What was your first week on Metformin like? Horrendous? Terrible? Filled with waves of nausea? The sickest you’ve felt in your life?
Let’s reminisce for a minute: About a dozen years ago, on December 24, I went to the doctor for a routine physical. Are you envious of my holiday plans? This was in the years before Pinterest, so I was carrying on with regular life activities on Christmas Eve morn rather than bedazzling the cap of an Elf on the Shelf. Anyway, at the Christmas Eve check-up, my physician mentioned that he had read promising things about Metformin being used in women with PCOS. We chatted about Metformin for a bit, talked about other PCOS things, finished up the tests, and then I headed to the pharmacy to pick up the prescription.
We had our traditional Christmas Eve dinner of ham, funeral potatoes, salad with asparagus and strawberries; rolls, and other delicious items. Breaking with tradition, this year’s Christmas Eve dinner was followed by Metformin for me. After dinner, we read the Christmas story from the Bible, watched a short film depicting the events in Luke 2, read a new Christmas book, and headed off to bed. That’s when the fun began. In sum: Worst Christmas Ever. Pros: Family, friends, gifts, good music, good food. Cons: Visiting the loo every 15 minutes, constant nausea, wanting to curl up in bed and not wake up for days.
Public Service Announcement: Do not start Metformin for the first time on the day prior to a major holiday.
My first year on Metformin was pretty rough. I felt like I had morning sickness every single day. I had diarrhea and nausea every morning. When I skipped a few doses hoping for relief, my symptoms would be twice as bad when I re-started. Looking back, I’m actually amazed that I kept taking the medication. If I started it now and had those side effects, there’s no way I would have continued with the medication. Fortunately, things gradually improved over a period of about three years and things are pretty good Metformin-wise now. I very rarely have noticeable side effects. It’s been a long haul, so I thought others may as well benefit from what I learned during my discomfort.
I only take Metformin once a day. I take it right before bed. I do not use the XR version. This isn’t the ideal dosing strategy; but, it’s what has worked to keep the side effects under control while still helping to decrease my insulin resistance.
When things were awful, I spoke with my doctor. His advice, combined with some wisdom gleaned from my pharmacist and the internet, lead to the following six tips that really helped me:
Obligatory disclaimer: I’m not a doctor nor anything like unto one. Use common sense. This isn’t medical advice.
1. If you take Metformin once a day, take it immediately prior to going to bed. If you take it more than once a day, take your night dose right before bed. This allows you to sleep through the worst of it.
2. When you take Metformin, always eat something with a bit of protein at the same time. A small glass of milk, 1/2 a piece of bread with peanut butter, a small handful of nuts, or an apple with a slice of cheese all work.
3. If you feel particularly awful and like you’re going to live in the bathroom for the morning–eat something! Even though you don’t want to eat. You’ll feel better if you eat. Aim for something with protein and carbohydrates. On the days with huge waves of nausea, I’d eat a few crackers and then work up to something bigger. Saltines were a lifesaver. If I ever do have a chance to have children–I think I’ve got the morning sickness abatement plan under control.
4. If you feel like the side effects are out of control, call your doctor. Ask for information about temporarily decreasing your dose. For example, if you are taking 1,000 mg and having terrible diarrhea, call your doctor and ask about cutting back to 500 mg for a few weeks. Your body may do better if you gradually work up to the recommended dose.
5. Try switching to the name brand, using the extended release (XR) version, or getting the generic from a different manufacturer (call the various pharmacies in your area and asking them what manufacturer produces their Metformin). Even though the components of the medication are the same, the pills produced by different manufacturers are absorbed differently. So, if you are having problems with one, try another. I’ve noticed big differences when I get the medication from different pharmacies.
6. Don’t give up. Things will get better eventually. In the long run, it’s worth it to stick with Metformin. The side effects will diminish. You won’t be sick every day. Carry on!
Note for those with crazy work schedules: I worked a variable shift job for three years while taking Metformin. This meant that I worked a mixture of days and nights, often in the same week. I found that it worked best for me to take Metformin prior to me going to bed–whatever time that meant. It’s certainly not recommended to make drastic changes in the time that you take your medication, but it worked out okay for me. When I took Metformin and then stayed awake all night to work, I became a very unproductive employee because I spent half the night in the bathroom. Turns out I really do need to sleep through the first few hours, even now.
Metformin was awful in the beginning. I’m glad things have mellowed now. I did notice that after a few months on Metformin, most of my acanthosis nigricans went away, and I no longer felt like I needed to shave my legs twice a day. Over time, it’s made an even greater impact. I know that medication may not be right for everyone; but, in my case, metformin was a good decision.
What tips helped you to cope with the side effects of Metformin? Please share in the comments!