Making Metformin Easier on Your Stomach
Based on American Diabetes Association, 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes, 2026
Simple ways to make metformin easier on your stomach, including extended-release, and the alternatives for lowering A1C when metformin is not tolerated.
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In this guide
Gentler on the Gut
- Start low and go slow
- Take it with a meal
- Ask about extended-release
If It Is Still Not Tolerated
- GLP-1s such as Ozempic or Trulicity
- SGLT2s such as Jardiance or Farxiga
- DPP-4s such as Januvia
Ask at Your Next Visit
- Which option fits my heart and kidneys?
- Do I need a B12 check?
- Does my weight change the choice?
What the guideline says
- Metformin is inexpensive, well studied and good for lowering A1C, but diarrhea, cramping, nausea and gas affect many people when they start.
- Starting low and increasing the dose gradually over weeks lets your gut adjust, and taking metformin with food, in the middle or at the end of a meal, also helps.
- Extended-release metformin releases the medicine slowly and causes far fewer stomach problems for many people.
- If stomach side effects continue, GLP-1 medicines, SGLT2 inhibitors and DPP-4 inhibitors also lower A1C, and the right choice depends on your heart, kidneys and weight.
- Current diabetes guidelines recommend a GLP-1 or SGLT2 medicine for people with heart disease, heart failure or kidney disease, whatever their A1C.
- Years of metformin can lower vitamin B12, so periodic B12 checks are recommended.
Read the full article: Metformin Upsetting Your Stomach? How to Fix It and What to Try Instead →
This guide is general health information and does not replace advice from your own provider.
Frequently Asked Questions
Current diabetes guidelines recommend a GLP-1 or SGLT2 medicine for people with heart disease, heart failure or kidney disease, whatever their A1C. For them, the next medicine may really be the right first one.
Numbness, tingling or tiredness are reasons to ask about a B12 check if you have taken metformin for years.
GLP-1 medicines such as semaglutide, sold as Ozempic, and dulaglutide, sold as Trulicity, also help with weight and lower heart risk.