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How is Metformin Dosage Determined?

E

ElloBee

Active Member
Messages
34
Type of diabetes
Family member
Treatment type
Tablets (oral)
Hi All,

I was wondering if anyone knows how the dosage of Metformin is determined?

Is it dependent on weight as well as blood sugar levels? What factors would make the dosage increase/decrease? I'm just after some advice to better understand the drug!

Thanks!
 
As far as I know doctors just up the dose 'as tolerated' by the patient - they believe absolutely that it is good for diabetics, so they work on that even if the tablets make your life a misery and prevent any form of exercise, cause disturbed sleep etc.
 
My dose was increased as my HBA1C levels increased, so I went from diet control to 1 pill/day to 3 pills /day as my HBA1C went from 47 to 54 to 66. My HBA1C has been dropping since September 2017 since eating between 30 to 40 carbs/day so as HBA1C has dropped over time to this last reading of 44 today !! (So readings were 66, 56, 49, 44) reduction in metformin has followed, I am now back to 1 pill per day and aiming for HBA1C of 42 or lower, come off metformin completely.
 

There are no official guidelines for GPs on Metformin dosage as far as I know. It is the first medication to be prescribed but the actual dosage depends on the GP and this decision should be made according to how he feels it will help you best. As it can aid weight loss slightly (appetite suppressant) then weight may come in to it, but only to help you lose weight and not because heavier people need extra. Your blood sugar levels should also be taken into account. I was overweight on diagnosis. My HbA1c was 53. I wasn't prescribed any at all.
 

I'm glad it's all going well and coming down for you! What would you levels need to be at for you to come off of metformin altogether?
 
ElloBee said:
I'm glad it's all going well and coming down for you! What would you levels need to be at for you to come off of metformin altogether?
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I talked with my dn today and she is happy for me to drop metformin altogether when I get below 42.
 
I was not overweight on diagnosis but was immediately prescribed what I imagine is the highest dosage of Metformin at four tablets per day (two per day for the first week then four per day). My liver function test result was poor, too, but whether this had a bearing I'm not sure. My LFT is now normal and the Met has been reduced to three per day. Hope this helps.
 
You may find this interesting

https://www.ncbi.nlm.nih.gov/m/pubmed/28963752/

There is a video on YouTube called ‘Metformin a series of unfortunate events’.
It is a rather odd video made during a conference presentation. On it, the presenter discusses Metformin and explains many of the common misconceptions held by doctors about the drug. These apparently include misunderstandings about when it should be prescribed, how much, when it shouldn’t be prescribed - and why.

I haven’t checked the references used in the vid, but the presenter states that doubling the dose from, say, 1000mg to 2000mg does not double the efficacy, so it becomes an increase of diminishing returns.
 

Hi,

Thanks so so much for the above info. VERY interesting. I'm not convinced of it's positive effects, hence why I'm asking all the questions as I want to research it and gather info from the people who use it. I can't seem to find the video though... do you have a link I could reach it on?

P.S --> I've had to delete the link from this reply as the site was pulling it up as spam and wouldn't let me reply... but I can access it and find it very interesting.
 
ringi said:
Fatty liver and/or high trigs is a good indication of insulin resistance.
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Would metformin help lower these liver levels? Or would it simply be as a result of better sugar control through taking the medication? I.e. would metformin have a direct affect on the fatty liver levels, or would they lower slowly as your body better controlled sugar levels? Sorry for all the questions, I'm trying to learn as much as possible!
 

Hi, yes this is very helpful thank you! Wow, yes i think that may be the highest dose. From what I've read it would seem that approx 2500mg is the daily maximum. This is really helpful thank you. Had your sugar levels reduced then for the metformin to be reduced? Sorry for all the questions, I'm trying to better get my head around the dosage so that I can better support a family member on metformin.
 

Ah I see. Yes it does seem that metformin has significant side effects, and from my reading, it would seem that an awful lot of the people on this medication experience them. Doesn't seem quite right that so many people should suffer so badly with side effects. I hope they can eventually develop a new form that eliminates these, but maybe that's wishful thinking!!
 

I see, this would make sense. I guess as weight is individual to everyone, then you're right, it may be used in addition to blood sugar levels when calculating the dosage. I wonder if theres (as a general rule of thumb) a level that HbA1c are typically at when met is prescribed.
 
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