If you’ve been prescribed metformin for type 2 diabetes, the biggest question is often “how much should I take?” The answer depends on your blood sugar, kidney health, and how you tolerate the drug. Below we break down the usual dosing steps, common adjustments, and practical tips to keep you on track.
Doctors usually begin with a low dose to avoid stomach upset. Most adults start at 500 mg taken once or twice a day with meals. Some start at 850 mg twice daily if their blood sugar is high and they can tolerate it. After two weeks, the dose may be increased by 500 mg increments, aiming for a total daily dose between 1500 mg and 2000 mg.
If you’re on the extended‑release (XR) version, the start is often 500 mg once daily with dinner. XR tablets can be raised to 1000 mg daily after a week, and many people end up on 1500 mg to 2000 mg XR once a day.
When your doctor checks your A1C or fasting glucose, they may tweak the dose. If blood sugar stays high, you might add another 500 mg. If you feel nauseous, dizzy, or have a sore stomach, ask whether a slower increase or a split schedule would help.
Kidney function matters a lot. If your eGFR (estimated glomerular filtration rate) drops below 45 mL/min, doctors usually cap the dose at 1000 mg daily. Below 30 mL/min, metformin is often stopped because the drug can build up and cause lactic acidosis.
Missed a metformin pill? Take it as soon as you remember, unless it’s almost time for your next dose. In that case, skip the missed one and continue with your regular schedule. Don’t double up – taking two pills at once can increase stomach irritation.
Stomach cramps, nausea, and mild diarrhea are the most frequent complaints. Taking metformin with food, starting at a low dose, and using the XR form can cut these down. If symptoms persist after a few weeks, talk to your pharmacist about switching brands or adding a probiotic.
Vitamin B12 levels can drop with long‑term use. It’s a good idea to have your B12 checked annually if you’ve been on metformin for more than a year.
• Start low (500 mg) and increase gradually.
• Aim for 1500‑2000 mg total daily unless kidney function limits you.
• Take it with meals to ease stomach upset.
• Missed a dose? Take it when you remember, but don’t double up.
• Watch for B12 deficiency and talk to your doctor about dose changes.
Keeping track of your dose, diet, and blood sugar readings will help you get the most out of metformin while staying comfortable. If anything feels off, reach out to your healthcare provider – they can fine‑tune the plan for you.
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