More Metformin ER REDUCES nausea?The reason why they have you start it in the evening is because many people get slight nausea and it's not usually bothersome to them in the evening. Stepping up the dosage reduces the chance that you will have nausea.
Unfortunately, for some of us, even extended release causes problems over time. I was getting severe gut pain after 5 years of using it. Tried again a few months ago after a 6 month break and that ended yesterday. Gut pain and nausea are definitely not the same thing.
I don't take any drugs that require food in the evening, I only take drugs before bed without food.
If I take Metformin ER at dinner then I have drugs 3 times a day.
I get mild intermittent gut pain .