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Metformin

Meat-farmer
Picmonic
Metformin is part of the biguanide class of diabetic drugs. It is the first line medical treatment for diabetes mellitus type 2 and can also be used for polycystic ovarian syndrome (PCOS). Metformin has multiple mechanisms, including inhibition of mitochondrial glycerophosphate dehydrogenase (mGPD), leading to decreased gluconeogenesis and increased insulin sensitivity. Side effects of this drug include lactic acidosis, GI distress, weight loss, and vitamin B12 deficiency. Metformin should be avoided in patients with renal failure.
9 KEY FACTS
INDICATIONS
Diabetes Mellitus Type 2
Dyed-bead pancreas in a (2) Tutu

Metformin is the first line medical therapy for patients with type 2 diabetes mellitus (T2DM) because unlike other antidiabetic agents, it does not cause hypoglycemia.

Polycystic Ovary Syndrome (PCOS)
Peacock with PCOS

Metformin can be used in PCOS particularly in women with co-morbid insulin resistance, as evidenced by the presence of type 2 diabetes or lab measures of insulin resistance. It can also assist with weight loss.

MECHANISM OF ACTION
Decreased Gluconeogenesis
Down-arrow Glue-genie

Metformin has multiple mechanisms of action. Metformin decreases hepatic gluconeogenesis via inhibition of mitochondrial glycerophosphate dehydrogenase (mGPD), an enzyme which normally facilitates the conversion of glycerol to glucose.

Increased Insulin Sensitivity
Up-arrow Insect-syringe at Sensitive-tears

Metformin also increases insulin sensitivity, which is the primary affliction in patients with T2DM. Metformin helps increase peripheral glucose uptake, helping to lower the blood sugar.

SIDE EFFECTS
Lactic Acidosis
Lake of Acidic-lemon

Metformin can cause elevations in lactate levels due to its inhibition of gluconeogenesis and prevention of lactate being converted to glucose. Therefore a side effect can be lactic acidosis, seen especially in cases of overdose or concurrent renal failure.

GI Distress
GI with Flare-gun

Metformin use can cause GI distress. It is associated with diarrhea, nausea and vomiting.

Weight Loss
Baggy-pants

This drug promotes weight loss, which is actually a favorable side effect for most patients.

B12 Deficiency
(12) Dozen Viking (B) Bees Broken

Another side effect of metformin is inhibition of vitamin B12 and/or folate absorption from the gastrointestinal tract.

CONTRAINDICATION
Renal Failure
Caution-tape Dead Kidney

Due to the increased risk of lactic acidosis, metformin is contraindicated in patients with renal failure. Men with a creatinine greater than or equal to 1.5 mg/dl (1.4 mg/dl for women) should not be on metformin. For patients receiving intravenous contrast for radiologic studies, metformin may be stopped for a period of time since contrast increases the risk of acute kidney injury.

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