Endocrine

Question 1

Indication : Metformin

Answer 1

Type 2 diabetes in adults, children ≥ 10 yrs (esp. overweight patients) not controlled by diet and exercise, initial treatment.

Adjuvant therapy in insulin-dependent diabetes in adult.

Question 2

Mechanism of Action : Metformin

Answer 2

Reduces blood glucose by:

1. Suppresses hepatic gluconeogenesis (gene expression).
2. Increases peripheral glucose utilisation (GLUT4 enhancer).

Question 3

Adverse Effects: Metformin

Answer 3

GI irritation: Diarrhea, cramps, nausea, vomiting, and increased flatulence.

Lactic acidosis (rare)

Question 4

Dose: Metformin

Answer 4

Conventional tablet, initially 500 mg 1–3 times daily; may be increased up to 850 mg 2 or 3 times daily according to response. Maximum daily dose 3 g.

Controlled release tablet, initially 500 mg once daily; may be increased up to 2 g once daily. When changing from conventional tablets, start with the patient’s usual daily dose. (If >2 g daily is required, use conventional tablets.)