I am a medical doctor, a resident, specializing in the popularization of medical knowledge for the benefit of human health, if you want to know more, please pay attention to me, have questions can be left a message, will respond!

What do I need to be aware of when taking metformin glucose-lowering drugs for a long period of time?

At present, the number of domestic diabetes is a lot of people, as early as 2015 there is a survey showed that the total number of diabetes in our country has reached 100 million, and we all know that diabetes is a chronic disease, need to take medication for a long time, and these many antihyperglycemic drugs have a tried and tested veteran, it is metformin. Mention of metformin is estimated that most people will not feel unfamiliar, because almost every diabetic patient has taken this drug, it can withstand the test of a hundred years and still standing, naturally have its advantages. Today I'll share some knowledge about Metformin and related facts to help clear up some of your doubts.

1. What are the advantages of metformin as a first-line hypoglycemic agent?

Metformin's glucose-lowering mechanism is mainly to inhibit the output of liver glycogen and reduce blood glucose, may be many people for liver glycogen is not too understand, in fact, it is the equivalent of a storage warehouse, is responsible for storing some sugar, when the body needs it will release some glucose to give us energy supply.

Additionally Metformin can have a hypoglycemic effect by promoting the sensitivity of peripheral tissues to insulin, which promotes the uptake and utilization of glucose by the body's tissues and organs. What does this mean? Generally speaking, in our body, insulin is the only hypoglycemic hormone, it wants to play a hypoglycemic effect, it must be combined with the body's insulin receptor in order to play a role, this point is similar to our ancient army with the tiger symbols, the two must be put together in order to mobilize the army.

In addition, some studies have also shown that metformin has certain effects of lowering blood lipids, anti-platelet aggregation, and inhibiting the proliferation of vascular endothelium. Many people may not have any concept of these additional effects, tell you this, the reason why those cardiovascular patients take aspirin + statins is mainly to anti-platelet aggregation and reduce blood lipids, and metformin has the effect of these two at the same time, with these effects are destined to metformin can improve the survival rate of diabetic patients and the quality of life, and delay the progress of diabetic complications.

Metformin also reduces body weight and is particularly suitable for those patients who are obese in combination with diabetes.

2. What should I be aware of when taking metformin for a long time?

• Try to choose metformin enteric-coated tablets:There are many benefits of taking metformin for a long time, but it is a drug after all, it also has some adverse reactions of its own, the most common adverse reaction of metformin is gastrointestinal irritation, there are some patients who show abdominal distension and abdominal pain, nausea, vomiting and so on after taking metformin. In order to reduce this gastrointestinal reaction of metformin, metformin enteric-coated tablets should be preferred, which is different from the general metformin in that a layer of film is added to the surface of the drug, in which case it can not be properly out of the stomach, but into the intestines in order to exert the effect of the drug. This reduces the irritation of the gastric mucosa, thus reducing digestive symptoms.
• Taking metformin should be started with a small dose:Metformin should be taken from 500mg/day, and then gradually increased to the optimal effective dose, but it should be noted that the maximum daily dose of metformin is not more than 2000mg, otherwise not only can not enhance the efficacy of the drug but also increase the probability of adverse reactions.
  
  
• Regular inspections are carried out:Metformin should be routinely checked for renal function during administration, and the frequency of checkups should preferably be controlled at 2 months/times, so as to not only reduce the risk of lactic acidosis, but also to monitor changes in renal function. When the glomerular filtration rate is found to be 45-60 ml/min should be reduced, if the glomerular filtration rate <45 ml/min should be discontinued metformin.
• Take care to take folic acid supplements:The latest research shows that long-term oral metformin can inhibit the body's absorption of folic acid, easy to lead to the human body lack of folic acid, so you need to pay attention to folic acid supplementation, you can take oral folic acid tablets can also eat more vegetables and fruits.

Final Summary: The dos and don'ts of taking Metformin are summarized as above, and it is important to note here that Metformin is a relatively safe medication that has relatively fewer adverse reactions to worry about. Compared to the dangers associated with diabetes itself, these adverse effects of metformin are really nothing.

Purely hand-typed, it is not easy, if you feel that the writing can also be rewarded a praise, point a concern, if you have any questions can be left below ......

What do I need to be aware of when taking metformin glucose-lowering drugs for a long period of time?

Li Qing, Tianjin TEDA Hospital

Metformin was formally used in clinical practice in 1957, and is currently the most prescribed oral hypoglycemic drug in Europe and the United States, and is also the drug of choice for the treatment of type 2 diabetes mellitus as stipulated in the Diabetes Prevention and Control Guidelines of the United States, Europe, and China. Metformin has survived for more than 50 years, which shows its strong vitality.

Metformin lowers blood glucose by 1) promoting the absorption and utilization of glucose by fat and muscle; 2) reducing glucose absorption through the digestive tract; 3) inhibiting the release of glucagon; and 4) increasing insulin sensitivity.

Metformin, in combination with any other hypoglycemic agent, can increase the hypoglycemic efficacy, which lays a solid foundation for it to become the primary therapeutic agent for type 2 diabetes mellitus. In addition, metformin reduces cardiovascular complications in patients with type 2 diabetes mellitus, which is its greatest advantage.

Metformin starts with a minimum dose of 500mg/day and an optimal effective dose of 2000mg/day. Metformin does not promote insulin secretion, so there are no hypoglycemic side effects.

In clinical work, there are still some doctors and patients who have misconceptions about the use of metformin. For example, because of the fear of gastrointestinal reaction and failed to take advantage of the dose of metformin; the fear of causing lactic acidosis; the fear of metformin damage to renal function and do not dare to use, and even proteinuria is also regarded as a contraindication. These concerns have caused some patients who could have benefited from metformin therapy to miss out on it.

According to 2014 our Expert Consensus on the Clinical Use of Metformin:

1, the main adverse reaction of metformin is gastrointestinal reaction, mostly appeared in the early stage of treatment (the first 10 weeks), with the prolongation of the treatment time, patients can gradually tolerate or symptoms disappear. Suggestion: Start with a small dose, gradually increase the dosage and take it with meals.

2. The issue of metformin and lactic acidosis is actually a "family feud" and has little to do with metformin. Metformin can cause severe lactic acidosis, and therefore withdrawn from the market.

There is no conclusive evidence linking metformin to lactic acidosis, and the Cochrane Collaboration's authoritative review 2010 meta-analysis indicates that "there is no evidence from prospective controlled studies or observational cohort studies that metformin treatment increases the incidence of lactic acidosis compared with other glucose-lowering treatments. "

3, Metformin is not nephrotoxic. Metformin is excreted through the kidneys, and impaired renal function may lead to drug accumulation, but it is not that, metformin impairs renal function.

Our guidelines still recommend that metformin use be adjusted according to the level of eGFR: no dose reduction is needed for eGFR ≥60 ml/min, dose reduction at 45-60 ml/min, and discontinuation at <45 ml/min.

The 2015 DKD (Organization for Improving Prognosis in Diabetic Kidney Disease) has the following recommendations for the use of metformin: some studies have shown that metformin can be used when eGFR is ≥45 ml/min, caution is needed when <45 ml/min, and it should be contraindicated when <30 ml/min. However, it can be used even if the eGFR is 15-29 ml/min when the patient's renal function is stable and other medications for glycemic control or other medications have significant side effects.

However, metformin should now be used in accordance with our guidelines, i.e., discontinued when eGFR is <45 ml/min.

The drug Metformin is no stranger to diabetics. Metformin is the preferred drug and full treatment drug for type 2 diabetics in the absence of contraindications, and metformin can also be taken for glycemic control in type 1 diabetics. Whether it is postprandial blood glucose or fasting blood glucose, metformin has a certain control effect, at the same time, clinical data also show that metformin long-term use, with a reduction in cardiovascular system risk and other in the face of the health benefits, therefore, although metformin is an old drug, but still in the treatment of diabetes, is very important one of the drugs.

What do you need to pay attention to during long-term metformin use? Today to talk to you briefly -

1. Attention to blood glucose monitoring

What is the purpose of our medication? Of course it is to control blood sugar! Then whether it is mild type 2 diabetes patients taking metformin alone, or a combination of drug regimen containing metformin, should pay attention to blood glucose monitoring, if you find that the blood glucose control is not good, you should promptly improve the diet, strengthen the exercise, and rationally improve the drug regimen.

Only fasting blood glucose, postprandial blood glucose control standards, can effectively reduce the occurrence of diabetic complications, in fact, if you can through diet, exercise, rational use of medication, etc., control blood sugar, diabetic life expectancy, and will not be affected by this slow disease.

2. Attention to drug side effects

Are there any side effects of Metformin, of course there are. The main side effects of Metformin are gastrointestinal adverse reactions, nausea, vomiting, abdominal pain, diarrhea and other digestive adverse reactions may occur. Therefore, it is generally recommended that at the beginning of the medication, you should choose to take a low dose, and then gradually increase the dosage after your body tolerates it. The initial dosage of Metformin is generally recommended to be 0.5g/day, while for some people with particularly sensitive gastrointestinal tract, starting from a dosage of 0.25g/day can also be considered.

3. Attention to liver and kidney function monitoring

First of all, Metformin is a drug that does not harm the liver or kidneys, and long-term use of the drug will not affect liver and kidney function. However, for those who have problems with their liver and kidney function, they should pay attention to the risk of lactic acidosis that may be caused by decreased liver and kidney function during the use of the drug.

Usually if the transaminase is more than 3 times higher than the normal value, metformin should be stopped, and for patients with weakened renal function, such as chronic kidney disease patients, elderly patients, etc. should also pay attention to the detection of renal function, recommended glomerular rate filtration of more than 45 do not have to reduce the dose of the drug, glomerular rate filtration between 30 to 45 attention to reduce the dose of the drug, while less than 30 should be discontinued.

4. Attention to vitamin B12 supplementation

Metformin long-term use, will affect the gastrointestinal tract for the absorption of vitamin B12, vitamin B12, as a kind of only contains metal elements of the B vitamins, vitamin B12 for promoting the production of blood cells, the health of the nervous system and other aspects has an important physiological function, so taking metformin, should pay more attention to supplementing vitamin B12, animal liver, some shellfish seafood, beef, dairy products are sources of intake of vitamin B12. Animal liver, certain shellfish seafood, beef, and dairy products are all sources of vitamin B12, and for those who do have a vitamin B12 deficiency, you can take oral methylcobalamin tablets and other medications to supplement.

5. Attention to other aspects of life regulation

For the regulation of blood sugar, taking drugs is only one aspect, in life, do a balanced diet, control sugar intake, quit smoking and alcohol, moderate exercise, reduce late at night, pay attention to blood glucose monitoring, understanding and learning about diabetes, through a healthy lifestyle to assist in the control of blood glucose, but also pay attention to the regulation of blood pressure and blood lipids, pay attention to weight loss and weight reduction, to do the above aspects, coupled with the reasonable use of medication, to control blood glucose is more than half the result. The control of blood glucose is twice the result with half the effort.

Metformin as one of the classic drugs for the treatment of diabetes mellitus, according to the past decades of experience in the use of the relevant clinical trials, has been confirmed that its hypoglycemic effect is obvious, high safety, it is recommended that no contraindications to the use of metformin diabetic patients should be used, the clinical use of its status is similar to the cardio-cerebral vascular disease of the 'miracle drug' aspirin.

Therefore, newly diagnosed type 2 diabetes mellitus should be perfect glycated hemoglobin test, the index can reflect the blood sugar status in the last 3 months, unless the glycated hemoglobin is close to the normal 7.5%, can be considered as a lifestyle control of blood glucose, 3 months or so, blood glucose can't reach the standard, it is recommended to give medication, drug treatment preferred metformin.

Metformin is a biguanide hypoglycemic drug that lowers blood glucose primarily by reducing the output of glucose from the liver and improving insulin resistance to increase insulin sensitivity. Metformin reduces hyperglycemia without lowering normal blood glucose levels, has a lower risk of hypoglycemia, and reduces insulin dosage when combined with insulin.

The most common adverse reactions to metformin during initial treatment are gastrointestinal symptoms, such as nausea and vomiting, diarrhea, abdominal pain, loss of appetite, and other reactions. In order to avoid gastrointestinal symptoms, metformin can be taken in 2-3 divided doses with or after meals, and gastrointestinal reactions are usually relieved on their own in most patients. Its most serious side effect is lactic acidosis, but the incidence of this side effect is extremely low and very rare.

Metformin is not used if there is moderate to severe hepatic or renal insufficiency; cardiopulmonary insufficiency; pregnancy and lactation; trauma and surgical stress. If you are going to have an enhanced CT, enhanced MRI, or other conditions that require the use of angiographic contrast media, you need to stop metformin 24 hours before and after the use of the contrast media.

In conclusion, metformin is effective with few side effects and is recommended for all diabetic patients without contraindications.

Metformin is a commonly used medication for diabetes, and many older sugar users are familiar with it. The following small sugar is to organize the things you need to pay attention to when taking metformin. If you find it useful, you may want to bookmark it.

1. Metformin can cause adverse gastrointestinal reactions, theThe main symptoms are diarrhea, nausea, vomiting, bloating, indigestion, abdominal discomfort, etc. These adverse symptoms mostly occur at the beginning of the medication, and most of the patients' adverse reactions will disappear as the treatment time is pushed longer. In order to avoid such adverse reactions, patients are advised to start with a small dose and gradually increase the dosage.

2. Metformin has no liver or kidney toxicity.Metformin is not metabolized by the liver and has little effect on kidney function, although it is excreted through the kidney tubules. However, metformin is not recommended in the presence of severe abnormalities of liver and kidney function; consult your doctor for details.

3. Metformin interferes with the absorption of vitamin B12.Long-term use of metformin can cause a decline in vitamin B12 levels, so sugar lovers need to pay attention to vitamin B12 supplementation, vitamin B12 is mainly found in animal foods, mainly liver, meat, dairy products also contain a small amount of, sugar lovers can usually eat some in moderation.

4. Metformin needs to be taken in doses thatThe minimum recommended dose is 500 mg daily, the maximum recommended dose is 2550 mg daily, and the optimal effective dose is 2000 mg daily. Please follow your doctor's instructions for exact dosage.

5. There is a time to take metformin.

Regular tablets or capsules: should be taken with or after meals to minimize adverse gastrointestinal effects.

Extended-release tablets or capsules: 1 time daily, usually with or after a dinner meal.

Enteric-coated tablets or capsules: should be taken 30 minutes before a meal to be able to have a better effect.

6. Alcohol consumption should be avoided as much as possible while taking metformin.For one, it may cause hypoglycemia, and for another, it is prone to serious adverse effects such as moderate lactic acid.

I hope this answer is helpful, remember to like it!

Metformin is the first-line drug for the treatment of diabetes, and many sugar lovers need to take it for a long time. However, many sugar users still have a lot of questions about the dosage and side effects of the drug. Today, "Ask the Doctor" will answer all of them.

How does metformin lower blood sugar? What are the side effects?

Metformin has been used for more than 60 years and its mechanism of action is mainly:Inhibition of hepatic glycogen output, increases the sensitivity of peripheral tissues to insulin. The drug itself does not stimulate insulin secretion, and the level of insulin does not increase after taking the drug, so it is suitable for sugar users with high fasting blood sugar.

Metformin also has side effects, and about 5 to 20% of patients taking metformin will developreversibilityof gastrointestinal reactions, like diarrhea, bloating, abdominal discomfort, nausea, vomiting, loss of appetite, abdominal pain, metallic taste in the mouth, and so on. The incidence of diarrhea is as high as 15-20%.

However, all of the gastrointestinal reactions described above are mild or moderate. Most patients tolerate or experience a decrease in symptoms over time without affecting the continuation of therapy, and fewer than 5% of patients discontinue their medication because of severe abdominal pain, diarrhea, nausea, and vomiting.

How should metformin side effects be minimized?

1. Start with a small dose of 0.5 grams, or 1 tablet, at a time.Monitor your blood sugar during medication. Increase the dose every 2 to 3 days depending on the blood sugar.Note: The maximum dose in a day should not exceed 2 grams, or 4 tablets.

2. Choose the right time to administer the medication.

regular filmIt is taken 3 times a day, usually within half an hour of a meal. This is because metformin can irritate the gastrointestinal tract, and by taking it after a meal, the food in your stomach can lessen the adverse gastrointestinal reactions caused by metformin.

enteric-coated tablet (medicine)It is taken 3 times a day, usually half an hour before meals. Compared with ordinary tablets, enteric-coated tablets are released after reaching the intestines and have less irritating effect on the upper gastrointestinal tract, which not only reduces the adverse reactions in the upper gastrointestinal tract, but also reduces the depletion of the drug in the upper gastrointestinal tract and increases the bioavailability of the drug.

delayed-release tabletIt is taken once a day, usually with dinner. This is because studies have found that taking extended-release tablets with food increases the absorption of the drug by about 50%, meaning that extended-release tablets are more effective in lowering sugar when taken with a meal. The extended-release form of metformin drug dissolves and releases slowly, causing fewer side effects on the stomach, and should only be taken once a day.

Note: Regardless of the dosage form, it should be taken strictly as described in the instructions and should not be broken, chewed or chewed.

3. Prolonged use of metformin can lead to decreased levels of vitamin B12, which should be supplemented in moderation.Foods rich in vitamin B12 include: beef, pork, lamb, ham, chicken and duck, fish, especially cod and tuna, dairy products such as milk, cheese and yogurt, and eggs.

The above content is edited and organized by "ask the doctor" for you, want to know more authoritative knowledge of diabetes medication, welcome to pay attention to us, check out the "start from scratch to reduce postprandial blood glucose: reversing diabetes" column!

What is Metformin?

Metformin is one of the commonly used hypoglycemic drugs used to control type 2 diabetes. Metformin does not cure diabetes, but helps to keep blood sugar in a safe range.

Metformin is a very safe and effective hypoglycemic agent and the drug of choice for the treatment of type 2 diabetes. In recent years it has been discovered that metformin may have other effects and may even have the potential to extend life. However, because the drug is so cheap, there is a demonization of metformin in the country and many diabetics do not prefer to take metformin.

Patients taking metformin often experience weight loss, it is the only drug among the hypoglycemic drugs that has such an effect, and it is good for diabetics to lose weight, but metformin does not have a direct weight loss effect, its effect is indirect.

How do I take metformin?

Blood sugar control in diabetics is a lifelong affair, so metformin must be taken for a long time.

The maximum daily dose of metformin is 2,550 milligrams, and doctors are divided into two schools of thought as to how to take it; endocrinologists and diabetologists are aggressive in their use of metformin, usually starting out with a high dose of 2,000-2,500 milligrams per day, if the patient can tolerate it, and internists are cautious, starting with 500 milligrams per day.

Which is appropriate depends on the patient's ability to tolerate it, that is, the side effects, and the results of regular testing. Because metformin has other benefits, if there are no side effects or if they are mild, a high dose should be used.

Metformin alone may not lower blood sugar to the desired range and is often combined with other glucose-lowering medications.

Patients taking metformin and other glucose-lowering medications should have blood tests every three to four months to make adjustments if abnormalities are found.

Common Side Effects of Metformin

These side effects, which vary from person to person and usually occur when you first start taking the medication and will go away after a while, include heartburn, abdominal pain, nausea and vomiting, bloating, gas production, diarrhea, weight loss, headache, and abnormal taste.

Serious side effects of metformin

The most serious side effects of metformin arelactic acidosis, which is very rare and must be treated immediately, has symptoms of excessive tiredness, weakness, loss of appetite, nausea, vomiting, difficulty breathing, dizziness, vertigo, fast or slow heartbeat, feeling cold, hot flashes, and abdominal pain. To prevent lactic acidosis, monitor kidney function regularly and reduce the dosage if there are problems.

Next.anemicBecause metformin can cause a drop in vitamin B12 levels, take a B complex vitamin supplement while taking metformin.

tersehypoglycemia, Metformin does not cause hypoglycemia by itself, but rather occurs with poor diet, strenuous exercise, excessive alcohol consumption, and combination with other hypoglycemic medications, with symptoms of weakness, fatigue, nausea, vomiting, abdominal pain, dizziness, headache, and abnormal heartbeat.

dimethylbis (chemistry)Guanidine contraindications

Metformin should not be used if you have severe kidney disease or are over 80 years old.

Metformin should not be used in people with acute heart failure or a recent heart attack because the kidneys do not supply enough blood to effectively eliminate metformin.

People with severe liver disease can out lactic acid buildup, raising the risk of lactic acidosis, and should not take metformin.

Drinking alcohol while taking metformin increases the risk of hypoglycemia and also increases the risk of lactic acidosis, so you should not drink alcohol while taking the drug.

If iodine contrast agents are used during surgery and radiography, discontinue metformin 48 hours before to minimize the risk of lactic acidosis, and only continue the medication afterward to make sure that renal function is normal.

Metformin is recommended as the first choice and full course of medication for the treatment of type 2 diabetes mellitus in the latest guidelines for diagnosis and treatment. Its hypoglycemic efficacy is a 1.0%-1.5% decrease in glycosylated hemoglobin and can reduce body weight. Numerous clinical studies have demonstrated that metformin can effectively reduce cardiovascular mortality and prevalence in obese patients, and metformin can also prevent and delay type 2 diabetes.

The main adverse effects and precautions for its long-term application are:

1, gastrointestinal reaction, mainly heartburn, acid reflux and diarrhea, related to the dose and dosage form, for the gastrointestinal reaction is heavy, you can start from a small dose and gradually increase the dose to the tolerated dose, the first 500mg, and gradually increase to 2,000mg, can also be replaced with extended-release dosage form or take after meals, and now Gerwalds has an extended-release dosage form on the market, which has a very good effect.

2, hypoglycemic reaction, when consumed alone will not cause hypoglycemia, but with other hypoglycemic drugs in combination with hypoglycemic reaction will still occur, hypoglycemia rapid diagnosis of hypoglycemia for hypoglycemic symptoms (palpitations, appeared, fatigue) + episodes of glucose less than 2.8 mmol / L + eating after the symptomatic relief, in order to avoid hypoglycemia should be taken according to the doctor's instructions, regular meals, avoid taking medication not to eat.

3、Biguanide is contraindicated in renal insufficiency, blood creatinine is more than 132.6umol/L for men and more than 123.8umol/L for women, or glomerular filtration rate is less than 45 ml/min, between 45-60 ml/min can be used in half the amount. Today's headline - Dr. Zhang, Department of Integrative Medicine

4, hepatic insufficiency: metformin is not metabolized by the liver, but aminotransferase is greater than 3 times the normal value of discontinued, long-term use should be regularly rechecked liver function, serious infections, hypoxia, or major surgical treatment, at this time there is a possibility of inducing lactic acidosis.

5. Iodinated contrast agents should be suspended if they are used during contrast examinations. It is generally considered to be suspended 48 hours before and after use.

6, long-term use should pay attention to vitamin B12 deficiency, but cause megaloblastic anemia is rare, it is recommended that long-term use of attention to vitamin B12 supplementation, but do not recommend that patients routinely test vitamin B12 levels.

7, special populations: in the past for the elderly patients over 80 years old do not use, the latest research as long as the patient's renal function is normal can be applied. However, it is not recommended for children younger than 10 years old. Although the major guidelines have evidence that pregnant women can be used, there is a lack of relevance studies in our country.

Metformin is well known as a first-line hypoglycemic agent, and it has defended its place in the clinic by being effective and inexpensive.

Metformin is a core medication for blood glucose control, which exerts its glucose-lowering effects by reducing the release of glucose into the bloodstream, decreasing the resistance of body cells to insulin, increasing the body's ability to utilize glucose, and facilitating the uptake of glucose by cells to utilize glucose.

Many diabetic patients in the use of metformin in the process there will be such questions: long-term consumption of this drug will not have an impact on the body? What should we pay attention to in the process of taking the drug? Today, Dr. Zeng will give you a comb through the patient concerns but also favored by doctors metformin, in the process of taking in the end need to pay attention to what?

1. Pay attention to adverse reactions

Common adverse reactions to metformin include bloating, diarrhea, nausea, vomiting, malaise, and dyspepsia. The occurrence of these adverse reactions is usually seen in the early stages of treatment and can be tolerated by the vast majority of patients. With the prolongation of treatment, the above adverse reactions will gradually disappear. Gradually increasing the dose from a small dose is an effective way to minimize the occurrence of adverse reactions in the early stages of treatment.

2, pay attention to the use of the dose

Metformin is used in a variety of dosages, and many people follow their hearts and make their own unauthorized adjustments. In fact, the glucose-lowering effect of metformin is positively correlated with the dose, 500 mg per day can reduce glycated hemoglobin by 0.6%, while 2000 mg per day can reduce glycated hemoglobin by as much as 2%. The minimum dose at which metformin works is 500 mg per day, and the optimal effective dose is 2,000 mg per day. You can start with a small dose of one tablet once a day and increase to two tablets per day after a week after the gastrointestinal tract has slowly adjusted to it, up to four tablets per day (2,000 milligrams) for optimal therapeutic effect.

3. Pay attention to the combined effects of drugs

Resin drugs, such as sulforaphane, blood extract, frankincense, etc., combined with metformin will reduce its absorption and decrease the therapeutic effect; the use of aminoclopramide, digoxin, procainamide, ranitidine, methoxybenzyl pyrimethamine, vancomycin, will affect renal function and increase the adverse effects of metformin; the concomitant use of diuretics, glucocorticosteroids, thyroid agents, estrogen, oral contraceptives, phenytoin, sympathomimetics, calcium channel blockers and isoniazid can cause an increase in blood glucose; these drugs should be monitored for hypoglycemia after discontinuation; combined with warfarin can enhance warfarin's antihyperglycemic properties. , calcium channel blockers and isoniazid can cause an increase in blood glucose, after these drugs are discontinued, close attention should be paid to the occurrence of hypoglycemia; combined with warfarin, it can enhance the anticoagulant effect of warfarin, which is easy to trigger bleeding.

4. Pay attention to the use of metformin during contrast or general anesthesia

Patients with normal renal function do not need to stop using metformin before contrast, but should stop using it for 48~72 hours after using contrast under the guidance of doctor, and then continue to use it after reviewing normal renal function; patients with abnormal renal function should temporarily stop using it for 48 hours before using contrast and general anesthesia, and then need to stop using it for 48~72 hours after that, and then continue to use it after reviewing normal renal function.

5. Attention to supplemental vitamin B12

Long-term use of metformin reduces intestinal absorption of vitamin B12, leading to significant decreases in vitamin B12 levels. A small number of people will cause megaloblastic anemia. Therefore, metformin should be supplemented with vitamin B12 and folic acid, and oral calcium supplementation is beneficial to prevent vitamin B12 levels from decreasing; methylcobalamin is a kind of active vitamin B12, and combined use can effectively prevent vitamin B12 deficiency.

6. Regular testing of indicators

During the course of treatment, especially at the beginning of dose adjustment, close observation must be made, and fasting blood glucose, urine glucose and urine ketone bodies must be measured regularly. In general, taking metformin usually requires 2 to 3 weeks of treatment to achieve hypoglycemic efficacy. If blood glucose has been controlled, the dose can be appropriately reduced to prevent hypoglycemia, coma or acidemia.

7, different dosage forms of metformin medication time has to be careful

Regular tablets or capsules: should be taken with or after meals to reduce gastrointestinal adverse reactions such as bloating, dyspepsia, abdominal discomfort, nausea and vomiting; Extended-release tablets or capsules: once a day, can be taken with or after dinner meal; Enteric-coated tablets or capsules: less gastrointestinal reactions, should be taken 30 minutes before meals. At doses ≥ 2000 mg daily, the drug is best taken in divided doses with meals for better tolerance. Chewing of enteric-coated and extended-release tablets or capsules is prohibited for oral administration.

8. Lactic acidosis

Many people worry that taking metformin will cause lactic acidosis, but the culprit is actually its big brother, phenelzine, which was withdrawn from the market because of the serious adverse reaction of lactic acidosis during its use. In fact, there are molecular structural differences between metformin and phenethylformin, so it is extremely rare for metformin to cause lactic acidosis in the therapeutic dose range. However, if the patient has conditions associated with systemic hypoxia, such as cardiopulmonary failure, acute myocardial infarction, shock, or abnormal liver function, this can cause an increase in lactic acid production and may induce lactic acidosis. When unexplained hyperventilation, myalgia, malaise, lethargy, somnolence, or other nonspecific symptoms occur, the drug should be discontinued immediately and prompt medical attention sought.

9, can not drink alcohol while taking

Ethanol can inhibit hepatic gluconeogenesis and increase the hypoglycemic effect of metformin. Therefore, try not to drink alcohol while taking Metformin, so as not to cause hypoglycemia, or even life-threatening.

★ If this answer is helpful, please like and support it!

Metformin is the main and most commonly used in diabetic patients an oral hypoglycemic drugs, it is listed in the domestic market for more than 20 years, the efficacy and safety has been clinically tested, but the long-term use of metformin, there must still be some side effects, only compared with the role of the treatment of diabetes, these side effects are generally speaking can be tolerated.

What are some of the things you need to be careful about with long-term metformin use?

1. The most common and most likely adverse reactions to metformin are gastrointestinal reactions, such as nausea, vomiting, diarrhea, bloating and other discomforts, which are usually more pronounced at the beginning of the dose, and with the prolongation of the medication time, the majority of patients can tolerate, and the symptoms can be reduced to a very mild. Therefore, the beginning of the medication should start with a small dose, and gradually increase the dose, can reduce the occurrence of hair action.

2. Metformin may interfere with the absorption of vitamin B12. For long-term use, attention should be paid to vitamin B12 supplementation, especially for the elderly, who have weaker gastrointestinal absorption function.

3. Metformin itself is not hepatotoxic, but if the patient's liver or kidney function is inherently inadequate, care should be taken when taking metformin.

In case of hepatic insufficiency, lactate metabolism may be reduced, and metformin inhibits lactate metabolism, so lactic acid accumulation toxicity is likely to occur, so for long-term use, monitor liver function for one thing, and be careful to monitor acid-base balance for another.

If the renal function is reduced, minor can not need to reduce the dosage, but severe renal insufficiency or even renal failure, when you need to take metformin need to reduce the dosage, generally glomerular filtration rate is less than 45 should be reduced according to the situation.

I'm Pharmacist Anonymous, click to follow and I'll share more of my drug knowledge with you.