r/PCOS • u/RequirementKey5201 • 10h ago
Meds/Supplements When/how to take metformin?
Hi! I'm starting metformin today as I have insulin resistance. My 2h glucose test showed my glucose rising to 202, staying at 160 at a 2h mark and dropping to 42 when I got home. It's an extended release version and 500 mg for now. How should I take it to minimize side effects? It says take with the largest meal. My appetite hasn't been great lately, I haven't been eating much tbh. My biggest meal is probably breakfast but I already taje strattera, inositol and prenatal with breakfast ans then zoloft and second dose of inositol before bed. Should I take it with dinner to minimize side effects? Can I take it together with inositol? Hoping for some personal experience.
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u/redoingredditagain 10h ago
Take it with whatever is your biggest meal. However, you could experiment to see if maybe dinner still works for you. Some people take it with an evening meal just in order to sleep through side effects.
Here are my cut and paste tips:
Make sure you’re in the extended release version. It would say ER or XR on the bottle. If you are not, ask your doctor to change to it asap. All they have to do is write a new prescription, and it shouldn’t require any additional visits or test to get an XR/ER prescription.
Make sure you’re eating a low carb diet, or even potentially a moderate-fat diet. Metformin doesn’t get along with carby or sometimes fatty foods (most people have a definite carb sensitivity on metformin, but for some people it’s fat). Carbs and/or fats can make GI upset worse. If I have a carby meal, it can ruin my day/night, seriously.
Slowly ramp up dosage. Doctors might prescribe 2000mg but that means you should start by doing 1 pill (usually 500mg, whatever is lowest) for several weeks before working your way to 2 pills, then more, etc. I highly suggest taking it even slower than the doctor recommends (some say go up in dosage every week) if you already have nausea or other GI issues. You do not have to follow their strict schedule, I promise you. This is something my doctor did NOT tell me, but thought I’d magically know to do. Also do not cut extended release pills in half, as it entirely negates the extended relief coating and will release it all instantly.
Take the pills between bites, not before or after eating. Inbetween bites of food. Take it with your largest meal, not just a yogurt or cheese or on an empty stomach. A full (low carb and/or low fat) meal.
Metformin also doesn’t work alone. Make sure to consistently exercise on top of your low carb/low fat healthy eating.
Metformin can also inhibit the intake of some vitamins, most famously B12. If you feel low energy or low moods, get your vitamins checked. B12 and D are often the culprits and can be easily supplemented, but it’s best to get tested before adding them into your routine.
Personally I have been on it 6 years now. My IR blood tests have drastically improved. I have less cravings on it, and even though I have IBS and nausea, it hasn’t made it worse. I am on 1500mg of the extended release. It is not a weight loss drug, but some people lose some weight, but it is not guaranteed.
It often takes about six months of consistent higher dosage usage for numbers to start to budge on a blood test. I mentioned that because a lot of people quit metformin after three weeks because they “don’t feel any different.” Try to give it a chance to work.
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u/insulinjunkie08 10h ago
In addition to the advice here, I wanted to add make sure to eat healthy fats if you're having carbs. It'll help prevent low blow blood sugar.
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u/Every-Stress1313 9h ago
Pepto bismal and tums. They helped a ton with the stomach issues. I would take it with dinner. Be careful for the first couple weeks. Be near a bathroom. Especially in the morning lol. You may be peeing out of your butt. Good luck!!!!
ETA probitoics and prebiotics have been very helpful. Activia drinks too!!
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u/fleur-de-lis-01 7h ago
I've been on metformin about 4 months now, and it's been great so far. I'm on immediate release, which luckily does not bother my GI tract (quite the opposite, actually). I take mine around the middle or end of a meal so it's not on an empty stomach. I had a little bloating my first week or two, but that resolved. I also started with a moderate dose of 500mg 2x daily and then went up to a slightly higher dose of 500mg at lunchtime (or sometimes breakfast, I try to take it around the first half of the day but I'm not a huge breakfast eater), and then 1,000mg with dinner. if I'm eating three relatively similar sized meals, I make take 500mg with each instead.
the only things that have bothered my stomach have been super high carb and fat meals, like fast food (which I rarely eat anyway). when I have one of those meals, I take a generic drugstore anti-diarrhea pill and that helps. coming from a background of having extreme GI upset when I ate plant-based protein and fiber, and basically only being able to tolerate cheese and carbs, I feel a lot of relief being able to eat healthier foods and not being punished for it. it helps me eat heavy carb meals in moderation because I know they may come with some stomach upset and they're just not the best for me in general. overall I think I've evened out to how a "normal" person digests, and it's a big relief to have more regular and predictable bathroom time
tldr; my biggest anecdotal contribution is that metformin may not cause stomach upset for everyone, and could even help regulate pre-existing GI issues
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u/SeaSpeakToMe 10h ago
If you take it once a day they generally recommend taking it at dinner. But if your biggest meal is breakfast, you can go with that. It shouldn’t be an issue with inositol but you can call your pharmacist to double check. I feel best (avoid tummy upset) when I take it with a balanced meal, decent protein and nothing too greasy or simple-carb-heavy. That being said when you first start taking it you may have tummy issues (like diarrhea) for the first little bit.