This is a very long story that at the moment I will keep very short.
At my annual physical 4 days ago I asked for a prescription of metformin – a diabetic drug. This is a treatment that the American Diabetic Association believes to be reasonable in the treatment of prediabetes to slow the onset of the actual disease.
Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes. The first therapy should always be an intensive lifestyle modification program because weight loss and physical activity are much more effective than any medication at reducing diabetes risk.
Several drugs have been shown to reduce diabetes risk to varying degrees. No drug is approved by the U.S. Food and Drug Administration to treat insulin resistance or prediabetes or to prevent type 2 diabetes. The American Diabetes Association recommends that metformin is the only drug that should be considered for use in diabetes prevention. Other drugs that have delayed diabetes have side effects or haven’t shown long-lasting benefit. Metformin use was recommended only for very high-risk individuals who have both forms of prediabetes (IGT and IFG), have a BMI of at least 35, and are younger than age 60. In the DPP, metformin was shown to be most effective in younger, heavier patients.
I don’t think my doctor would have given it to me otherwise, but because I referenced the ADA’s view on it, he agreed, though maybe, just maybe, with a little annoyance. Note that my BMI is lower so I don’t exactly fit the profile.
My blood sugar, which hung out in the prediabetic range of 100 to 125 most of the time now resides mostly in the 80s.
Instantly, my appetite has changed. I feel like how I imagine ‘normal’ people feel when they eat. I eat, I am full, and I don’t think about food after. It is very, very early in all this, and I am not exactly thrilled to be on another medication, but what once seemed hard – avoiding the goodies – that pizza that calls my name from the kitchen at night – seems to have been quieted.
This made starting fresh at a ketogenic low carb diet July 1 seem a heck of a lot easier and I was in ketosis by July 3.
I don’t know how long this will last, if it is a placebo effect, or something else entirely is going on that I am attributing to the metformin, but it feels as if an appetite switch was thrown somewhere and everything’s changed.
I wonder if somebody’s missing something: might one of the secrets to weight loss be to maintain ‘normal’ blood glucose at all costs? Is it possible that if the medical community simply watched people’s blood glucose more closely, and didn’t permit it to be ‘high-normal’ but instead hammered away at us with the same urgency to keep that number in the solidly normal range like they do with blood pressure, would the obesity epidemic disappear?
Obviously, it’s not just some pill, but a combination of low carb, the pill and exercise – all seem to help in managing blood sugar – and I think would be necessary to be used in tandem. I don’t think it would be much good to me if I was eating high carb junk food and expected the pill to do all the work.
Pills also come with side effects. This one can cause gastric upset. I’ve been taking it with food – usually a Greek yogurt, and a glass of water. The first day I did have some stomach upset (and was sure happy a restroom was nearby), but it really hasn’t been an issue since. It is also NOT a good idea to take the stuff and drink alcohol because it could cause extreme low blood sugar apparently – and that can kill. Since I don’t drink anymore, that isn’t an issue.
Again – this is all quite premature – just some speculation by some idiot on a blog. Interesting though.
Low Carb Confidential 
I have been on metformin since 2009. It had no effect on my appetite – the only thing that helped me not to feel hungry was switching to a high fat, low carb diet.
I agree with your line of thinking. Metformin works in a couple of ways- one of which is helping your cells become resensitized to insulin and thus decreasing hyperinsulinemia, and therefore decreasing blood sugar yo-yoing and the resultant big hunger surges (or as my husband says, the “Feed me or die!” look I used to get before I went low carb). I think more docs should consider using it for their patients who are banging their heads against the wall trying to lose weight. Oddly, I believe THAT would be considered more acceptable medical practice than suggesting patients go on a low carb diet. “Eat more fat and less grains” is not something you are likely to hear in an office visit any time soon. Sadly.
So far I wouldn’t call it a ‘magic bullet’, but it does seem to have an impact. I forgot to take it yesterday and my appetite could not be quenched. I only realized I forgot in the evening. I can see it playing a role in helping me with my low carb diet – combined with other things like exercise.
Thanks for writing.
Today is my second day of my second induction in a decade. I came across your blog and I am very impressed by how insightful you are about diabetes/atkins/weight loss dilemma. I think I will ask to go on Metformin from my doctor, too.
This morning my fasting blood sugar was higher than it normally is:105. I suspect it was because my body did not produce insulin like it nommally does due to low carbs. What do you think?
I’ve heard the same thing as well, that low carbers sometimes paradoxically have higher (not high) blood sugar at times, but it’s all educated guesswork at this point.
I have found that metformin keeps my appetite down. However, I found that doing low carb was less effective for me when I am on it. Am I weird?
I don’t think you’re weird. Some people lose weight when they take metformin – some gain. I also just learned that long-term use can result in a vitamin b12 deficiency, which can lead to peripheral nerve damage and mimic diabetic neuropathy. I’ll bet most docs don’t know this. One thing to consider: if you really go LOW carb you might be able to control your blood glucose without needing metformin – and if you get low enough to go into ketosis, blood ketones are an appetite suppressant.