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If you have diabetes, prediabetes, or polycystic ovary syndrome (PCOS), chances are you’ve heard of metformin.

It’s the most common diabetes medication in the world, prescribed to more than 120 million people. It comes in tablet or clear liquid form.

Despite its popularity, it has some risks, and many people look for other ways of managing their condition. If you have type 2 diabetes, you may be able to stop taking metformin if you commit to long term lifestyle changes.

Be sure to talk to your doctor before you break up with metformin.

Doctors often prescribe metformin for people with type 2 diabetes because it effectively lowers blood sugar (aka blood glucose).

It does this by:

  • reducing the release of blood sugar by your liver
  • delaying your stomach’s absorption of sugar from food
  • making your body’s cells more receptive and sensitive to insulin

Metformin also helps with other aspects of type 2 diabetes, including:

  • curbing appetite, which could lead to moderate weight loss
  • increasing high-density lipoprotein (HDL) cholesterol (the “good” one)
  • reducing low-density lipoprotein (LDL) cholesterol (the “bad” one)
  • lowering lipids, resulting in a decrease in blood triglyceride levels (high triglyceride levels can lead to heart disease)

Side effects of metformin are often digestion-related.

They include:

  • appetite loss
  • moderate weight loss
  • gas
  • a metallic taste in your mouth
  • heartburn
  • stomach cramps
  • vomiting
  • diarrhea
  • vitamin B-12 deficiency

About 30 percent of people who take metformin for a long time develop a vitamin B-12 deficiency. Your doctor may check your B-12 level every year or so while you’re on metformin.

Symptoms of a deficiency include:

  • shortness of breath
  • peripheral neuropathy (nerve damage)
  • feeling weak

Hypoglycemia

Metformin lowers your blood sugar, which can cause hypoglycemia in rare cases. This is more likely to happen if you take metformin with insulin or other diabetes medicines.

Symptoms of hypoglycemia include:

  • headache
  • feeling faint or shaky
  • sweating
  • nausea

If you think you may be experiencing hypoglycemia, eat 15 grams of carbohydrates that break down easily in your body, such as:

  • 1/2 cup of juice or regular soda (not diet)
  • 1 tablespoon of honey or sugar
  • 4 or 5 saltine crackers
  • 3 or 4 pieces of hard candy or glucose tablets

Hypoglycemia can be life threatening. If someone experiencing hypoglycemia can’t ingest food or is unconscious, they need medical attention immediately.

Make sure to regularly monitor your blood sugar levels so your doctor can adjust your metformin dose accordingly.

Lactic acidosis

Lactic acidosis is a buildup of lactic acid in your blood. This condition is rare but life threatening.

Lactic acidosis is more common in people with preexisting alcoholism, heart failure, or kidney problems. Make sure your doctor knows if you have a history of any of these conditions before you start taking metformin.

Though metformin can help reduce the symptoms of type 2 diabetes, it doesn’t affect the lifestyle factors that may contribute to the disease — diet, activity level, and weight.

Type 2 diabetes can often be reversed through healthy lifestyle changes. Some people taking metformin may choose to stop the medication if their doctors think they can manage the condition by losing weight, eating healthfully, and exercising regularly.

A 2017 study suggests that type 2 diabetes can be managed through “dietary knowledge, attitudes, and practices.”

Furthermore, a 2018 study found that after maintaining a healthy lifestyle for just 1 year and losing weight, almost half the participants kicked their diabetes into remission.

So say goodbye to sugary drinks, fried foods, and salty foods and hello to the possibility of a medication-free future.

Criteria for breaking up with metformin

According to the American Diabetes Association, these are the criteria people with diabetes need to meet before breaking up with their diabetes meds:

  • blood sugar level — at random or after eating — under 180 mg/dL
  • fasting morning blood sugar level under 130 mg/dL
  • A1C less than 7 percent

If you don’t meet these yet, it may be too risky to stop taking medication.

The criteria can change depending on your age and overall health, so talk to your doctor about any changes you want to make to your metformin dose.

Lifestyle changes that can help you get off metformin include:

  • exercising regularly
  • reducing your carb intake
  • maintaining a healthy weight
  • stopping smoking
  • reducing or eliminating alcohol

Also, never underestimate the power of community. Working with a personal trainer, a registered dietitian, or a support group can help you stay on track and hold you accountable to your goals.

When you’re pregnant, one of the first orders of business is to find out if any of the medications you’re taking could pose risks to the fetus.

So, first things first: Metformin during pregnancy can be really beneficial for women with diabetes and/or PCOS, and it has few side effects.

Doctors may prescribe it to women who weren’t on it prior to pregnancy to make sure their blood sugar levels are stable and/or to reduce the risk of gestational diabetes. Metformin is also safe to take while breastfeeding.

Because metformin was created for type 2 diabetes, if it’s prescribed for something else, like PCOS, that use would be described as “off-label.”

Pregnant women with PCOS have a higher risk of miscarriage, fetal development issues, and gestational diabetes than women without the condition.

However, a 2008 study found that pregnant women with PCOS who consistently used metformin during their pregnancies had a significantly reduced chance of those outcomes.

Metformin can also help address the extra weight gain and blood sugar issues that are common among pregnant women with PCOS. The drug can even help increase your chance of getting pregnant in the first place.

Stopping metformin and other diabetes meds always comes with the risk that symptoms may get worse. That’s why committing to healthy lifestyle changes is crucial.

If high blood sugar is left untreated, it can cause unwanted complications, including:

  • heart problems
  • foot problems
  • sexual health problems
  • diabetic neuropathy (nerve damage)
  • diabetic retinopathy (impaired vision)

You don’t want any of those. So as always, stay on top of your health and be in contact with your doctor.

Step 1 of stopping metformin is to do it under the supervision of your doctor. Step 2 is to genuinely implement healthy changes into your life.

Many people with type 2 diabetes can manage the condition without medication by eating a healthy diet, exercising regularly, and maintaining a healthy weight.

People with diabetes who don’t want to take metformin but still need medication have other options.

They include:

  • Dapagliflozin (Farxiga): used to lower blood sugar levels and reduce the risk of artery-related heart disease
  • Actos (pioglitazone): used to lower blood sugar levels and help reduce the risk of a stroke or cardiac arrest
  • Canagliflozin (Invokana): used to lower blood sugar levels and reduce the risk of heart disease
  • Empagliflozin (Jardiance): used to lower blood sugar levels and blood pressure and help with weight loss
  • Prandin (repaglinide): used to quickly lower blood sugar levels

These medications can cause serious side effects, so make sure to go over them in depth with your doctor.

Natural options

Natural remedies have been used for a long time to treat symptoms of type 2 diabetes. Some research had shown they may help reduce blood sugar levels.

These natural remedies include:

  • apple cider vinegar
  • bitter gourd
  • aloe vera
  • fiber and barley
  • fenugreek
  • ginger
  • berberine
  • cinnamon
  • okra
  • gymnema, gurmar, or cowplant
  • zinc
  • neem

It’s important to get the OK from your doctor or pharmacist before trying any of these options, because herbal supplements could interact with prescription medications you’re taking.

If you have type 2 diabetes and you want to stop taking metformin, the first thing to do is talk to your doctor. The second is to implement some healthy lifestyle changes.

It’s often possible to manage type 2 diabetes by eating healthfully, exercising regularly, and maintaining a healthy weight.

If you’re pregnant and need to take metformin, don’t worry. It’s perfectly safe to take while pregnant and breastfeeding.

Always consult a medical professional if you’re thinking about stopping metformin. They will be able to assess the risks and help you get where you want to be.