sugar dropped to 72 when i noticed i felt funny, this was after an hour and a half after eating….i took a glucose tablet and still dropped down to 52 and took another. to say that it does this every evening after dinner which i dont understand…oh and i ate a small piece of chocolate cake after dinner with chocolate icing. my sugar is usually 160 to 180 in the mornings. my a1c is down to 6.4. i want to understand my after dinner drop. just to let u know, some doctors dont seem to know cause they dont have an answer…jus to tell me to watchvmy sugar and carbs at night for a better morning number, which i do know this is true for me. any comments would be appreciated 🙂

    • Teodora

      What happens of you decrease night dose?

    • Anita Gibb

      Paula you’re eating way too many carbs per Neal and are now getting Reactive Hypoglycemia aka rebound low blood sugar. Your breakfast smoothie us high carb stop that.i calculated well over 60 grams carbs when most type 2s can only manage 15-20 grams carbs per meal. Eat real eggs un the morning ditch egg whites all the nutrition is in the yolks! And what were you thinking with chocolate cake again reactive hypo which taxes your adrenals. Instead treat yourself to 1 or 2 squares dark chocolate. If youre hungry after a meal you didnt eat enough protein!

  • mike

    I was recently diagnosed type 2 with an A1c of 6.8. I had been monitoring my glucose levels for 3 months and rarely saw a reading over 6.0 but the doc started me on 850 mg metformim daily and not much difference in readings. I only took metformim for 10 days and stopped because i caught flu and also noted metformim limited my sleep to 4 hours a night and i felt this was interfering with my recovery from the flu.
    I am fine now but have noted that since stopping the metformim my blood readings have shot up to levels i nevet saw prior to starting this med. My readings now vary between 8 5 and 13.5 which is odd seeing that i regarded 6.5 as high before using the medicine.
    Is this normal. Has metformim switched something on or perhaps off in my metabolism?

  • mike

    I just started metformim 10 days ago. 850mg per day in one dose. My latest A1C was 6.9 hence the diagnosis of type 2 diabetes.
    After 10 days on the drug i caught flu so stopped taking metformim until i cleared the flu bug from my system. One reason for doing this was that metformim stopped me sleeping more than 4 hours a night and i thought that the lack of rest would hinder my recovery from flu!
    Prior to taking metformim my blood glucose ranged from 5.5 to 6.5 and very rarely 7 but never higher. After just 10 doses of metformim and having stopped i have noted a huge upwards leap in my glucose to between 8.5 and 13.5.
    Could this be due to the flu, which has now cleared up and readings still high? Or could it be connected with the short time i took metformim? Maybe metformim switched on or off some mechanism in my metabolism that has remained as altered!
    Any advice welcome.

    • Andrew Dodd

      Stress (including sickness, especially any form of sickness that causes a fever) is well known for increasing bloodsugars and causing insulin resistance.

      Being sick with the flu is probably the worst time to *stop* taking metformin.

      This is why flu shots are so strongly recommended for diabetics – the flu can REALLY screw up both T1s and T2s.

  • shana smithey

    I get sick to my stomach a lot, I feel nauseated, shimmy headed weak and sometimes I sweat profusely while I’m having all of these symptoms. I have type 2 my sugar is high. I take metformin. I noticed if I take more than 1000, milligrams my sugar isn’t so high . But I never really feel good I just stranded taking more than what I was prescribed. Can you help me

    • Bijan X

      Hi Shana ,
      In Iran ( Tehran ) most Doctors would advise people with type 2 diabetes a Combination treatment with a 500 milli gram metformin and a 5 milli gram Glibenclamide, talk to your Doctor on this matter.

  • mzlisamichelle

    Unlike “Superhero” I don’t think it is silly at all. I don’t think it will be a fast fix, but over time and eating healthy it definitely couldn’t hurt. I take it daily with everything else prescribed. Still working on my healthy diet though.

  • Deborah Newton

    I have been diagnosed with RA and my enzyme levels in my liver have increased over the last 5 months. My Rheumatologist thinks that Metformin is to blame for this. I am currently taking Methotrexate. What if any is the correlation betwerb these two medicines and the liver?
    Really need some help on this one.

    • Deborah,

      Both methotrexate and metformin sometimes cause raised liver enzymes. From what I read, methotrexate is a bigger risk, but both can
      cause problems. Strangely, taking them together doesn’t seem to increase the risk much. I don’t know what you should do. There are non-drug substitutes for metformin, e.g. vinegar and bitter melon, but metformin is a good drug. Maybe an experienced pharmacist could tell you something.

  • Jefferson Eng

    I recently added a prescription of glipizide 5 mg (twice daily) in addition to metformin 1000 mg (twice daily), but I’ve been noticing my late afternoon glucose readings dip below 95 mg/dl as well. Usually, I stave off the sugar crash with some fruit juice or a granola bar, but I called my primary physician and she says to halve the dosage of the glipizide. My glucose readings have mostly been below 150 mg/dl unless I really overeat. I also take 35 units of levemir before bedtime…

  • Anna

    I would like to try it for weight loss. I don’t have diabetes and at most test have to low sugars. Due to the way I eat but I’m 30 pounds overweight, I have an overactive stomach that’s capable of eatting alot. Not that I’m ignoring poster below me on liver cancer, I did quick Google and looks like it might prevent liver cancer….of course that could be a coverup. Anyway anyone here take it just for weight?

  • Maxine “Maxine Reddy Erasmus”

    Can someone please help me understand my issue or tell me who to speak to about it? My gynecologist put me on a 3 month course of Lipitor and Glucophage/Diaphage. My cholesterol and glucose has gone down but my insulin levels has gone up. My Glucose fasting results was 5.70 mmoL in November 2015 and now is 5.40 in Feb 2016 and my insulin levels was 16.3 uUlmI in November 2015 and after being on glucophage, my results are now 19.1. Can someone please explain this to me?

    • Hi Maxine, No way to know for sure, but most likely the glucophage is lowering your glucose a bit while the lipitor is increasing your insulin resistance and raising your insulin level. These effects have been small in your case and not much to worry about, but I would ask my doctor why the lipitor. Maybe you can get off that.

  • helen price

    Dr. Jason Fung…google and listen to his videos or read his Q&A. You never cure diabetes with medication…of any kind. The only way to cure it is either gastric bypass or low carb diet. Stop feeding you body sugars, do intermittant fasting and within eight weeks you are well on your way to curing your diabetes. But this is only for the people that truly want to cure, and stop eating improperly. It works! Just listen or read his stuff. Amazing.

    • Revolutionary

      You will NEVER cure type one with diet or a gastric bypass. You either take insulin or eventually complications will KILL you.

      Youtube is not a medical professional nor a reasonable resource for medical advice.

  • Sharon Kane

    Metformin was an awesome drug for me! . In 2003, I was diagnosed with type 2 diabetes. Long story short, I was my own worst enemy –my lack of impulse eating, lack of will power, etc. I had the knowledge and tools, but lacked the effort and self discipline. For several years I suffered with unexplained severe IBS, or in short, severe diarrhea. I had many tests done, no answers. Everything was ruled out. But still, no matter what i did, no matter what I ate, severe diarrhea. ok, so … years go by.. nausea, the dreaded bowel issues, etc. Chalked it up to IBS or nerves. Starting about a year ago, I begged my hemotologist (blood doc) to check my lactic acid levels during my visits. He humored me. My family laughed at me. I was being paranoid. Fast forward to 2 weeks ago. I go in for my labs at my blood doctor’s office. Waited 3 days. Lactic Acid levels for some reason when sent out for testing take FOREVER. I was about to track my results down like usual because doc offices seem to forget you are kinda waiting on results, but before I could, my doc calls. He informs me that my lactic acid level is 3.1. Being the little researcher I am, I knew that anything over 2.0 is critical. Still, they told me stay the course, keep taking it. And go to my primary doc for a re-check. Ok, did that. Got the slip, went to Labcorp.. another 3 days. go by. Get a call. It is better but not by much. I am barely in the normal range. In fact, according to most lab standards around the US, there normal range would have easily flagged me once again.. so now, I call my diabetic specialist who monitors my meds. He says stop the metformin until they can figure out why I am borderline lactic acidosis. I stopped it for maybe 3 days before the not knowing was killing me, keeping me up all night. Worrying and stressed. Does anyone realize that lactic acidosis is fatal in many cases? … that you literally go into sepsis. No way was I waiting for an appointment then another 3-4 day turnaround for those results. This is nothing to play with. You know I actually thought it was an infection of some kind. Not metformin. Maybe the lab staff mishandled the specimen? .. but both times? … My mind was racing about what could be wrong. Oddly enough.. the very same day I stopped my metformin, lo and behold my diarrhea was GONE. None. No episodes since. Weird huh? …. So I go to the ER and thank God I had a very kind doctor. I explained everything. No problem she agreed to rule out things, recheck the levels, and go from there. I thought this is it, I stopped the metformin so if it is still high, I might be getting admitted into the hospital while they figure out what is causing the critical levels of lactic acid. She went over and beyond, chest xray, so many blood test, a urine test, even did a test for blood gases… trying to do whatever she could to rule out, exclude, and pin point the issue. The result: my level was perfect!! .. 1.1. They ruled sepsis out, I did not meet the criteria for either sepsis or lactic acidosis, not even infections. She said that metformin is a known agitator to the GI system causing very bad diarrhea on many people and was shocked that no one ever put that together much less warned me about that. I became anemic for the last 3-5 years, loss of iron, low vitamin D, low b12, basically the diarrhea was causing all my deficiencies. And all this time, metformin was the reason? I am sad that I had to stop the medication. I still have my Levemir insulin and Glyburide but it is very clear what was the real work horse drug in the equation, metformin helped my sugars, the others don’t do much in the long run. Now my body is in total rebellion. It was explained to me that the lack of metformin is the reason why no matter what I eat, no matter how low carb it is, my sugars are now 260-380. Unbelievable. They refuse to reinstate my metformin because I had built up a toxicity to it and lactic acidosis is deadly, not worth the risk. I get it. I understand. At the same time I feel like I am back to square one while they scramble to figure out the next move. They are not concerned with the sky high blood sugars, but I am. They say it takes a bit, maybe weeks to regulate your body again. The damage concerns me though. All I worked for, out the window.. I already notice signs of the high sugars, increased urination, blurred vision, increase thirst. Glad to be alive and know what the culprit was, but sad to see it go. 🙁

    • Reddog

      Sharon, try nopal cactus juice. AKA prickly pear cactus: It’s the oblate cactus paddles you want – not the red fruit. Burn off the needles over a stove. Then put the paddles through a juice machine. You can save the and freeze the pulp in a ziplock bag to roast in an oven and eat with your proteins. The juice will bring your sugar down. 16 oz of the juice will bring your sugar down from 300 to about 130 (YMMV) in less than an hour..

    • Donna Perkins

      sounds like you may want to study Celiac disease. also an autoimmune disease, genetic and often a precursor to type two. that’s what happened to me. wish I had learned about it before I was 58, may have prevented the diabetes altogether

  • Angel Davis

    I disagree with you both – Keeping in mind diabetes is one of 2 things, either you are a diabetic because of your food choices and environmental or medications such as Prednisone, or you are a diabetic because of Genetics – family history and genealogy. When Genetics is the reason, gastric bypass or anything that alters the stomach is NOT a cure! In addition, dietary changes, fasting, and even diabetes medications are NOT a cure! In fact, I wish there was more money going into the Genetic testing of diabetes, but the research for that truly does need to be several generations and well….sometimes, that simply is not possible when the life span of family member’s is getting shorter and shorter.

    • ElderandSister Vingoe

      It is a FACT that diabetes 2 is directly related to the deposit of fat in the liver and pancreas. Don’t fuss with the myths and cons that are widespread on the web. Go to the research of Professor Taylor, Newcastle, UK. He is proving again and again that if a Type II diabetes patient will lose 20% of their body weight they will reverse their symptoms. And he is not selling any drugs, diet fads or anything else. Just promoting good health – one of the benefits of the UK NHS – free from big pharma interference. In his first study eleven Type II patients all reversed their diabetes by losing weight on a low calorie diet. When the results were publicised thousands of Type II sufferers contacted him about doing the same. He collected data from over 1500 people who tried the 20% weight loss and this confirmed the initial trial – lose weight on a low calorie diet and you will reverse Type II. He is now conducting research with a large group, including with a control group to further confirm the result.
      The reason people are tempted by gastric band treatment is because all obese patients who have gastric band surgery show that diabetes is reversed typically within the first ten or so days of treatment. Why? Because the liver converts body fat to glucose in the circumstance of significant reductions in calorie intake – and the first fat deposits it uses are in the liver and pancreas.
      Western diets have taught that carbs should be 50-60% of our plate since the 1950s. Then we were conned into believing that fat was the enemy. We now know that sugar and carbs are the enemy. Eat less calories. Eat more fresh vegetables and fruit. Exercise more. We know the answers but we lack the discipline to do it. We lack self respect and intelligence. We lack will power.

  • bwils74

    I am Type 2. My A1c is 5.5 and I just moved from 500mg metformin two times a day to once per day. Doc said to take it in the evening. My night time BG is generally 110-120. My morning BG is 140-160. I am wondering though, if I should not be taking it in the AM rather than the PM. What do you think?

    • G A

      Most Docs and the instructions that most people do not read says to take it with meals as it acts with the food to do it’s job. If your A1C is 5.5, you’re not type 2. Fasting as in first thing in the am should be 95-110. 140 is considered pre type 2. take your Metformin with your morning meal, then again at dinner. Check your BS first thing in the am. And have your A1c rechecked in 3 months. If you’re not doing any exercising, do some. You don’t have to be a gym rat or run 5 miles. Do some weight training, some biking and swimming if you can. 3 times a week with the weights for 30-45 minutes, bike evenly and do some fast, then moderate at the end, maybe a few miles then take it up to 5. Swimming nice and easy for as long as you can, it’s easy on the joints and helps with lung capacity.

      • ms.p

        I would encourage everyone to watch this information. ..i was blown away by it ….dr fung is reversing diabetes at Scarborough General hospital in Toronto …

  • Ragin’ Human

    Hi, first of all thanks for setting up this website as it really helps me understand diabetes management.

    I was diagnosed as Type 2 earlier this year (fasting blood glucose was 110 mg/dl and HbA1C was 6.5%. I have to mention here that I used to smoke for the last 15 years and had just quit about 4 months prior to the blood testing. Unfortunately, I ended up substituting the nicotine craving with chocolate. In any case, I decided I had to lose some weight (5 – 8′, 220 lbs) and took the doctor’s advice to start metformin. Unfortunately, the regular version played havoc with my digestion and after 2 weeks of torture I moved to the ER version, which I take post-dinner (typically at 8:00 PM).

    My problem is this: I have a blood glucose monitor and measure randomly. I have noticed that the morning blood glucose reading is now 108 mg/dl, but at 5 PM (with a lunch at noon) is consistently 70-75 mg/dl. Also, immediately after a meal, my measurements were consistently 140-145 mg/dl. All measurements were conducted over a month span.

    Is this something different than what others typically measure? I had contacted my PCP (who had meanwhile suspected a diagnosis of sleep apnea, which was correct and I am currently on CPAP therapy), and she mentioned that she would want to wait at least 6 months and another HbA1C test before making any conclusions. Then I read this article and I am wondering whether I am experiencing the dawn effect. Any advice on metformin usage?

    • According to, the peak action of metformin extended release is about 7 hours after taking it. You might try speaking to your doctor about taking your daily dose at bedtime to lower morning glucose. I hope the CPAP also helps.

      • Ragin’ Human

        Thanks David, I will speak to my doctor about it.

        CPAP has changed my life, I sleep much better now. And I can push myself to work out harder.

    • G A

      140 is considered pre type 2 a 110 is not. My doctor tested my A1c and it came back a 12.4. She said I should be on insulin and in a hospital. I said I know what caused the spike and told her I’ll get it down to what she wanted (7.0) in 3 months. In 3 months I had a 7.0 from knocking out the F ing fake sugar italian pops, No soft drinks at all, barley flakes, oatmeal, or 2 eggs in the am. Lunch was a tuna sandwich, PB and fruit or hard boiled egg and yogurt with fruit. Dinner chicken, rice, broccoli, Red meat maybe twice a week, Salmon 2-3 times a week. I blew it the other night, pasta with meat sauce and extra lean hamburger, some veggies and a couple of those freakin turnovers you get in the box in the deli section, and another one before bedtime. My glucose was 120 in the am.

  • Mike Smith

    I came to this article while searching for “metformin before bedtime”, as I have been getting great results having no “dawn effect” after I started taking 500mg metformin before bedtime, late in the night (11 to 12pm). Previously, I took my metformin before dinner, or right after dinner, which was usually 7 or 8pm.

    So, you are right, at least in my case, timing is important.

    One question, when you say it takes 2 hours to take effect, and lasts 5 hours, do you mean it will last 5 hours after the 2 hours ?


  • G A

    Take it with meals.

  • G A

    Take it with your meals.

  • G A

    Stomach problems usually come by taking it on empty and your blood sugar can go too low with no food in your body when you take it. My doctor said to take it with food. So take it with your am meal, then at dinner. I usually take it about 1/3 of the way while eating. Also have your A1c checked every 4 months. A1c takes 3 months to change, so give it a little space and see what you have going on.

  • Jason Harmon

    Not taking Metformin due to bad reaction, but taking Januvia and Losartan instead. Glucose is high in the morning 150-160 and spikes again at 10:00 PM, 3 hours since my last meal. Glucose is typically 90-114 just before lunch and dinner. Does this sound like leaky liver? I do have fatty liver. Are there alternatives to Metformin that I might tolerate?

    • It does kind of sound like leaky liver. There are a number of herbs you could try. Bitter melon, vinegar with dinner, or okra are a few that are worth trying, and there are more. If you have fatty liver, weight loss might help.

  • Marium Williams

    I have type 2 diabetes I have fatty liver my diabetes has reversed I sill have no diet plan I eat what I want my sugar doent go up i stopped metphormine for a while and i started going online to see how it helps in other ways so I started back I wonder if it helps fatty liver since it does help you lose a little weight.

  • Ata TA

    My AC1 result was 6.4 and Glucose 143. My doctor prescribed Metformin 500 mg one pill in the morning with food. So today I started at 9 am with one pill with food. four hours later I had lunch. Then half hour later I started to sweat over my neck and back, hand shaking. I checked my levels and it was 79. I ate bread after that, soda and chips to go back to normal….I called my doctor and he said Metformin not suppose to do that, take half pill and lets see what happens and if he needs to give me new Meds. Any thoughts on this?

    Sounds strange, I have googled to find out anything similar but nothing was found. Even some people are taking 2000 mg a day…lol

    • TA, Hospitals around here (Portland, Maine) know about this rare insulin-like behavior of metformin and will never allow inpatients to take it during their recovery from surgery. Be careful. Search YouTube and the Web for articles and videos by doctors on “intermittent fasting”. It works much better than metformin to manage type 2 diabetes without medicine.

  • Glock27a

    I am new to this–72 yrs old–6.2. Been testing and numbers are up to 144 mg/dL early morning (5:00 to 7:00). On metformin 500mg 2x’s a day. As the day wanes numbers go down but not to normal range. One days numbers 6:00 (114 mg|dL), 12:21 (108mg|dL), 1:20 (106 mg|dL), 5:52 (134 mg|dL). Next morning at 7:18 (132 mg|dL). Took a 1 hour intro. class to diabetes and learned nothing and doctor shared nothing. If normal is 90-99 mg|dL, how bad off am I? Maybe I am way too soon for anything but diet and exercise for a few months?

    • Hi 27a, You don’t say how you’re feeling, but your fasting numbers are in the diabetic range, but not by much. Why not keep taking your metformin, cut down on starches and sugars, and move your body more? You should feel better that way. If you want to do something else, consider bitter melon tea or vinegar with meals.

      • Glock27a

        I take the metformin. Been doing this for about three to four weeks since the Dr. informed me. PANIC!!! A problem I am facing now is with the restriction of carbohydrates, I am feeling light headed, weak in the muscles. When I complete a task I feel this way. It seems reminiscent of hypoglycemia. I have had this sensation from years past when I would down candy, ice cream, pop, or juice in an effort to alleviate the sensation, which it did do within 30 minutes. How is it possible to have both at the same time??? This is all very confusing. won’t be seeing DR. for another few weeks.

      • Glock27a

        This is an awful late reply, but move. I have an arthritic condition that plays hell on me. I do move but not as I would desire. My numbers have fallen down to the 101 with a high of 127 and a one time high of 271. However after a second check a minute later and opposite hand i was at 147. Currently I am using ACV and black seed oil.

  • aimer

    What about people who are only slightly overweight (15 or less lbs) and take metformin but won’t do anything else to change (still eating sweets and junk food, no exercise)? What’s the point?

    • ML

      The pancreas slowly burns out. Apparently, if everyone lived long enough, no matter their weight, their pancreas would burn out. Exercise helps your insulin sensitivity….meaning less insulin will be required to cover sweets, etc. And really, as far as insulin goes, gumdrops are somewhat equivalent to pineapple. Both will spike your blood sugar. In excess, both of their sugars will convert to fat which then creates insulin resistance which then requires more insulin which then makes you gain weight because it is an anabolic hormone that causes weight gain. Mmm, so maybe kudos for taking the metformin and hopefully with a little encouragement or back the heck off, even more kudos will be given with lifestyle and medication improvements.

  • How to get tested for a LEAKY LIVER ? LENTUS and NOVARAPID insulin failed and I shifted on METFORMIN- twice a day and its not working ……………………:(

    • ML

      Maybe titrate the insulin higher. You can’t really fail a basal-bolus regimen with lantus and novolog, although dosing times can be inconvenient to curb overnight spikes to blood sugars.

  • Alice

    Am Alice am on metforfin 1500mg extended release which i take after dinner for the last 3 weeks. The problem is that am still getting after meal spikes of 170. I have tried the regular metformin and did not work either. What should i do?

    • Alice, metformn doesn’t do much for after-meal spikes. If you could walk after meals or take a spoonful of vinegar before meals, that would probably bring your sugars down. There are also prescription medicines for that, the “glinide” drugs. And don’t eat too much starch at one meal. You should be fine.

    • ML

      Maybe try a rapid acting insulin for meals with carbohydrates? As I’m sure you know, ideally, blood sugars are 80-120 with a 40 point spike with meals. What is your blood sugar before the meal? If it’s 130ish, maybe you need a basal, long acting insulin.

    • Revolutionary

      After meal spikes of 170 are not bad for diabetics. Of course ideally you should be seeing 120-130 but in the grand scheme of things if 170 is as high as its getting you are pretty well controlled. At this point I would be looking at A1C with the intent of getting them 6 and under.

  • Elana Su

    Hi , I’m a type 2 diabetic patient. And I’ve been consuming metformine for the past few years. And out of sudden, non of the diabetic drugs are being effective. My glucose level reading is as high as 15-19. I’m currently consuming glicazide 80mg , diamide + metformin 800mg, no changes in reading. I’m having an itch too . Pls do advice. Thank you .

    • Elana, you need to ask your doctor about this, but something must have changed — perhaps you have an infection or some new condition, or perhaps your diet has changed or you’ve had some kind of trauma. This needs to be checked out ASAP. A glucose of 19 is way too high.

      • Doug Gonzaga

        Hi David. I am sure you have done some research or watch some of Dr. Jason Fung’s lectures on Youtube? He has documented MANY, Type2 patients that were cured of T2 and/or reduced their medications by quite a lot by following his regime (fasting/intermittent fasting//keto diet) as well as getting some T1 (autoimmune) way down on their use of insulin!

        Here is a link to his website with lots of science based info. I appreciate all you do for diabetics!

  • Madavor Media

    Hi La Tondra Reagan,

    We’re so very sorry to hear about the difficult time you’re having. If you’re thinking of hurting yourself, please reach out to someone right away — the National Suicide Prevention Lifeline can be reached by phone at (800) 273-TALK (8255) or via chat at

    When you’re feeling up to it, looking over some of the tips in “Managing Hyperglycemia” may help give you ideas for things you can try to reduce your blood sugar levels. But know that this is a difficult condition to manage for everyone and that not having your blood sugar levels where you’d like them doesn’t mean you’ve failed. If you’re able, speaking with a certified diabetes educator might be helpful.

    Again, please reach out to someone who can help you through this difficult time, and please know that we care and are thinking of you.

    Diabetes Self-Management

  • Hi La Tondra, I’m sorry you’re going through such a hard time. I don’t know how long you’ve had diabetes, but learning to manage it takes time. And it takes help. Please reach out to people, either professionals or people you know, to get support for living with this condition. It’s hard! You might be amazed at how much having someone to share with helps. For example, if you had a person or a dog to walk with after every meal, I’ll bet that would get your numbers way down. You can see many other ideas at the links Madavor Media posted. I’m sure our readers will have other ideas. This will get better.

  • jojo

    Advice no.1 change diet,2. juicing carrot cucumber, celery garlic,ginger and green apples. or spinach, cucumber celery and one piece of beetroot, drink this daily and you will see improvement,am doing myself and l can tell you it works l have reduced my tablet and not told my Dr because he will tell me to take that high dosage which ends me up with hypo lifestyle is the first to deal with,some exercise or even go for a walk regularly will bring blood sugar down,try to take really less carbohydrate vegetables instead and it will help you a lot ,go on YouTube there are tausends of good advices on video lots of tips ,

    • Donald Duncan

      Hi Everyone,
      I also have had experience juicing fruits and vegetables. To make it work you need to juice more vegetables than fruit. I juiced every day for breakfast and lunch than had a normal dinner. I did loos about 60 lbs.
      Before the weight loss my leaky liver used to send me up over 100 points (from 106 to 220) without eating anything. After the weight loss it was more around a 50 point gain.

      So doing a juice diet or eating right either way will help. The main goal is to loose the weight and I know from personal experience it is not an easy thing to do. Just keep at it. Juicing did help me mainly I think because I use to not eat any vegetables, but it was weird that I liked the vegetable juice or found it more tolerable. I used to do straight juices instead of mixed juices. So find something that might work and just keep trying it is when we do not keep trying is when this disease will win.

      Hope this helps someone!

  • Revolutionary

    If your monitor is reading High then as far as I know your blood sugar is over 1000 at that point.

    You need to change doctors NOW.

    I have quite a bit of experience with a diabetic who had dramatically high sugars like this and many times she ends up in the hospital for weeks until they can get it under control.

    You also need to go see a specialist as well. That much insulin should be doing more than it seems to be doing.

    Also, it sounds like you have type 1 diabeites instead of type 2. Almost always type 2 is treated with medicines and not insulin…there are a few exceptions to that rule but very few according to what I know.

    Part of that hopeless feeling you are having is from the mental effects of diabetes itself. The suicidal thoughts and depression will lessen as your glucose levels normalize.

    Evidently your body has partly adapted to the higher sugar levels because there are some people who are totally disabled and heading toward coma state after 600 and you evidently are beyond that due to your monitor saying HI all the time.

    Find a new doctor…and live

  • Ange Hofmann

    Hi. I’m Ange. I was diagnosed early this year (2017). Was put on metformin (500mg x1 in the morning and x1 in the evening). It was the devils own work and the side effects were terrible. Have been moved to slow release and the side effects are not much better. However, the metformin does work in that my post prandial spikes are in check. Its my fasting (overnight) levels that are a problem (I had Gestational Diabetes with my youngest son (nearly 3) and it was the same then). As such, this article makes perfect sense to me as my morning glucose levels are always over target. I tried to take the x2 metformin at night instead, but it made the side effects far worse and made no difference to my overnight levels anyway.

    • Hi Ange, It sounds like these metformin problems can be worked out. You might want to talk to your doctor about it, but rather than taking both pills at once in the evening, I would suggest going back to the way they were ordered, but taking the evening dose later, close to bedtime. It might also help to take a couple of teaspoons of vinegar at bedtime, as you can read about on our site (just double check with a pharmacist to ensure the medicine and vinegar won’t interact). The intestinal side effects of metformin often go away with time. If they don’t, don’t be shy about asking your doc for a different medication.

  • David

    Ok last September I was diagnosed with Type 2. My A1C was 11.7 and my BG was 527. My ketones were wide. I was basically in ketoacidosis but for the most part felt ok. I stopped drinking sodas and fruit juice and cut out donuts, pastry, and white bread. Two weeks ago I tested my A1C and it was 5.6. That’s below pre-diabetes. It was that simple cut out what I listed above and it changed that much. I don’t get the hypoglycemia any longer. But I do still take metformin twice a day (500mg) to control blood sugar. I am guessing the insulin resistance is still present and will take time to return to normal. I feel so much better when I keep my blood glucose around 100.

  • Pete

    I’m sorry to hear the troubles this disease is causing you. Please take the time to watch a documentary about the raw food diet and diabetes. by Dr. Cousins on You Tube. He has had remarkable results with type 2 and raw food. I can promise you this does work if you follow the regimen. It can keep your diabetes in check, as long as you adhere to the protocol, which is primarily raw foods in many forms. I hope this information will help.

  • wayno12

    Read a couple of places that metformin LOWERS Testosterone – which can cause a PASSEL of problems. On .5 ml IM a week with normal T levels 6 months now, blood sugar coming down slowly. metformin 2x day 500 mg. Last 2 days before meds in am 100 BG and 116. Fasting since 6pm till 8:00 am next day,

  • Dianne Hess

    La Tondra; don’t give up on yourself. When I was diagnosed with Type II Diabetes in November of 2016, I was devastated. My A1C was 9,8 and Ave BS were 235. I decided to make some changes in my diet. I cut out carbs completely and ate vegetables, strawberries, berries, and lots of protein. It didn’t matter what kind of protein. I experimented with my carbs simple and complex . I found the only complex carb. that did not raise my sugars is dark pumpernickel rye. I would limit myself to a half of a slice a few times per week. I also did stationary bike riding for a half hour and walking 1 mile per day. I gradually increased this to two miles per day. I have bad knees and lymphodema in one leg so walking does tend to bother me depending on the day. I made quite a few different soups out of fresh vegetables and stopped eating potatoes and rice. No white bread whatsoever. Processed white flours raise havoc on sugar levels with me. Within three months of 1000 mg of Metformin 2x/ per day and eating healthy my A1C dropped down to 7.2 with averages being 160. We increased the metformin to 2000 mg taken twice per day. My doctor put me on Januvia, 50 mgs per day at first and then 100. He wanted to see my daily levels between 79 – 99. This worked. By the end of July my A1C was 5.6 and my daily average BS were 116. By September, 2017 I started to have low numbers in the range of low 70’s and 80’s. I started not feeling well with dizziness, headaches, tiredness and weakness. I had a couple of really low numbers in the 60’s and one that read 51. I found I had to eat more inbetween meals just to get the numbers in the 80’s. I could not get in to see my doctor so I wrote him and sent a copy of my numbers. I asked that I be taken off the 100mg of Januvia and he agreed. It has been 2 weeks. The numbers have been in the higher 80’s and at most 105 but mostly in the first set of numbers. I feel so much better. I believe that everyone’s chemistry is different along with how their livers and pancreas functions. Doctors can give us a generalization of what to do but they have problems pin pointing how to control the sugars. My triglycerides have decreased by 2/3 and my good HDL increased by 5. I eat Greek Yogurt, lots of carrots roasted and seasoned, strawberries and berries as mentioned earlier. Chicken, Fish (cooked any way except don’t eat the skin and the breading), hamburger, eggs, cabbage, celery, tomatoes, cottage cheese, cheese, sauces without sugar such as spaghetti sauce. I stay away from noodles of any kind. If I want to treat myself I do occasionally eat 28 Chili Cheese fritos with sour cream. I know this sounds bad but if we eat the same amount of carbs as protein the sugars will stay stable. I do know that the simple carbs are my worse enemy. I have lost a total of 60 lbs in less than a year and I am full. The plain Greek yogurt can be mixed with truivia, stuivia, cocoa, hazelnut flavoring, and berries. Once in a while I throw some puffed wheat cereal as a topping, but only if I know it will be a while before my next meal. The highest my fasting blood sugar has been since stopping the Januvia is 105 but is now usually in the 94-99 range and stays throughout the day. If you want to really keep your sugars level break up your meals and eat about 4 small portions throughout the day. You might be amazed. Stress will also cause sugars to go up so once in a while after you get your numbers down don’t be surprised if they raise up once in a while. My cholesterol is also down from 235 to 151. Just don’t give up and experiment with your body. Your body is the best medical advisor out there when it comes to Diabetes. Listen to it.

    Please keep in mind that I am not a medical doctor or a nurse, but I have found what works with me by experiementing with myself. Keep in mind there are carbs in generally everything we eat, but know the difference between simple carbs (which get stored) and complex carbs (which are used up quickly).

    Good luck to you and please take care of yourself.


  • Syed Waqar

    I am 57 and my father and his all develop diabetes in their middle ages all started with type II. So I am very much familiar with this disease. I find new information from your above article related to diabetes specially about the Metformin and its line of action. I just started Metformin 25 mg three times a day and check blood sugar level 6 times a day. Before breakfast and after 2 hours. Same is with lunch and dinner. I realize that my blood sugar level has increased by 25% after this Medicine. Then i quit that medicine and test my sugar levels, i tested that my sugar levels dropped 25%. May be I am taking very less grams. Now I will again started with little high dosage and looking for new blood sugar level tables. In some lace it is stated that in future Metformin will be used to increased the life of human cells.

    I lann to take like 500 mg 1.5 hours before the breakfast and then 25o mg during lunch and 25o before going to sleep because it also effect on kidney so in day time I can take lanty of water but night time less water means less flushing of kidney and less movements. As kidney is a filter and will choke if not shake well foreign agents may seated inside the kidney. Lets see how it works with slight increase of Metformin level in the body.

    lease guide me if i am wrong somewhere.

    Waiting for your rely.


    • Syed, I’m not sure this is a good plan. Metformin doesn’t prevent after-meal sugar spikes. It’s more for keeping the liver from producing sugar during times of less food, like at night. Some people do take four or five doses a day, so this may work for you. As long as you keep checking your sugars to see if it’s working, you can try different things. Let your doctor know what’s going on, and let us know how this goes.

  • Josselyn Sery

    What you shared in this article is very interesting. Thank you. Should I consider what you say about Metformin the same way as for berberine. I don’t take Metformin but berberine. Does it work the same way and take it four to five times per day? Thanks for your precious advises.

  • James

    I was diagnosed with type II in Feb, 2017 I had a AIc level of 11.5 , I had a sore on my toe and had a sensitivity to light, an eye doctor said I had glaucoma. I was prescribed 1000 mg of Metformin to take twice a day with food breakfast and diner. Prior to this diagnoses I drank 10 cans of soda per day ate 5 candy bars ate fast food a McGriddle in the morning 2 cheese burgers at lunch an apple pie a chocolate shake then a few more snakes from a gas station then when I got home for the day I would drink 5 more sodas and eat hungry man meals eggs cookies and what ever else I could eat I did this for 40+ years and now I had Diabetes first thing I did when they said I was going to die is I stopped everything cold turkey and took the medications prescribed my vision took a turn for the worst I sat in dark rooms with dark sunglasses on I became bitter and would growl at my wife she kept asking me about what I eaten and I would protest the question she kept trying to get me to eat but I wouldn’t I was going out of my head I couldn’t think
    straight but I had a ebay account selling items and I managed to fill the orders and read from the computer but I also discovered my eyesight would come back at times so I could not understand the diagnoses of glaucoma and looke on line for answers I was sure the doctors did not know everything and one thing stood out I had stopped drinking the sodas cold turkey and now I see that diabetes robes your body of water , your kidneys and eyes and I didn’t replace all that water that had been in those sodas so now I began drinking waters at the same rate as I had been drinking sodas so here is what happened next my vision cleared up the sensitivity to light is gone my sores are down to only one toe now and my A1C is now 6.0 my doctor was stunned by these results and was asking me what I did because she had never seen results like this before. Water seems to be the mighty powerful remedy here nearly resolving all my issues I still take the Metformin but I usually test my glucose first most mornings I wake up with a reading of 105 but I too have been taking my PM dose later in the evening and lately I wake up with a reading of 81 so I’m waiting to take that metformin until I’m up about 115 I think my dosage is too high so I bought a pill cutter to make this a 500 mg dose instead I think I’m ok so long as I monitor this and can always take the other half I keep that with me in an empty test strip vial I can’t say for sure but I think since I’m at pre diabetic levels I probably am pre diabetic now. I may have just been saturated with un healthy levels for so long that now my body has caught up now , my doctor will have the finale say but I’m no longer on deaths door and I got all my limbs so thus so far so good WATER!

    • Thank you for sharing your story, James. Your lifetime diet is actually the most unhealthy diet I’ve ever heard of, but you are recovering from it! Congratulations! Please ask your doctor about cutting your dose, because metformin rarely causes low blood sugars unless you don’t eat. 81 in the morning is not too low. Glad you’re doing so well.

  • Robert

    A week ago i diagnosed with Type 2 Diabetes after going to the Urgent Care, the wife took me in because I had severe abdominal pain and upper back pain and pain my right shoulder. UC found the high blood sugar and ordered an Ultrasound for my kidneys, liver & gallbladder.
    The Ultrasound results came back and I also had “Fatty Liver” disease so my liver is a warehouse of sugar & fat all the bad stuff, Urgent Care prescribed Metformin twice a day 500mg dosage and informed me I needed to change my diet now! I am 62 year old male 6′ tall 190 lbs…minimal fat in decent shape. (not obese).
    I want to repair my enlarged fatty liver condition asap…..I will eat all of the fruits, nuts, vegetables & fish that need to along with cutting out the pop, gatorade & beer.
    My question is, after researching a 600 calorie per day strict diet with exercise is said to repair the fatty liver & pancreas is this true??
    I want to get my liver back to a 100% if possible ASAP and I do not want to be on Metformin for life if that is possible by controlling my diet….how can I best repair my liver?? HELP.

    • Robert, this sounds like you should see your personal medical provider to supervise your healing plans. This is not something you need to do ASAP, or now. You need to find out more about your body and what works for you. Check your blood sugars at various times and after various foods and see what makes it go up and down. In studies, a 600-calorie diet has gotten the fat out of people’s liver and pancreas, but that is a very strict diet and I would like you to be monitored while you’re doing it, if you try. And nobody knows how long the benefits of such a diet will last. Please try to relax about this; see what cutting out the pop, Gatorade and beer, and taking metformin do. Then, if needed, try something else.