July 12, 2007

Taking a Drug Holiday

Every year I go off my metformin for a week or two, usually because my digestive system gets upset enough that it makes sense to cut out a drug notorious for causing stomach issues.

Since I am using insulin at mealtime now, going off metformin does not pose a danger to my health as long as I adjust my insulin dose to match the higher blood sugars I get without metformin in my system.

This past week, off the metformin, has been very interesting. As expected, my digestive system got a lot happier very quickly. No heartburn or weird feelings in the heart region that turn out to be signals from the esophagus or top of the stomach. (If you take Metformin, you probably know what I'm talking about.)

But after stopping, I was surprised at how much more energy I got. I'd been very sleepy in the evenings the last couple months but now, after almost a week without met, I'm bright and alert at 10 PM. My mind feels clearer during the day, too. Interesting!

My insulin needs have gone up, though my carb/insulin ratio is still that of a non-insulin resistant person--1 unit to 11 or 12 grams rather than 1 unit to 15. It took me a few days to adjust my dosage up, very carefully, a half unit at a time. Now I'm using 4.5 or 5 units, instead of 2.5 or 3 per 40-50 gram meal.

I do find it easier to go low with the higher amount of insulin, hence the higher carb intake. I'm not eating those 50 grams all at once, but instead eating a some at 2 or 3 hours to prevent lows. I'm using R, which hits hardest between 2-3 hours. Novolog would require a different approach, but I haven't had the time to work it out.

I'm also hungrier--which is one reason I started taking metformin, because without it I can be hungry and that pushes up my intake and weight. I consider hunger a symptom, not a moral failing, and for years metformin has been helpful in giving me normal hunger patterns. That's one reason I might go back to taking it.

Metformin also lowers my triglycerides dramatically, and since they are one of the more predictive elements in the lipid profile, I see that as good reason to take it. I'm sure my triglycerides are nastier now as I'm eating a bit more carb than usual, reworking the insulin dosing.

Finally, for some reason, taking metformin also lowers my blood pressure enough that when I take a blood pressure pill along with metformin, I can have serious problems with BP going very low. Now that I'm off the Met, I'm taking my blood pressure pills more frequently. I can't take the Diovan every day, never could. For years one Diovan would last me 2 days, and when I'm on Metformin it often controls my blood pressure very well for four! Any more Diovan and I'm likely to find myself flat on my back in the garden seeing stars if I bend over to pick a weed.

But I'm wondering, now that I feel so much more alert and awake without metformin, what this tells me about potential side effects. Is it subtly poisoning me in ways I didn't know about? We know it acts on the liver, and, well, I'm fond of my liver and would really like to keep it around for years to come. Metformin has been used for decades, so it has a pretty good safety record, but even so, the old "listen to your body" thing is telling me that maybe a little less Metformin might be in order.

I'm going to stay off the Metformin for a while longer and then go back on it and see if the sleepiness comes back. This kind of "challenge test" is what my endo instructed me to do years ago when I expressed other concerns about metformin side effects.

All in all, I think it probably is a very good idea to go off any drug we are taking day in and day out after we've taken it for years, to see if 1) it is still actually doing anything--many drugs don't after a while and 2) whether the drug has been causing side effects we haven't connected with it.

Obviously, if you stop a drug you need to closely monitor the area it impacts. You don't stop a blood pressure medicine without testing your blood pressure several times a day. Ditto blood sugar meds and blood sugar.


For many meds you can't stop cold turkey, because, although doctors often fail to mention this, the drugs are physiologically addictive and you'll have very nasty rebound symptoms or even, in the case of beta blocker blood pressure meds, a heightened risk of heart attack. If you feel a drug vacation is in order discuss your particular drug with your doctor before you stop taking it.

But it is well worth reviewing the rationale behind any drug you've been taking for a few years or more. Your condition changes, other drugs you have added since starting a drug may be duplicating the effect of that older drug, or the drug you have been taking may have become ineffective over time. A good doctor will take these concerns seriously and help you understand how to audit what you are taking and decide if it's time for you to try a drug holiday.


Anonymous said...

I stopped taking metformin (and a generic statin) cold turkey when I got a bad flu bug in January. My BGLs have been great without it and I expect my A1c and cholesterol levels (taken this week) to be even better than with the meds.

I don't take insulin, so I don't have to deal with that issue, but I have actually lost some weight since stopping the metformin and watching my carbs more closely to keep my BGLs happy. (I've been eating low carb for over 4 years and lost 50 lbs the 1st year.)

Yes, I felt hungrier at first (you tend to do that when the motion-sickness feeling of the metformin is gone), but that has subsided and I feel much healthier without meds in my system. Especially with the latest news about drug problems, I'm relieved to not be taking any.

Don't be afraid to stay off the metformin for good. You may have to adjust your carbs and other meds to find the right balance for your body, but going off doesn't mean you'll gain weight and ruin your BGLs. Go for it! You'll be glad you did!

Jenny said...

I'm thinking along the same lines. I was only controlling with diet when I started the metformin, and I think the hunger was largely because I was still going a bit too high after meals, even with a low carb diet, thanks to not secreting insulin.

With insulin supplementation if I get it right, I'm usually not hungry because I don't go too high.

And since I know I'm not really insulin resistant, the main reason for using Metformin isn't there anymore.

And congrats on losing 50 lbs! That's quite an accomplishment!

Anonymous said...

I see you've been tagged:


Nicky said...

I felt the same way when I came off metformin - and I still have more energy, and less tiredness, almost a year later. Met was great for getting rid of a fatty liver, and for removing dawn phenomenon and reducing liver dumps - but I'm glad to be off it. If my DP comes back, I'm contemplating trying a short dose of the herb Silymarin instead. I'm not saying I won't ever go back on the metformin - but I'm in no hurry!

Jenny said...


I ended up going back to a 1/2 dose of metformin after three weeks, because I started to develop the peculiar raging hunger that was the original reason I had started taking metformin.

The 1/2 dose took care of that.

My fasting blood sugar also rose about 10 mg/dl after the 3 weeks off, which combined with the 10 mg/dl the fasting bg rose when I stopped the estrogen put me at too high a fasting level. That was interesting because when I started metformin 3 years ago, it made no difference at all in my fasting blood sugar.

Probably yet another side effect of stopping the estrogen which for me seems to have been a very powerful blood sugar improver.

Anonymous said...

Ive been taking metformin for about a month nw. The first week was 500 mill. twice a day and it was great hunger left me i felt good but after 3 weeks of 1000 mill twice a day i am allways hungry and tired i dont get. I am allso sick to my stomach a lot.

Jenny said...


Metformin makes people sick to their stomach. Are you taking the ER form? If not, ask your doctor if you can switch, it often helps.

If you are hungry it may be because your blood sugar is going up too high. Metformin helps a bit, but it does not normalize blood sugar. Try the technique described here:

A.S. D. Newly Diagnosed Advice.

Bringing down your blood sugar with this technique should help with the hunger dramatically. If it doesn't bring down your blood sugar, you need to talk to your doctor about moving on to insulin.

Anonymous said...

I was on metformin for 6 months for PCOS (like insulin resistance) and was doing well. Suddenly my bowels actually slowed right down. I went off the metformin for a holiday and the bowels started to get better. Now I am off the metformin for good and my bowels have never been so screwed up. I blame it on this drug! I'm not sure that it has to do with the fact that I responded amazingly well to the metformin, but the effects tapered off. I am not a fan of lifelong medications and I too want to preserve my organs. Anybody else run into these slowed down bowel issues?

Jenny said...

The problem I eventually ran into with metformin was that it irritated my stomach lining and gave me ulcer like pains. It could be controlled with Prilosec, but I don't like treating side effects with more drugs.

Other people report diarrhea with metformin. I have not heard of it causing constipation, though.

It is possible you have something else going on which the metformin is intensifying, rather than that the problem is caused by the metformin.

I still have an occasional problem
with the ulcer-like pain almost a year after I stopped taking Metformin, so while it made it more obvious, I don't think it caused it.

Anonymous said...

After 2 years to date, I went off metformin 9 days ago...so far no side effects and numbers have been 80-90's. I feel great!
My Dr. said I have steriod induced diabetes, due to a lung infection.
I'm sure my numbers are going to shock my Doc!!! And my husband and I have been on garlique and fish oil for 3 monthes and 3 weeks, his
cholesterol dropped 62 points. Can't wait to see mine.
What can I say ;)

Unknown said...

Does metformin cause bleeding and stomach issues head aches and muscle aches my Dr quit my metformin cold turkey and will I get better

Jenny said...


If metformin caused your stomach distress, stopping it should stop all the symptoms. However, as I learned from personal experience, if you have an infection in your digestive tract or an ulcer, or some other such medical problem, metformin can make the problem more painful, but stopping it won't stop the symptoms because they were coming from the underlying problem, not the metformin. It is rather like rubbing lemon juice on your skin. If there is a cut there, the juice will make it sting. But the juice didn't cause the cut.

So if you stop metformin and the problems persist, your doctor should test for an ulcer. If you don't have one, see a gastroenterologist--a doctor who specializes in stomach problems. They will be able to diagnose and treat your problem.

I had this kind of problem a year ago and it turned out to be an unusual kind of gastric infection which when treated with the proper drug went away. As soon as it was treated I could take metformin again with no pain or symptoms at all.

Unknown said...

Thanks Jenny I phone him and tell him he phone his Dr he kant function very well I been absolutely worried about him he need stomach screening I think further tests he had this as they kept him in hos for two wk came out easter I guess waitin for results