People with type 2 diabetes do not always need insulin straight away; taking an oral anti-diabetic drug such as metformin and controlling diet can control blood sugar very effectively.

About diabetes

Type 1 diabetes often develops in early life and usually needs to be treated with insulin injections. Type 2 diabetes, diabetes mellitus, develops later in life and has a more gradual onset. Good control of type 2 diabetes can be achieved using oral medicines such as metformin, combined with changes in lifestyle. Metformin is particularly helpful for overweight diabetic patients who, despite their best efforts, cannot control blood sugar effectively using diet alone.

For some people, using metformin can postpone the need for insulin injections but if insulin becomes necessary, it can be combined with oral metformin for superior glycaemic control.

How does metformin control blood sugar?

Metformin hydrochloride, or metformin HCl, acts in two ways. Firstly, it reduces the amount of sugar released into the blood by the liver. Secondly, it acts on body cells to make them more sensitive to the insulin that is still being produced. This enables the cells to take up sugar from the blood more efficiently. This two-pronged action can control blood sugar very effectively.

How many tablets? How big?

Metformin tablets need to be swallowed with plenty of liquid, preferably during a meal. Oral medicines are easy for some people to take but a problem for others because of the sheer size and dose of the tablets.


The maximum dose in tablet form is 2500 mg per day, spread over the three meals. It is common to start with a daily dose of 2 x 500 mg tablets or one 850 mg tablet, but this may eventually need to be doubled or trebled, depending on the body’s response. An 850 mg metformin tablet is a big pill to swallow. For people who have medical dysphagia – physical difficulty swallowing – or those who just naturally dislike swallowing tablets, this can cause real anxiety.

Liquid metformin is the perfect solution, in more ways than one. It comes in an easy-to-swallow peach or peppermint sugar-free syrup that contains exactly the same active ingredient as the tablets. The usual starting dose for metformin liquid is one 5 ml spoonful, which is equivalent to a 500 mg tablet, two or three times daily. Like the tablets, metformin liquid should be taken during or after meals, not on an empty stomach.

Adjusting metformin dosage

The response to metformin treatment is assessed after two weeks on the starting dose. Regardless of whether liquid or tablets are taken, the dose may need to be adjusted on the basis of measurements of blood glucose. If an increase in dose is needed, this is done very gradually as metformin, liquid and tablets, can be poorly tolerated by the stomach in large doses. The maximum recommended dose of metformin liquid is six 5 ml spoonfuls each day. This is equivalent to 3000 mg of tablets, but is a lot easier to swallow.

Do you suffer from diabetes? You may be surprised to discover that there easy ways to take your medication that doesn’t involve swallowing tablets. You can find lots more information about the different medication available if you suffer from swallowing difficulties at http://www.rosemontpharma.com

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