The Best Time to Take Metformin to Reduce Side Effects and Balance Blood Sugar Fast
Plus learn what to do if you accidentally miss a dose of the medication
Learning that you have prediabetes or type 2 diabetes can be overwhelming, even though both conditions are extremely common. The CDC notes that over 38 million adults in the United States have diabetes, and most cases fall into the type 2 category. And about 98 million people have prediabetes, meaning their A1C level (an indication of average glucose levels over the last couple of months) is elevated but not yet in the diabetes range. Lifestyle changes can play a big role in managing blood sugar, but many people are also prescribed medication such as metformin. If you’re taking the med for the first time, you may already be wondering about the best time to take metformin. We asked experts to explain how the right timing can minimize unwanted side effects and maximize your results.
What is metformin?
“Metformin is an oral medication used to treat type 2 diabetes and also prediabetes,” says Frank Dumont, MD, Executive Medical Director at Virta Health. “It is one of our older and most commonly used medications for type 2 diabetes, considering its relative safety.”
The drug essentially helps the body use insulin more effectively, says Jeffrey Chester, DO, medical director at The Ohana. “Insulin is a hormone. It helps move sugar from the bloodstream to the cells.” Dr. Dumont notes that metformin also signals the liver to produce and release less glucose, which helps keep blood sugar in a healthy range.
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More recently, metformin tablets are being prescribed off-label to help with weight loss and health conditions such as polycystic ovary syndrome (PCOS) as well.
The 2 main types of metformin
People tend to talk about metformin as one medication, but there are several different forms of the drug used to treat high blood sugar.
“Metformin is available in an immediate release (IR) form, where the medication is more quickly absorbed into the bloodstream and also goes away more quickly, and also in a number of extended release (ER) formulations, where the medication is more slowly released within the gut and more slowly taken up into the bloodstream,” says Dr. Dumont.
The different metformin versions have different dosing schedules. “The immediate release version needs to be taken two times per day for most people in order to keep the medication at a good level throughout the day and night. But the extended release versions only need to be taken once per day,” says Dr. Dumont.
The best time to take metformin depends on the type
Dr. Dumont says the best time to take metformin depends on whether you’re prescribed the IR or ER version. He breaks down how the daily dosing differs between the two:
Best time to take metformin IR (immediate release)
Because IR metformin is taken twice a day, the goal is to space the doses so blood levels in the body stay steady. Ideally, that means taking your two doses for the day about 12 hours apart. But because IR can be hard on the stomach, many people end up taking it with food instead of sticking to an exact 12-hour schedule.
“Most people take the IR version with breakfast and again with dinner,” says Dr. Dumont. “Taking metformin IR with [those two meals] can help to lessen the gut side effects.”
Best time to take metformin ER (extended release)
“The situation with the ER version is a bit different,” Dr. Dumon explains. “Since metformin ER tends to cause fewer gut side effects, it is less important to take it with food in order to avoid side effects. That said, metformin ER is better absorbed when it is taken with a meal. Since the evening meal is generally larger, a lot of patients take the ER version with dinner.”
Dr. Dumont also says some people prefer timing their dose of metformin extended-release tablets as a way to lessen symptoms. “With the ER version, although taking it with a meal is less important than it is for the IR version, it still might help to decrease side effects,” he notes. “Some individuals preferentially take the metformin ER at night so they can sleep through mild side effects rather than being troubled with them during the day.”
Consistency is key
Dr. Dumont adds that the most important factor (regardless of what type of metformin you take) is consistency: taking metformin with a meal and choosing the same meal or meals every day, whether that’s breakfast, lunch or dinner.
And what happens if you accidentally miss a dose? Take it as soon as you can, unless it’s close to the time for your next pill. In that case, skip the missed dose and just continue with your normal schedule.
Which type of metformin should you take?
Talking to your doctor or a healthcare professional is the best way to determine which type of metformin is right for you. Dr. Dumont says a few key factors that may influence that decision are side effects and dosing.
Metformin ER causes fewer gut side effects because it’s released more slowly into the gut, making it a good choice for someone worried about irritation. And if fitting a medication you need to take more than once a day into your routine feels inconvenient, the ER version may be a better fit.
Metformin side effects to watch for
Dr. Dumont says that most people who take metformin can tolerate it well, especially when they start with a lower dose and increase it gradually. Still, some people will notice side effects. He says the most common side effects of metformin have to do with irritation in the gut and can include:
- Bloating
- Diarrhea
- Gas
- Nausea
- Stomach discomfort or pain
- Vomiting
He adds that metformin can also lead to a vitamin B12 deficiency, which is why doctors often suggest taking a vitamin B12 supplement if you’re on metformin. If you’re concerned about these side effects or already experiencing them, taking your metformin at the right time as noted above can help minimize GI upset. (Read here for the signs that metformin is working.)
Small timing tweaks can make a big difference
By working with your doctor to find the right type of metformin and timing for your needs, you’re taking an active role in your health. And that’s something to feel good about.
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