Eli5: How does Metformin work for Type 2 Diabetes?
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I’ll need to talk about some physiology first.
One of the things the liver can do is make glucose when there isn’t enough in whatever food is being eater – or isn’t being eaten. The process is known as “gluconeogenesis”.
Generally, it only happens when there isn’t enough glucose around, and if there is excess glucose – enough to increase insulin levels – the gluconeogenesis stops, because there is no need for that glucose.
In people with insulin resistance, that regulation gets messed up, so the liver produces glucose all the time. That leads to the chronic high insulin that is characteristic of type 2 diabetes.
*One* of the functions of metformin is to reduce the amount of glucose created by gluconeogenesis, which reduces the high insulin, which makes the diabetes better.
There are, however, other things that metformin does that might have a role as well.
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