Metformin

Question 1

Metformin

Answer 1

Biguainide - decreases liver glucogenesis and increases peripheral use
1st line in ALL patients with type 2 diabetes

Question 2

Metformin - SE

Answer 2

Lactic acidosis
GI disturbances
- N + V
- Diarrhoea
- Take with or after meals and increase dose gradually
- Switch to MR if persists
Weight loss
Taste disturbance
Reduced B12 absorption
RARELY HYPOGLYCAEMIA

Question 3

Metformin - contraindications

Answer 3

Acute metabolic acidosis (lactic + DKA)

Question 4

Metformin - lactic acidosis

Answer 4

Increase risk of lactic acidosis in:
- renal impairment
- sepsis
- hypoxia (cardiac failure, respiratory failure, MI
- liver failure
- dehydration

Question 5

Metformin - renal impairment

Answer 5

AVOID if eGFR <30 ml/min
Dose adjustment in moderate impairment (<45 ml/min)

Question 6

Metformin - monitoring

Answer 6

Renal function before + annually (every 6 months if at risk)

Question 7

Metformin + alcohol

Answer 7

hypoglycaemia

Question 8

Interactions - hyperglycaemia

Answer 8

Prednisolone
TLD + Loop diuretics

Question 9

Metformin + HF

Answer 9

Generally, considered safe in stable HF
Not safe in acute or unstable HF