Oral hypoglycaemics i.e. Metformin Flashcards
What is the first line treatment relating to oral hypoglycaemics in adults and children?
Metformin is the first-line treatment for type 2 diabetes in both adults and children. If metformin fails to control HbA1c levels then combine with a sulfonylurea, or a dipeptidyl peptidase-4 inhibitor, or a sodium-glucose cotransporter 2 inhibitor. If metformin is contraindicated then first-line treatment should be a dipeptidyl peptidase-4 inhibitor, a pioglitazone, or a sulfonylurea.
What are the indications of metformin?
Diabetes mellitus (type 2), polycystic ovary syndrome.
What are the contraindications of metformin?
acute metabolic acidosis (including lactic acidosis and diabetic ketoacidosis).
What is the mechanism of action of metformin?
Metformin is a biguanide which acts by increasing the use/uptake of glucose by muscle and fat cells, reducing glucose synthesis in the liver, and reducing glucose absorption from the intestine, therefore reducing blood glucose levels.
What are the common/very common unwanted side effects of metformin?
abdominal pain, anorexia, diarrhoea, loss of appetite, nausea, taste disturbances, vomiting.
What are the monitoring requirements of metformin?
determine renal function before treatment and at least annually (at least twice a year in patients with additional risk factors for renal impairment or if deterioration suspected).
What is the patient/carer advice for metformin?
inform patients/carers about risk of lactic acidosis and to seek immediate medical attention if symptoms develop such as dyspnoea, muscle cramps, abdominal pain, hypothermia or asthenia.
