Creatine monohydrate is one of the most extensively researched sports supplements, widely used to enhance exercise performance and muscle strength. For people living with type 2 diabetes, questions often arise about whether creatine is safe and whether it might offer additional benefits for blood sugar control or exercise capacity. Whilst creatine is not included in NHS or NICE diabetes guidelines, emerging research has explored its potential effects on glucose metabolism and insulin sensitivity, particularly when combined with resistance training. This article examines the current evidence on creatine and diabetes type 2, covering safety considerations, potential benefits, risks, and practical guidance for those considering supplementation as part of a comprehensive diabetes management plan.

What Is Creatine and How Does It Work in the Body?

Creatine is a naturally occurring compound synthesised primarily in the liver, kidneys, and pancreas from three amino acids: arginine, glycine, and methionine. Approximately 95% of the body's creatine is stored in skeletal muscle, with smaller amounts found in the brain and other tissues. The average adult stores roughly 120 grams of creatine, which plays a crucial role in cellular energy metabolism.

The primary function of creatine involves the rapid regeneration of adenosine triphosphate (ATP), the body's main energy currency. During high-intensity, short-duration activities, creatine phosphate donates a phosphate group to adenosine diphosphate (ADP), quickly converting it back to ATP. This process is particularly important during the first few seconds of intense muscular effort, such as weightlifting or sprinting.

Dietary sources of creatine include red meat and fish, with approximately 1–2 grams obtained daily through a typical omnivorous diet. Vegetarians and vegans often have lower baseline creatine stores and may respond more to supplementation. Many individuals, particularly athletes and those engaged in resistance training, use creatine monohydrate supplements—the most extensively researched and evidence-based form—to increase muscle creatine stores beyond normal levels.

Supplementation can be approached in two ways: a loading phase of 20 grams daily (divided into four doses) for 5–7 days followed by a maintenance dose of 3–5 grams daily, or starting directly with 3–5 grams daily without loading. The latter approach is equally effective over time and may reduce gastrointestinal side effects, which can be particularly relevant for people with type 2 diabetes who may already experience digestive symptoms from medications such as metformin.

It is important to note that creatine supplementation can modestly increase serum creatinine—a waste product measured in blood tests—without indicating actual kidney damage. This rise reflects increased creatine metabolism rather than reduced kidney function, though it may affect creatinine-based estimates of glomerular filtration rate (eGFR). Creatine is not recommended during pregnancy or breastfeeding, or for those under 18 years, due to limited safety data in these groups.

Beyond athletic performance, emerging research has explored creatine's potential therapeutic applications in various clinical conditions, including neurological disorders and metabolic diseases. Understanding creatine's fundamental mechanisms is essential when considering its use in individuals with type 2 diabetes, where energy metabolism and glucose regulation are already compromised.

Can People with Type 2 Diabetes Take Creatine Safely?

Current evidence suggests that creatine monohydrate supplementation may be used by some people with type 2 diabetes, though the evidence base is limited to small, short-duration trials and medical supervision is advisable. Unlike some supplements that may interfere with diabetes medications or exacerbate metabolic dysfunction, creatine has demonstrated a generally favourable safety profile in the clinical studies conducted to date in diabetic populations.

Several controlled trials have examined creatine use in individuals with type 2 diabetes without reporting serious adverse events. The supplement does not appear to cause hypoglycaemia (dangerously low blood sugar) or hyperglycaemia (excessively high blood sugar) when used at recommended doses. However, individual responses vary, and certain precautions are warranted.

Key safety considerations include:

• Kidney function monitoring – Creatine is metabolised to creatinine, which is excreted by the kidneys. Individuals with diabetic kidney disease or reduced renal function should discuss supplementation with their GP or diabetes specialist. According to NICE guidance on chronic kidney disease (NG203), those with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m² or evidence of albuminuria should have their kidney status reviewed before starting creatine. It is important to understand that creatine can increase measured serum creatinine without indicating true kidney damage; if results are uncertain, your clinician may consider alternative tests such as cystatin C-based eGFR or repeat monitoring to clarify kidney function trends.

• Medication interactions – There are no well-established, clinically significant interactions between creatine and common diabetes medications such as metformin or SGLT2 inhibitors. However, individual responses vary, and patients should inform their healthcare team about all supplements being taken. Continued monitoring of blood glucose and HbA1c remains important.

• Product selection – Choose plain creatine monohydrate powder from reputable brands with third-party testing certification, such as Informed-Sport, which is recognised in the UK. Flavoured or ready-mixed creatine products may contain added sugars or carbohydrates that can affect blood glucose levels, so check labels carefully.

• Hydration status – Creatine increases water retention in muscle cells, so adequate fluid intake is essential, particularly for those taking diuretics or experiencing diabetic complications affecting fluid balance.

Patients with type 2 diabetes considering creatine supplementation should discuss this during routine diabetes reviews with their GP, practice nurse, or diabetes specialist, particularly if they have existing complications, take multiple medications, or have concerns about kidney function. Regular monitoring of HbA1c, renal function, and blood glucose levels remains essential, as outlined in NICE guidance (NG28) and NHS diabetes annual review protocols.

Effects of Creatine on Blood Sugar and Insulin Sensitivity

Research into creatine's effects on glucose metabolism has yielded some promising findings, though results are modest and variable between individuals. Several mechanisms may explain how creatine might influence blood sugar regulation in people with type 2 diabetes, particularly when combined with structured exercise.

Creatine may support glucose transporter type 4 (GLUT4) translocation to the cell membrane in skeletal muscle, particularly during and after exercise. GLUT4 is the primary insulin-regulated glucose transporter, and its proper functioning is often impaired in type 2 diabetes. By potentially facilitating GLUT4 activity and supporting insulin signalling pathways within muscle cells, creatine may help improve the muscle's ability to take up glucose from the bloodstream. However, these mechanisms are largely derived from exercise physiology studies and small trials, and the clinical significance in people with type 2 diabetes requires further investigation.

Systematic reviews of clinical trials have found that creatine supplementation, particularly when combined with resistance or mixed exercise training, may produce modest improvements in glycaemic control in some individuals with type 2 diabetes. Studies have reported small reductions in fasting blood glucose, postprandial (after-meal) glucose levels, and HbA1c—the key marker of long-term blood sugar control used by the NHS to monitor diabetes management. The most consistent benefits appear when creatine is paired with supervised resistance training, rather than used as a standalone supplement.

The proposed mechanisms include:

• Enhanced muscle glucose uptake, particularly during exercise

• Improved insulin signalling pathways within muscle cells

• Increased muscle mass (when combined with resistance training), which provides greater glucose storage capacity

• Potential effects on inflammatory markers associated with insulin resistance

It is important to emphasise that responses vary considerably between individuals, and not all studies have shown significant effects. Creatine should be viewed as a potential adjunct to support exercise performance and training quality, not as a replacement for prescribed diabetes medications or the lifestyle modifications recommended in NICE guidance (NG28). The foundation of type 2 diabetes management remains evidence-based medications (such as metformin), structured dietary changes, regular physical activity, and ongoing monitoring.

Potential Benefits of Creatine for Type 2 Diabetes Management

Beyond modest and variable effects on glucose metabolism, creatine supplementation may offer several additional benefits relevant to type 2 diabetes management when integrated into a comprehensive treatment plan that includes diet, exercise, and medication as recommended by NICE.

Enhanced exercise performance is the most well-established benefit. Physical activity is a cornerstone of type 2 diabetes management; NICE guidelines (NG28) advise at least 150 minutes of moderate-intensity activity weekly, including resistance training on two or more days. Creatine supplementation can improve strength, power output, and recovery from resistance training, potentially making exercise programmes more effective and improving training quality. Increased muscle mass resulting from resistance training creates additional glucose storage capacity, which may contribute to better glycaemic control over time.

Creatine may indirectly support body composition improvements. Type 2 diabetes is strongly associated with excess body fat, particularly visceral adiposity. Whilst creatine itself does not directly burn fat, it can facilitate more intensive and consistent training, which may contribute to fat loss and lean muscle gain when combined with appropriate dietary changes. Improved body composition is associated with better insulin sensitivity and reduced cardiovascular risk.

Some preliminary research suggests potential neuroprotective effects, which may be relevant given that diabetes increases the risk of cognitive decline and peripheral neuropathy. However, this evidence is early-stage and not specific to people with type 2 diabetes, so these potential benefits should be considered speculative at present.

Early evidence also suggests creatine might have cardiovascular effects, though again these findings are preliminary and not established in type 2 diabetes populations. Any cardiovascular benefits would likely be indirect, mediated through improved exercise capacity and body composition.

It is crucial to emphasise that these potential benefits are adjunctive—creatine should complement, not replace, evidence-based diabetes treatments including metformin, lifestyle modification, and regular monitoring as outlined in NICE guidance. Creatine is not included in NICE or NHS diabetes guidelines, reflecting the limited clinical evidence base rather than endorsement or prohibition. Decisions about its use should be individualised and made in consultation with your diabetes care team.

Risks and Precautions When Using Creatine with Type 2 Diabetes

Whilst creatine is generally well-tolerated, individuals with type 2 diabetes should be aware of specific risks and take appropriate precautions before and during supplementation.

Kidney function concerns represent the primary consideration. Diabetic kidney disease affects approximately 40% of people with type 2 diabetes and is a leading cause of chronic kidney disease in the UK. Creatine supplementation increases creatinine production—a waste product filtered by the kidneys—which can raise serum creatinine levels and lower creatinine-based eGFR estimates without indicating true kidney damage. Whilst current evidence does not suggest creatine causes kidney damage in people with healthy kidney function, those with existing renal impairment should exercise caution.

According to NICE guidance on chronic kidney disease (NG203), individuals with an eGFR below 60 mL/min/1.73 m² or evidence of albuminuria should discuss kidney status with their clinician before starting creatine. Creatine is generally not recommended for those with advanced chronic kidney disease or acute kidney injury. If kidney function results are uncertain after starting creatine, your clinician may consider cystatin C-based eGFR or repeat testing to distinguish between analytical effects and true changes in kidney function.

Gastrointestinal side effects, including nausea, diarrhoea, and abdominal cramping, occur in some users, particularly during high-dose loading phases. These symptoms may be more problematic for individuals taking metformin, which commonly causes gastrointestinal disturbance. Starting with lower doses (3–5 grams daily without a loading phase), taking creatine with meals, and ensuring adequate fluid intake may minimise these effects.

Weight gain from increased water retention in muscles is common and typically amounts to 1–2 kg. Whilst this is not fat gain, patients should be aware of this effect, particularly if monitoring weight as part of their diabetes management plan.

Quality and purity concerns exist within the supplement industry. Food supplements in the UK are regulated under food law by the Food Standards Agency (FSA) and Trading Standards, not by the Medicines and Healthcare products Regulatory Agency (MHRA), which oversees medicines. This means supplements do not undergo the same pre-market authorisation as medicines, and quality can vary. Choose plain creatine monohydrate from reputable brands with third-party testing certification, such as Informed-Sport. Avoid proprietary blends with undisclosed ingredients, and check flavoured products for added sugars or carbohydrates that might affect blood glucose.

When to contact your GP or diabetes team:

• Before starting creatine if you have known kidney problems, diabetic complications, or an eGFR below 60 mL/min/1.73 m²

• If blood glucose patterns change significantly after starting supplementation

• If you develop persistent gastrointestinal symptoms

When to seek urgent medical help (NHS 111 or 999):

• Severe muscle pain, weakness, or cramping with dark-coloured urine (possible rhabdomyolysis)

• Marked dehydration or sudden reduction in urine output

• Symptoms suggesting acute kidney injury

Regular monitoring of kidney function, HbA1c, and blood glucose remains essential for anyone with type 2 diabetes, as outlined in NHS diabetes annual review protocols. If you experience any suspected side effects from creatine or any supplement, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

NHS and NICE Guidance on Supplements for Type 2 Diabetes

The NHS and NICE provide comprehensive guidance on type 2 diabetes management, though specific recommendations regarding creatine supplementation are not currently included in formal clinical guidelines. Understanding the broader context of supplement use in diabetes is essential for informed decision-making.

NICE guideline NG28 on type 2 diabetes in adults emphasises lifestyle modification as the foundation of management, including dietary changes and increased physical activity. The guidance recommends structured education programmes—such as DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) or X-PERT—and individualised approaches to diet, but does not endorse routine supplementation with products like creatine for glycaemic control. The absence of creatine from these guidelines reflects the limited clinical evidence base in type 2 diabetes, rather than a specific endorsement or prohibition.

The NHS position on dietary supplements for diabetes is generally cautious. NHS guidance states that most people can obtain necessary nutrients through a balanced diet and that supplements should not replace healthy eating or prescribed medications. However, this does not preclude the use of supplements like creatine for specific purposes, such as supporting exercise performance, provided they are used safely and under appropriate supervision.

Current NHS and NICE recommendations prioritise:

• Evidence-based medications (metformin as first-line treatment)

• Structured lifestyle interventions including diet and physical activity (at least 150 minutes of moderate-intensity activity weekly, including resistance training)

• Regular monitoring of HbA1c, blood pressure, cholesterol, and kidney function (eGFR and albumin-to-creatinine ratio)

• Annual reviews for diabetic complications, including kidney disease, retinopathy, foot health, and cardiovascular risk

• Patient education and self-management support through structured programmes

Food supplements in the UK, including creatine, are regulated under food law by the Food Standards Agency (FSA) and local Trading Standards authorities, not by the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medicines. This means supplements do not undergo the same rigorous pre-market safety and efficacy assessment as medicines, and quality can vary between products. Consumers should choose reputable brands with third-party testing certification.

Patients interested in creatine supplementation should raise this during routine diabetes reviews with their GP, practice nurse, or diabetes specialist. Healthcare professionals can assess individual suitability, consider potential interactions with existing medications, review kidney function status in line with NICE guidance on chronic kidney disease (NG203), and arrange appropriate monitoring. This collaborative approach ensures that any supplement use is integrated safely within the overall diabetes management plan, consistent with the personalised care approach advocated by NICE and the NHS.

For further information, consult NICE guideline NG28 (Type 2 diabetes in adults: management), NICE guideline NG203 (Chronic kidney disease: assessment and management), and NHS resources on type 2 diabetes annual reviews and monitoring.

Frequently Asked Questions