Should I take metformin if my sugar is 104? Understanding Your Prediabetes Diagnosis

October 11, 2025 •

4 min read

Roughly one in three American adults has prediabetes, a condition where blood sugar is elevated but not yet high enough for a diabetes diagnosis. The question of should I take metformin if my sugar is 104? is common for those in this range, and the answer involves a comprehensive look at your health beyond just a single blood glucose reading.

Quick Summary

A blood sugar of 104 mg/dL indicates prediabetes, often first managed with lifestyle changes. Metformin is sometimes used for high-risk individuals, but this decision requires a doctor's evaluation of all health factors, not just a single glucose test.

Key Points

Blood Sugar of 104 mg/dL: This level falls into the prediabetes range (100-125 mg/dL), signaling a heightened risk for developing type 2 diabetes.
Lifestyle Changes Are First: For most people with prediabetes, the initial and most effective strategy involves diet, exercise, and weight management, which can often reverse the condition.
Metformin Is Not Universal: Metformin is not a default recommendation for everyone with prediabetes but may be considered for high-risk individuals based on a doctor's assessment.
Medical Guidance Is Essential: A decision about taking metformin should only be made in consultation with a healthcare professional who can review your full health profile.
Metformin Has Risks: Like any medication, metformin carries potential side effects, including gastrointestinal issues and a rare risk of lactic acidosis, which require careful monitoring.
Prediabetes Is Reversible: Taking proactive steps with lifestyle changes offers a strong possibility of reversing prediabetes and preventing the long-term complications of type 2 diabetes.

What a blood sugar reading of 104 mg/dL means

A fasting blood sugar level is measured after you have not eaten or had anything to drink besides water for at least 8 hours. A result of 104 mg/dL falls squarely into the prediabetes range, which is defined as a fasting blood glucose level between 100 and 125 mg/dL. This is not a diagnosis of type 2 diabetes, which is indicated by a fasting blood sugar of 126 mg/dL or higher. Instead, it serves as a crucial warning sign that your body is not effectively processing glucose and that you are at a higher risk of developing full-blown type 2 diabetes, as well as heart disease and stroke.

The reason for this elevated sugar is often insulin resistance. Insulin is a hormone that helps move glucose from your bloodstream into your cells for energy. When you have prediabetes, your cells do not respond to insulin as they should, causing sugar to build up in your blood.

Lifestyle changes: The first line of defense

For many individuals with prediabetes, the initial and most effective course of action does not involve medication at all. Major health organizations, like the Centers for Disease Control and Prevention (CDC) and the American Diabetes Association (ADA), recommend lifestyle modifications as the primary intervention. In many cases, these changes can be enough to reverse prediabetes and bring blood sugar levels back to a normal range.

Key lifestyle changes include:

Dietary adjustments: Focus on a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. The 'diabetes plate method,' which involves filling half your plate with non-starchy vegetables, one-quarter with protein, and one-quarter with carbohydrates, is a helpful tool for managing portion sizes and carbohydrate intake.
Regular physical activity: Aim for at least 150 minutes of moderate aerobic activity per week, such as brisk walking, and add muscle-strengthening activities at least two days a week. Exercise increases insulin sensitivity and helps your cells use glucose for energy.
Weight management: For individuals who are overweight, even a modest weight loss of 5-7% of your total body weight can significantly reduce the risk of progressing to type 2 diabetes.

The role of metformin in prediabetes

While lifestyle changes are the standard first-line treatment, metformin may be considered for certain high-risk individuals with prediabetes. The American Diabetes Association (ADA) and other medical experts recognize that some patients may benefit from medication in addition to or when lifestyle interventions alone are insufficient.

Criteria for considering metformin in prediabetes can include:

Having both elevated fasting blood glucose (100-125 mg/dL) and elevated A1C levels (5.7-6.4%).
Additional risk factors such as high blood pressure or high cholesterol.
A history of gestational diabetes, which increases the long-term risk of developing type 2 diabetes.
Being under 60 years old and having a body mass index (BMI) of 35 or higher.

Metformin works primarily by reducing glucose production in the liver and improving the body's sensitivity to insulin. It is generally considered a safe and inexpensive medication. However, it is not a cure, and potential side effects, such as gastrointestinal upset and a rare risk of lactic acidosis, must be carefully considered by a healthcare provider.

Metformin vs. Lifestyle Changes for Prediabetes

| Feature | Lifestyle Changes | Metformin | Primary Action | Address root causes like diet and inactivity. | Reduces liver glucose production and increases insulin sensitivity. | Effectiveness | Highly effective for reversing prediabetes, sometimes more so than medication. | Effective in high-risk groups, often used in conjunction with lifestyle changes. | Side Effects | Generally none, with numerous health benefits beyond blood sugar control. | Potential gastrointestinal issues, vitamin B12 deficiency, and rare lactic acidosis. | Long-Term Risk | Significantly reduces long-term risk of type 2 diabetes. | Does not cure diabetes but manages progression; long-term safety profile is good. | Cost | Low or no cost; may save money on long-term healthcare. | Inexpensive, especially as a generic, but still a recurring medication expense. | Implementation | Requires significant personal commitment and discipline. | Simple daily oral medication; may have lower adherence than lifestyle programs.

Actionable steps for managing a blood sugar of 104

Consult a healthcare professional: Before making any decisions, schedule an appointment with your doctor. They can perform a full health assessment, including an A1C test, to confirm your prediabetes status and discuss the best course of action for your specific situation.
Commit to lifestyle changes: Regardless of whether medication is prescribed, dedicate yourself to a healthier lifestyle. This includes focusing on a balanced diet and integrating regular physical activity into your routine.
Consider a weight management program: If you are overweight, working with a dietitian or participating in a structured program can help you achieve modest weight loss goals, which have a powerful effect on blood sugar control.
Monitor your progress: Regularly check your blood sugar levels as advised by your doctor to see how your body is responding to lifestyle changes. You and your doctor can then decide if adding a medication like metformin is necessary.
Address other health factors: Work with your doctor to manage any other risk factors you may have, such as high blood pressure or high cholesterol, as these often coexist with prediabetes.

Conclusion: A proactive, personalized approach is key

For an individual with a blood sugar of 104 mg/dL, the most important takeaway is that you are in a critical window of opportunity. While this reading places you in the prediabetes category, progression to type 2 diabetes is not inevitable. For many, dedicated lifestyle changes are the most powerful tool for returning blood sugar to a healthy range. The decision to take metformin should never be made alone or lightly. It requires a thorough discussion with a trusted healthcare provider who can evaluate your overall health profile, risk factors, and personal circumstances. By taking a proactive and personalized approach, you can effectively manage your blood sugar and significantly improve your long-term health outlook.

Mayo Clinic - Prediabetes

Frequently Asked Questions

A fasting blood sugar level of 104 mg/dL indicates prediabetes. This means your blood sugar is higher than normal but not high enough for a type 2 diabetes diagnosis. It signals an increased risk of developing diabetes and other health issues.

No, it is not always necessary. For many people with prediabetes, the first-line treatment is focused on lifestyle changes, such as modifying diet and increasing physical activity. Metformin is typically reserved for high-risk individuals or when lifestyle changes are insufficient.

Effective lifestyle changes include eating a healthy, balanced diet rich in fruits, vegetables, and lean proteins, getting regular physical activity (at least 150 minutes per week), and achieving modest weight loss if you are overweight.

Common side effects of metformin include gastrointestinal issues such as diarrhea, nausea, bloating, and stomach discomfort. Less common but more serious risks include vitamin B12 deficiency with long-term use and a rare condition called lactic acidosis.

Metformin by itself does not typically cause low blood sugar. However, the risk of hypoglycemia increases if you take metformin alongside other diabetes medications, especially insulin or sulfonylureas.

Your doctor may consider metformin if you are at high risk for progressing to type 2 diabetes. This might include those with a BMI over 35, a history of gestational diabetes, or an A1C level over 6%.

It is vital to consult a healthcare professional for an accurate diagnosis and a personalized treatment plan. They will assess your overall health, risk factors, and monitor your progress to determine if medication or other interventions are needed.

Yes, prediabetes can often be reversed without medication through sustained lifestyle changes. Committing to a healthy diet and regular exercise is a powerful way to manage blood sugar and prevent type 2 diabetes.