New to metformin and feeling awful? What it is actually doing

New to metformin and feeling awful? What it is actually doing

It probably is working, which is exactly why it is so easy to miss what it is not fixing, and what it is quietly costing you.

I left the hospital with a bag of medication and a piece of paper telling me when to take each one. I was in a different country, and the language barrier meant only certain people could talk to me or translate, so nobody actually told me what any of it was for. There were six heart and diabetes medications in that bag, and I had to use Google Translate and figure them out myself. I had never taken medication in my life, not even over the counter, so my whole world was upside down.

If you are a few days into metformin, feeling worse than before you started, and quietly wondering whether it is even working, I want to talk to you from the other side of it. Not as a doctor, but as someone who was where you are, and then spent the next few years actually understanding what was going on.

The first weeks are a bit of a blur

I was going through a lot after the heart attack, and the diabetes medications like metformin were masked by all of my cardiovascular recovery. It was like a big tangled ball of yarn I had to undo, so a lot of what I can tell you here is in retrospect, from going back and looking at it later. My symptoms might be yours, or some of yours, or none of them, and that is worth saying up front.

It is a bit of a blur for me at times, partly because it is hard to relive. In reflection, part of it was dizziness and part of it was my stomach acting up, and that was my body adjusting to the medications, or the withdrawal from them. Feeling rough in the early stretch is common, and it does not automatically mean the drug is failing you. It usually means your body is adjusting, though it can also be something else that almost nobody checks, and I will come back to that.

It worked, and that was never really the question

I monitored my blood sugar closely in those early weeks. They had given me a logbook from the hospital, and after every finger prick I would write the number down, several times a day. Over time the numbers came down and steadied, because metformin was doing its job.

What I notice looking back is what did not happen next. My blood sugar stayed well under control for a year's worth of tracking, and whenever I went in to refill the prescription, no one ever thought about reducing it. The number looked handled, so it was left alone, and I left it alone too, until I got curious. That gap, between a number being controlled and the problem being solved, is where the whole story lives, so let me show you what metformin is actually doing, in plain terms.

Two taps, and the drug only turns one of them down

Picture the sugar in your blood as coming from two taps that are both running. One tap is what you put in your mouth, the food that feeds the glucose in your bloodstream. The other tap is your own liver, which quietly produces glucose on its own. Metformin turns the liver's tap down, so your body makes less of its own sugar and the number on your meter comes down.

But all you have really done is turn off one tap. The food is still coming in through the other one, and if your insulin resistance is high, which is the reason you are on the drug in the first place, the doors into your cells are closed, so that sugar has nowhere to go. Metformin lowered the number without touching why the number was high. It is masking the problem, not fixing it.

Here is the part that took me a while to connect. The extra sugar you keep taking in does not just sit in your bloodstream, because your liver holds onto the overflow and turns it into fat. You can end up with a good glucose reading on paper while your liver quietly fills up, and there are almost no symptoms for that until it is well along. The drug did not cause it. The drug just made the number look good enough that it was easy to stop asking the harder question.

What it quietly pulls out of you

There is also the matter of what the drug draws out of you. Once I finally went looking at my own lab work, I learned that metformin carries a nutrient cost, and the one tied most directly to it is vitamin B12. As it happened, I was already taking a B-complex, which covers B12, more by luck than by any plan of mine, but if you are not, that is worth testing and knowing early rather than waiting until you feel it.

Beyond B12, I would look at vitamin D3 and magnesium, ideally with K2 alongside the D3. These are not strictly a metformin depletion, and I want to be honest about that, but the reason you are on metformin is that you have insulin resistance, and that means metabolic dysfunction, and D3 and magnesium are foundational for anyone in that situation. Magnesium in particular gets used up easily, because so much of the body depends on it, and most of us are low on D3 regardless, because we simply do not get enough sun anymore.

Put those two things together, because this is what I really want you to hear. If your nutrient levels were already low from the rest of your life, and the drug quietly pulls a little more from that same pool, you start feeling worse, and you blame the pills. Indirectly you are right, but you would never know it unless you checked your levels. That is why getting a baseline blood panel early is one of the most useful things you can do, because it turns feeling bad into information you can act on.

Why they call it "for life"

You have probably heard that metformin, and diabetes, are for life, and it is worth understanding that rather than fearing it. It is for life in the sense that the moment you stop taking it, your liver's tap opens right back up. If nothing else in your life has changed, your blood sugar climbs again and you are diabetic again. The drug was holding the number, not healing the cause, so of course you would need it for life if the plan is to change nothing else.

But that "if" is the whole door. For me it was not forever, because by changing the real inputs, the food, the movement, the things driving my insulin resistance, I was able to move my diabetes into remission and come off it. I say remission rather than cure because it holds for as long as you hold the changes, and the cure, if you want to call it that, was doing the right things in the first place and then keeping on doing them.

I want to be clear about this part. Going on metformin was the right call for the risk in front of me. It is a safe, well-studied drug that has been around a long time, and getting that dangerous glucose out of my blood was exactly what needed to happen at the time. I am not anti-medication, and I am not anti-doctor. The mistake is not taking the drug, it is stopping there and treating the drug as the finish line, instead of the thing that buys you time to go and do the real work.

If you are a few days in and feeling terrible

The first thing I would do is prove to yourself it is working. Do your finger pricks and write the numbers down the way I did in that logbook, because watching them come down over a few days is how you know the drug is holding up its end, even on the days you feel rough, and that alone takes some of the fear out of it.

You may also have to push through some of the early adjustment while your body meets something new, and for most people that part settles. While you are at it, use the moment to get your bloodwork done and get a baseline on your minerals and vitamins. If you are not already taking vitamin D3, K2, and magnesium, those are worth getting on sooner rather than later, because those levels tend to drift low whether you are on a drug or not, and it is worth knowing your B12.

And hold onto this. Feeling awful right now is not proof that you are broken, or that this is your life now. It is the front end of an adjustment, and very often it is a nutrient story hiding underneath a medication story, and you will get through to the other side of it if you take action.

The one reframe to keep

Metformin working and your problem being solved are two different things. The number coming down is real, and it is good, and it is worth having, but it is the beginning of the conversation with your body, not the end of it. The drug quiets the alarm, and what you do with the quiet is where the actual healing happens. Start with the log and the bloodwork this week, get curious about both taps instead of just the one, and let the number be a signal rather than a verdict. If you want the whole way I think about this, it is in the ebook.

~ Foster