Biguanides

Question 1

What is an example

Answer 1

Metformin

Question 2

What are the indications for use

Answer 2

Type 2 DM

Question 3

What is the mechanism of action

Answer 3

• Lowers blood glucose by increasing sensitivity to insulin
• Suppresses hepatic glucose production (glucogenolysis + gluconeogenesis)
• Increase glucose uptake + utilisation by sk muscles
• Suppress intestinal glucose absorption
• Reduces weight gain + induce weight loss

Question 4

What are the side effects

Answer 4

• Taste disturbances
• anorexia
• Diarrhoea
• Lactic acidosis

Question 5

What are the contraindications

Answer 5

• Sev renal impairment
• Dose reduction in mod impairment
• Withheld in AKI (sepsis, shock, dehydration)
• Acute alcohol intoxication
• Severe tissue hypoxia
• caution in hepatic impairment + chronic alcohol overuse

Question 6

What are the interactions

Answer 6

DIAMOND HLA

• Withheld before + after IV contrast (renal impairment)
• ACEi
• NSAIDs
• Diuretics (use with caution)
• Prednisolone
• Thiazide
• Loop diuretics oppose action + reduce efficacy