Metformin in Australia: A GP’s Honest Review for People Over 30

Written from an Australian general practice perspective. General information only — always speak with your own GP before starting or changing any medicine.

Attention: The Silent Worry of High Blood Sugar

If you are over 30 and have been told your blood sugar is “a bit high”, you may be feeling tired, thirsty, or worried about what diabetes could do to your eyes, kidneys, heart and nerves. Perhaps you are already struggling with weight gain, low energy, brain fog, or the fear of needing injections. As a GP, I hear this almost every day: “I don’t want to go on medication.”

I understand. But the good news is that one of the most effective, safest and cheapest diabetes medicines is not new, not injected, and not complicated. It is called metformin. For many Australians, starting metformin is the single most important step to bring glucose levels down and protect long-term health.

Interest: Why Metformin Is the First Choice in Australian Guidelines

Metformin has been used for decades and is still recommended by the Royal Australian College of General Practitioners (RACGP) as the first-line oral medicine for type 2 diabetes. It is also used in polycystic ovary syndrome and, in selected cases, to help reduce the risk of progression from prediabetes to diabetes.

RACGP guideline for metformin initiation

The RACGP handbook for type 2 diabetes says metformin should usually be started at diagnosis, together with lifestyle changes, unless there is a medical reason not to use it. The usual starting approach is:

Is metformin recommended by the RACGP for type 2 diabetes?

Yes. Metformin is firmly recommended as the first-line medicine for most people with type 2 diabetes. It reduces HbA1c, does not usually cause weight gain, has a very low risk of hypoglycaemia when used alone, and improves long-term outcomes. The RACGP advises that metformin should be continued even when other diabetes medicines are added later.

Are there any recalls of metformin in Australia?

This is a common concern, and it is understandable. In 2020, the Therapeutic Goods Administration (TGA) recalled some batches of extended-release metformin because they contained a manufacturing impurity called NDMA above the acceptable limit. Importantly, this was not all metformin. Standard immediate-release metformin, which most Australians use, was not affected. Current supplies sold in Australian pharmacies must meet strict TGA quality standards. If you ever want the latest information, you can search the TGA recalls database or speak with your pharmacist. Do not stop metformin suddenly without talking to your GP — stopping can cause blood sugar to rise quickly.

Desire: How Metformin Can Improve Your Daily Life

Here is what many patients over 30 like about metformin once they start it properly:

• It is a tablet, not an injection. No needles, no complicated devices.
• It usually does not cause dangerous low blood sugar when used on its own.
• It is weight-neutral or may help prevent weight gain, which matters if you are already carrying extra weight.
• It protects long-term organs by improving glucose control and reducing the risk of diabetes complications.
• It is inexpensive — one of the most affordable diabetes medicines in Australia.

Can metformin prevent type 2 diabetes?

For people with prediabetes, metformin can reduce the risk of developing type 2 diabetes by about 31% over three years, according to the landmark Diabetes Prevention Program. Lifestyle changes are still the most powerful tool, but for some higher-risk people — such as those with a strong family history, previous gestational diabetes, significant central weight gain, or metabolic syndrome — metformin may be considered. In Australia, metformin is PBS subsidised for type 2 diabetes; using it for prediabetes is generally an off-label or private prescription decision. Your GP can help you weigh the benefits.

Can I drink alcohol with metformin?

Many patients ask this. The cautious GP answer is: small occasional amounts may be acceptable for some people, but alcohol can increase the risk of a rare but serious side effect called lactic acidosis.

• Occasional moderate drinking, such as one standard drink for women or one to two for men, may be safe for stable patients without liver or kidney disease.
• Avoid binge drinking and heavy daily alcohol intake.
• Do not drink alcohol on an empty stomach.
• If you have liver disease, kidney impairment, pancreatitis, or heart failure, avoid alcohol and discuss this with your GP.

Alcohol itself can lower blood glucose unpredictably and may hide symptoms, so be honest with your doctor about how much you drink.

Can metformin cause drowsiness?

Metformin does not usually cause drowsiness by itself. If you feel unusually sleepy or exhausted, do not ignore it. Common causes include:

• Blood glucose still running high early in treatment
• Rare hypoglycaemia, especially if metformin is combined with other diabetes medicines
• Vitamin B12 deficiency from long-term metformin use, which can cause fatigue, tingling, or memory fog
• Dehydration from stomach side effects such as diarrhoea
• Sleep apnoea or thyroid problems, which are common in people with type 2 diabetes

Your GP can check HbA1c, vitamin B12, kidney function and other tests to find the cause.

Treatment for metformin overdose

Metformin overdose is a medical emergency. It can cause severe nausea, vomiting, abdominal pain, rapid breathing, confusion, extreme tiredness and lactic acidosis. If you suspect an overdose:

• Call 000 immediately or go to an emergency department.
• Call the Poisons Information Centre on 13 11 26 for fast advice.
• Hospital treatment may include activated charcoal if the overdose is recent, intravenous fluids, glucose monitoring, and haemodialysis in severe lactic acidosis or kidney failure.

Never double a missed dose. If you forget a dose, take it with your next meal unless it is almost time for the next one; then skip the missed dose.

Cost of metformin at Chemist Warehouse vs Priceline

Metformin is one of the cheapest diabetes medicines available in Australia. If you have a Medicare card and a PBS prescription, your cost is capped by the PBS co-payment. If you buy privately, prices vary by brand and pharmacy. Below are indicative typical private prices only — always check current in-store or online prices.

If your usual PBS co-payment is higher than the private price, ask the pharmacist whether it is cheaper to buy the medicine privately for that brand. Some patients find the small generic packs cost less than the general PBS co-payment.

Action: Speak to Your GP and Take Control

If you are over 30 and have been told you have type 2 diabetes, prediabetes, or you are worried about high blood sugar, metformin could be one of the safest, most effective and best-value medicines available in Australia today. It is not a magic cure, but it is a strong first step when combined with realistic food changes, regular walking and weight management.

Your next steps:

1. Book a GP appointment and ask: “Is metformin suitable for my blood sugar and kidney function?”
2. Request an HbA1c, kidney function and vitamin B12 test if relevant.
3. Ask your doctor for a PBS prescription if you have type 2 diabetes.
4. Compare prices at Chemist Warehouse and Priceline, and always use a registered Australian pharmacy.
5. Start low, take it with food, and follow up after 3 months to see your progress.

Millions of Australians have improved their diabetes control with metformin. If it is right for you, it can help you avoid complications, keep your energy more stable, and reduce your long-term health burden — without the needle, and without breaking the budget.

Medical disclaimer: This article is general information only and does not replace individual medical advice from a registered Australian doctor. Always discuss your personal health history, alcohol intake, kidney function, and any medicines you take before starting metformin. If you suspect an overdose or have severe symptoms, call 000 or Poisons Information Centre 13 11 26.