How to Navigate Metformin Side Effects

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Hi there and welcome back to another episode of the Diabetes Digital Podcast.

Today we’re tackling a common topic for people who are newly diagnosed with type 2 diabetes.

This is something that always comes up.

Not always, but often comes up with patients and it is how do they navigate some of the side effects of metformin when they first start.

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Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

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Visit diabetesdigital.co that’s CEO, to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

So for those of you who are not sure what metformin is, let’s start by discussing it.

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So metformin is an oral medication that belongs to a class of drugs called biguanides, and it works in the body by improving your insulin response.

It also reduces the amount of sugar produced by the liver, and it increases the uptake of glucose by the muscle cells.

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So it does 3 amazing things, and it’s a medication that’s been around for a really long time.

It’s safe most people and that’s why it’s often prescribed as a first line treatment for type 2 diabetes due to its effectiveness in lowering blood glucose levels.

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And like I said, it’s low risk of causing hypoglycemia or low blood sugar.

Now before we jump in to how you can navigate the side effects of metformin, I’m going to read a listener review.

And by the way, for those of you who love to review, thank you so much.

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This review is from La Kimchi and they write finally a weight inclusive approach for diabetes.

Such great conversations, easy to digest information and outstanding dietitians.

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Drop us some stars.

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Love that name.

La Kimchi.

That’s one of the best ones I’ve heard so far.

Very creative.

So Matt Foreman, I think for most people it’s pretty well tolerated.

But side effects are something that I come across often with talking to patients who start off on metformin especially because what I have seen is that with time the side effects tend to go away, which is the case for a lot of these diabetes medications.

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For some people they don’t and that’s when you want to talk to your provider.

But in the beginning, it’s very common, you know, to experience side effects.

And with metformin, a lot of those side effects are going to affect your gastrointestinal system.

So you might have diarrhea, you might have stomach aches.

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It could affect your appetite when maybe you’re not as hungry anymore.

Some people report having a metallic taste in their mouth.

And like I said, although a lot of these side effects can be mild and temporary, for some people, they are severe, they’re persistent, they’re not going away.

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So it’s a conversation that you want to have with your provider.

And today, we’re going to talk about what you can do about the side effects, like things that are going to be helpful so that you feel a little bit better when taking this medication.

And just one quick note about blood sugar.

3:37
So I had mentioned that the reason why metformin is considered safe or one of the reasons is it typically doesn’t cause low blood sugar, with one caveat being that metformin taken by itself usually doesn’t cause low blood sugar or hypoglycemia.

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However, when you are taking metformin with other diabetes medications such as insulin or glipizide, you might experience low blood sugar.

And for those who maybe aren’t familiar or are taking another Med and kind of want to be on the lookout if they’re adding metformin to their treatment plan, you want to keep an eye out for feeling excessively hungry, trembling or shaking, sweating, confused, and even difficulty concentrating.

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And those are all symptoms for people of low blood sugar.

And you should take action when that happens.

We have a whole podcast episode about what to do when you have low blood sugar.

We’re going to include that in the show notes.

But that has some really great tips, yeah.

So if you’re experiencing some of the side effects that I mentioned, typically the duration of them could be anywhere from a few days to a few weeks.

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Typically, for people that experience side effects, side effects, they vary from person to person.

So you could have someone that has diarrhea while you have another person that’s having a metallic taste in their mouth, you know, It just really depends on what your unique reaction is to the medication and you might not experience any side effects at all.

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And I mean, that is the ideal situation.

Now if your side effects are more on the severe side or you’re noticing that they’re not going away, the good news is that there’s a long list of diabetes medications.

So metformin might not be the right fit for you.

If you’re noticing that, you know, this is not really getting better.

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You know, I’ve had patients where it’s just so intense and so severe from the start that they’re like I literally cannot take, I can’t take this medication another day.

And again, there’s like just different classes of medications that might be a better fit for you.

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And so, you know, it’s good to have that conversation just so that you can explore.

OK, well, if metformin the right fit, then maybe, you know, you could do a GOP one or you could do something like a glipizide or even insulin.

You know it’s all individualized based on what your body takes to the best. 100% OK, so let’s get into some of the helpful strategies that you can do when you’re taking Metformin.

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They can kind of help with the side effects.

So first and foremost, and your doctor and pharmacist may have already recommended this, maybe they haven’t, but that is take it with food.

So this is a way to reduce the gastrointestinal side effects, also known as GI side effects, like Wendy said, nausea, upset stomach, vomiting, things like that.

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So taking it with meals can help buffer the effects of metformin on the stomach and lessen the likelihood of experiencing those things.

You can take it with a meal, breakfast, lunch or dinner depending upon the timing that your doctor wants you to take your medication or with a snack, and that often will be enough to help mitigate some of those side effects.

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The second thing that we recommend is start low and go slow.

So if you’re just starting metformin or you recently have had your dose increased, your healthcare provider may recommend starting with a low dose and gradually increasing over time.

And the reason they recommend this is because this approach allows your body to adjust to the medication more slowly and reduce the severity of the side effects.

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Because as Wendy mentioned, typically with time people become accustomed to the medication and the side effects are no longer there or no longer bothering them.

So if you can start low and go slow, that might give you enough time to not even have the side effects in the first place.

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Now the third recommendation is to stay hydrated.

Especially if metformin is causing things like diarrhea.

You want to make sure that you’re drinking plenty of water throughout the day, and hopefully the diarrhea will resolve with time.

But drinking enough water is going to help you avoid dehydration, and I know that people often time, and I do this myself, they’ll often times drink a ton of water at once, right?

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Like you have 5 cups in the morning and then like 5 cups in the afternoon.

But it’s best to take small, frequent sips of water to avoid dehydration because that gives your body like time to absorb the water so you don’t just end up peeing it all out.

And if you are curious about your hydration status, we have an amazing podcast episode.

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This is one of our most popular podcast episodes ever, and it’s how to use your urine to indicate your hydration status.

Cliff Notes answer is light lemonade is well hydrated.

So if your urine is the color of light lemonade that is the color that you want.

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You don’t want it to be clear, and you don’t want it to be dark like the color of tea.

So we’re gonna include that episode in the show notes, and we’ll also include some articles we’ve written about ways to stay hydrated that are a little more exciting than just drinking water.

Because we know that for many people, including myself, water can get real old real fast.

8:47
Yep, and I also wanted to mention that there is an XR version of metformin.

So there’s standard metformin and then XR is Extended Release and with this variation it’s designed to break down slower and so you might experience less of those side effects compared to the immediate release.

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So you can talk to your doctor and you know, ask them, is the Extended release an option for me?

Can I see how my body reacts to that to see if that might be a better fit?

If you are going, as just mentioned, to start low and go slow, just make sure you have clearance from your healthcare provider.

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Because I’ve seen so many people adjusting their own medications where they’re like you know, like breaking their pill in half or they’re just like kind of cutting their dose in half.

And you just want to make sure that your provider knows what is going on.

Because again, there might be better alternatives for you and you might experience some adverse effects if you’re, you know, just kind of doing things on your own.

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So just make sure that you’re always keeping your care team aware of what is happening.

Absolutely.

And now let’s talk about the metallic taste.

And honestly, this can happen with many medications.

I know that I’ve taken meds and had that metallic taste, and I hate having that metallic taste in my mouth.

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I will say that with metformin specifically, that taste should subside after a few weeks again once your body adjusts to the medication.

Now if it doesn’t improve, you definitely want to check in with your doctor and see if there’s any adjustments that you should make.

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But I would say, like you know, maybe give it a month or two to see if your body can adjust naturally.

And while you’re waiting for your body to adjust, there are some steps that you can take to help improve that metal taste immediately.

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So one option is to drink plenty of water.

Like we already said, this may help improve your dry mouth and lessen that metal metallic taste.

You can also try chewing sugarless gum that will have the same effect as well, like just adding more moisture to your mouth.

You can also try adding different herbs and spices to your food to help add additional flavor and maybe even overpower a little bit of that metallic taste.

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And for some people, eating their food cold can be helpful, or having it at a lower temperature can help to make that metallic taste a little bit less amplified.

So that’s it.

Those are our tips for how to navigate metformin side effects.

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So #1, take it with food.

You want to start low and go slow.

Make sure to stay hydrated, especially with small, frequent sips of water to avoid dehydration.

As Wendy said.

Consider the metformin extended release.

That has been the thing that has worked the best for my patients in the past and it’s something that I will always typically recommend and then of course communicating with your healthcare provider to see if there’s anything else that can be done.

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Now if you are someone who has been diagnosed with diabetes, whether it’s type one, type 2, type 1.5, gestational, we are here to help.

We are a team of registered dietitians who focus on diabetes and pre diabetes.

We’re in 25 States and counting, and we also accept most major insurance plans.

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So if you want to sign up, head on over to our website.

It’s www.diabetesdigital.co and fill out our intake form and you can go ahead and book your dietitian from there.

Thank you so much for listening and we’ll see you guys next Wednesday.

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Bye, bye.

Thanks for joining us for today’s episode.

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