Metformin glucose metabolism effects

Antidiabetic Drugs other than Insulin. Figure 3 The antihyperglycaemic effect of metformin involves enhanced insulin-mediated suppression of hepatic glucose production and muscle glucose uptake. Metformin also exerts non-insulin-dependent effects on these tissues, including reduced fatty acid oxidation and increased anaerobic glucose metabolism by the intestine. FA, fatty acid f, increase i decrease. 

In a placebo-controlled study in 40 patients with impaired glucose tolerance metformin 500 mg bd for 6 months increased insulin-stimulated glucose metabolism by 20% with minimal improvement in glucose tolerance this effect was maintained after 12 months (11). 

Lehtovirta M, Forsen B, Gullstrom M, Haggblom M, Eriksson JG, Taskinen MR, Groop L. Metabolic effects of metformin in patients with impaired glucose tolerance. Diabet Med 2001 18(7) 578-83. 

Metabolism Prickly pear cactus is a popular food among Mexicans, Mexican-Ameri-cans, and Hispanics and is commonly used to treat type 2 diabetes mellitus. The combination of prickly pear cactus with oral hypoglycemic agents, such as metformin and glipizide, in patients with type 2 diabetes mellitus may increase the risk of hypoglycemia because of additive blood glucose lowering effects [70" ]. 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

ALCOHOL METFORMIN Enhanced effect of metformin and t risk of lactic acidosis. May cause a clisulfirain-like interaction Alcohol is known to potentiate the effect of metformin on lactate metabolism. It inhibits glucose production and release from many sources including the liver The onset of lactic acidosis is often subtle with symptoms of malaise, myalgia, respiratory distress and t non-specific abdominal distress. There may be hypothermia and resistant bradyarrhythmias... 

Hollenbeck CB, Johnston P, Varasteh, BB, et al. Effects of metformin on glucose insulin and lipid metabolism in patients with mUd hypeitryglyceridaemia and noninsulin dependent diabetes by glucose tolerance test criteria. Diabete Metab 1991 17 483 89. 

Reaven GM. Effect of metformin on various aspects of glucose, insulin and lipid metabolism in patients with non-insulin-dependent diabetes mellitus with varying degrees of hyperglycemia. Diab/Metab Rev 1995 11 S97-S108. 

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