6 Signs Metformin Is Working to Balance Your Blood Sugar and Boost Weight Loss
Plus find out how to manage uncomfortable side effects
Metformin, an oral medication used to treat type 2 diabetes, is often prescribed off-label for weight loss. It helps to control blood sugar by reducing both the amount of glucose produced by the liver and the amount of glucose absorbed by the gut. Over time, that can lead to improved insulin sensitivity, gradual weight loss and a lower risk of long-term diabetes complications. But what are the signs metformin is working?
It turns out the benefits can be subtle at first, and the gradual changes may be harder to spot. We asked a doctor what to watch for, plus what you can do if the diabetes medication isn’t delivering the results you’d hoped for.
6 signs metformin is working
Whether you’re taking metformin for weight loss, diabetes management or both, it can take time to kick in. Here’s how to know if it’s actually working.
Woman's World Answers
1. You’re not hungry all the time
Feeling less snackish than usual? That can be one of the telltale signs metformin is working. Metformin helps to keep your appetite in check, although researchers are still trying to determine why it’s effective.
“The exact mechanism of how metformin suppresses appetite is unknown,” says Desiree Granados, MD, an integrative medicine and medical weight loss specialist with The Sanctuary Wellness Institute. One theory is that metformin boosts insulin sensitivity, so your body uses glucose more efficiently.
Metformin also increases secretion of GLP-1, a natural hormone that helps to regulate appetite. (Weight loss drugs like Wegovy and Zepbound work by mimicking this hormone.) Side effects like nausea and acid reflux may also cause people to eat less, Dr. Granados adds.
2. Your clothes feel looser
While metformin doesn’t cause the same rapid weight loss as Ozempic or Wegovy, you may notice the number on the scale gradually going down. “Weight loss with metformin is modest and slow,” Dr. Granados says. “Expect to lose half a pound per week.”
But over time, that adds up. People taking metformin typically lose at least 5 percent of their body weight in the first year of taking metformin, according to research published in the Annals of Internal Medicine. That translates to about 8 lbs for a 160-lb person.
3. You have more energy
Fatigue is a common symptom of insulin resistance, and it can be one of the earliest signs of diabetes in women. So, as metformin starts to stabilize your blood sugar and improve insulin sensitivity, an increase in your energy level may be one sign that it’s working.
“High blood sugar and fluctuating blood sugar can cause fatigue, so you might experience improved energy after getting your blood glucose levels under control with metformin,” Dr. Granados says.
4. Your fasting blood sugar improves
Shortly after metformin was FDA-approved in 1995, a study published in the New England Journal of Medicine found that metformin helped to lower fasting blood glucose by more than 20 percent. Participants who took metformin for 29 weeks had an average fasting blood glucose level of 189, compared to an average of 244 for the placebo group.
“People typically see improvements in blood glucose levels within the first week of starting metformin,” Dr. Granados notes. “Results vary based on your baseline blood glucose levels and how well you adhere to the medication.”
5. Your A1c starts to drop
The results of a “finger stick” glucose test can vary dramatically, as your blood sugar spikes and drops throughout the day. That’s why it’s also important to monitor your A1c levels if you’re diabetic.
When glucose builds up in your blood, some of it binds to the hemoglobin found in red blood cells. A hemoglobin A1c test measures what percentage of your hemoglobin is bound to glucose, which can help your doctor determine your average blood glucose levels over the past three months. Anything between 5.7-6.5 percent is considered prediabetes, and anything above 6.5 percent may indicate type 2 diabetes.
According to Johns Hopkins Medicine, people typically see their A1c drop by about 1.5 percent while taking metformin. “You can expect to see improvements in A1c after two to three months of using metformin,” Dr. Granados adds.
6. Your bloodwork gets better
As your blood sugar stabilizes, you should start to see other biomarkers improve, including cholesterol levels and markers for inflammation, Dr. Granados notes.
According to a review published in ACS Pharmacology & Translational Science, metformin may help to lower LDL cholesterol (the “bad” cholesterol), alleviate chronic inflammation and reduce the risk of cardiovascular disease and stroke in people with diabetes.
What to do if you think metformin is not working
First things first: If you’re dealing with side effects, that doesn’t mean metformin is not working. “Side effects like nausea and acid reflux are common,” Dr. Granados says. Eating low glycemic foods and avoiding high-fat meals can help to minimize any GI side effects, she adds.
Vitamin B12 deficiency is another common side effect of metformin. According to the American Diabetes Association, the amount in standard multivitamins may not be enough to fill the gap. Dr. Granados recommends taking a vitamin B12 supplement to help prevent deficiency.
You can also make healthy lifestyle changes like eating a balanced diet, staying hydrated, exercising regularly and getting enough sleep to help metformin work faster.
If you’re still not seeing positive changes, review the instructions on your prescription—and then reach out to your healthcare provider. “Double check whether you’ve been sticking to the prescribed dosage,” Dr. Granados says. “If you got that right, consult with your doctor” for other options that may be better fit.
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