Hi and have a question

[Anth0ny]

Hi my name is Anthony and I'm type 2.
Was diagnosed a couple of years ago but things have been under control, until recently, when things went up slightly.
I'm, putting it down to lockdown and not being as active as I was before lockdown, taking steps to fix that.
No my question, we have just had a change of of diabetic nurse and she is changing when I take my medication, I'm unsure whether she is correct.
I take two 500mg slow release Metformin, up till now I've taken them both in the morning, now I'm being asked to take one in the morning and one before I go to bed, that does not make sense to me, why take one just before your nightly fast?
I should add I usually have dinner around 6PM

 

[rebrascora]

Hi and welcome

It really doesn't matter too much when you take the Metformin as it doesn't have a short term activity time scale. It takes a couple of weeks of taking it for it to build up in your system and have an impact and then you are just topping the levels up each day, from what I understand, so even not taking any for a day or two would have little effect. Also, Metformin doesn't work directly on food, it works by better enabling your cells to access the glucose in your blood and also inhibiting the liver from releasing so much glucose into the blood stream when you are not eating.... If it did have a short half life, then that would be the benefit of taking one at night because your liver trickles out glucose throughout the night and also ramps up that output in the morning (Dawn Phenomenon) to give your muscles fuel to start the day.

The benefit of splitting the dose is usually so that it is easier on your digestive system, but I would take the second tablet with my evening meal in that situation rather than at bedtime. As it is, you are on the slow release version, so hopefully not having any gastric upheaval, so probably not relevant in this case.

Did you ask her the reason for this change?

 

[Felinia]

When I asked my GP about when to take my slow release Metformin, she told me to take both together in the middle of my evening meal, NOT one morning and one evening. I'm currently still on one, but expect to be increased to two in a few weeks.

 

[Vonny]

I agree with @rebrascora, one at breakfast and one with the evening meal. That's what my DN suggested when I was on 2 a day, although @Felinia's DN clearly thinks 2 together are ok. I'm on standard, not slow-release, metformin, so maybe that's why.

 

[Felinia]

I agree with @rebrascora, one at breakfast and one with the evening meal. That's what my DN suggested when I was on 2 a day, although @Felinia's DN clearly thinks 2 together are ok. I'm on standard, not slow-release, metformin, so maybe that's why.

Yes - my GP said as they were slow release they work steadily over the 24 hours

 

[Drummer]

Metformin builds up over time and it takes some time to dissipate. A 24 hour effectiveness isn't how it works.

 

[Leadinglights]

NICE guidelines say for modified release metformin tablets.
Initially 500 mg once daily, then increased if necessary up to 2 g once daily, dose increased gradually, every 10–15 days, dose to be taken with evening meal, alternatively increased to 1 g twice daily, dose to be taken with meals, alternative dose only to be used if control not achieved with once daily dose regimen. If control still not achieved then change to standard release tablets.
So either regime is in accordance with the guidelines.

 

[rebrascora]

So either regime is in accordance with the guidelines.

Yes, except that this new nurse was suggesting taking the second one at bedtime which would not be with a meal. I assumed it didn't matter with the slow release but still better to err on the side of caution and take with food.

 

[grovesy]

I was told to take mine with the biggest meal of the day which is in the evening.

 

[Felinia]

And I was told having it half way through a meal offers more protection against the unpleasant stomach side effects. It did in fact take a good 6 weeks for the side effects to subside, and that was on just 500gm a day.

 

[Anbemcc]

I'm going into week 4 of metaformin, 2 in the morning at 2 with dinner. It helped me to take in the middle of a meal. I've been good for a couple of days, no side effects anymore, long may it last

 

[Lucyr]

For the slow release metformin it doesn’t really matter when you take it, it can be taken once or twice a day and taking it with or without food doesn’t seem a big deal. I take two x 1g tablets together in the evening somewhere between dinner and bedtime

 

[SB2015]

Reading the responses on this.it is no wonder people get confused with GPsand nurses giving such different advice. I hope you find what works for you @Anth0ny .

 

[everydayupsanddowns]

Reading the responses on this.it is no wonder people get confused with GPsand nurses giving such different advice. I hope you find what works for you @Anth0ny .

Ha! I was thinking just the same @SB2015

It seems like there are multiple options, but most people are only being recommended the one, and not necessarily with much in the way of an explanation as to the possible reasons or benefits!

My understanding is also that metformin builds up over time and sort of soaks into the system, reducing glucose output from the liver, and improving insulin sensitivity… rather than specifically acting on the meal closest to when the tablets were taken.

Hope you find a timing of the tablets that works for you 🙂