Should I Take Metformin With Food?
I have been taking 500 mg of metformin on an empty stomach since being diagnosed with type 2 diabetes in 2000. A nurse recently told me that metformin doesn’t work without food. Although the medication label says “Take medication with food” as well as “Do not drink alcoholic beverages while taking this medication,” I thought these statements were for people with sensitive stomachs and that women could have one alcoholic beverage per day. What is your professional opinion? Linda Friend, Mobile, Alabama
Roger P. Austin, MS, RPh, CDE, responds:
Metformin is one of the most effective oral medications used in the treatment of type 2 diabetes. It is the preferred initial treatment at the time of diagnosis and can be used virtually throughout the lifetime of a person with type 2, so long as kidney function is routinely monitored.
What to Know
Metformin works by reducing the liver’s overproduction of glucose, which is one of the characteristics of type 2 diabetes. It also appears to improve the sensitivity of the liver and muscles to the action of insulin (reduces insulin resistance). Metformin is generally recommended to be taken with meals, because food appears to increase its absorption in the stomach.
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Alcohol use can cause blood glucose to fall too quickly in people with diabetes and may result in hypoglycemia (low blood glucose). Given that metformin lowers blood glucose, the combination of alcohol and metformin could increase the potential for low blood glucose events. The combination of metformin with alcohol may also increase the potential for lactic acidosis, a buildup of lactic acid in the body that develops when cells burn glucose for energy without enough oxygen. This rare but extremely serious complication is more likely to occur in people who binge drink and also take metformin.
The American Diabetes Association recommends that people with diabetes be cautious when consuming alcohol. The recommendation is that alcohol always be consumed with food and that quantities be limited, as you note (no more than one drink per day for women and two for men). Taking metformin with food and limiting alcohol are both prudent steps to take in managing your type 2 diabetes.