Metformin is one of the most widely used diabetes medicines in the world: inexpensive, well studied and good for lowering A1C. Its most common problem is the stomach. Diarrhea, cramping, nausea and gas affect many people when they start. The good news is that most people can stay on it with a few changes, and good alternatives exist for those who cannot.
Ways to make metformin easier on your stomach
- Start low and go slow. Increasing the dose gradually over weeks lets your gut adjust.
- Take it with food, in the middle or at the end of a meal.
- Ask about extended-release metformin, which releases the medicine slowly and causes far fewer stomach problems for many people.
- Watch your timing. With extended-release metformin, taking the full dose with the evening meal works well for some people.
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When metformin is still not tolerated
If stomach side effects continue, several other medicine families lower A1C, and the right choice depends on your heart, kidneys and weight:
- GLP-1 medications such as semaglutide (Ozempic) and dulaglutide (Trulicity), which also help with weight and lower heart risk
- SGLT2 inhibitors such as empagliflozin (Jardiance) and dapagliflozin (Farxiga), which protect the heart and kidneys
- DPP-4 inhibitors such as sitagliptin (Januvia), which are gentle on weight and the stomach
Current diabetes guidelines recommend a GLP-1 or SGLT2 medicine for people with heart disease, heart failure or kidney disease, whatever their A1C, so for some people the "next" medicine is really the best first one.
A long-term check worth asking about
Years of metformin can lower vitamin B12, so periodic B12 checks are recommended, especially if you notice numbness, tingling or tiredness.
Get help from Hope Integrative Medicine
If metformin is not working for you, we can review your A1C, your heart and kidney health, and the options that fit. Our primary care team in West Ashley sees patients in person and by telehealth across South Carolina, and new patients are often able to be scheduled within a week of requesting an appointment. Request an appointment.
This article is general health information and does not replace advice from your own provider. Never start, stop or change a medication without talking with your prescriber.
Frequently Asked Questions
For many people, yes. Stomach side effects are usually worst in the first weeks and after dose increases. Taking it with food, increasing slowly and switching to extended-release often solves the problem.
Yes. Metformin ER releases the medicine slowly and causes fewer stomach problems for many people who could not tolerate the immediate-release form.
Alternatives include GLP-1 medications such as Ozempic or Trulicity, SGLT2 inhibitors such as Jardiance or Farxiga, and DPP-4 inhibitors such as Januvia. The best choice depends on your heart, kidneys and weight.