diabetestalk.net

Metformin Induced Hypoglycemia

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

Metformin, Sulfonylureas, Or Other Antidiabetes Drugs And The Risk Of Lactic Acidosis Or Hypoglycemia

A nested case-control analysis Abstract OBJECTIVE—Lactic acidosis has been associated with use of metformin. Hypoglycemia is a major concern using sulfonylureas. The aim of this study was to compare the risk of lactic acidosis and hypoglycemia among patients with type 2 diabetes using oral antidiabetes drugs. RESEARCH DESIGN AND METHODS—This study is a nested case-control analysis using the U.K.-based General Practice Research Database to identify patients with type 2 diabetes who used oral antidiabetes drugs. Within the study population, all incident cases of lactic acidosis and hypoglycemia were identified, and hypoglycemia case subjects were matched to up to four control patients based on age, sex, practice, and calendar time. RESULTS—Among the study population of 50,048 type 2 diabetic subjects, six cases of lactic acidosis during current use of oral antidiabetes drugs were identified, yielding a crude incidence rate of 3.3 cases per 100,000 person-years among metformin users and 4.8 cases per 100,000 person-years among users of sulfonylureas. Relevant comorbidities known as risk factors for lactic acidosis could be identified in all case subjects. A total of 2,025 case subjects with hypoglycemia and 7,278 matched control subjects were identified. Use of sulfonylureas was associated with a materially elevated risk of hypoglycemia. The adjusted odds ratio for current use of sulfonylureas was 2.79 (95% CI 2.23–3.50) compared with current metformin use. CONCLUSIONS—Lactic acidosis during current use of oral antidiabetes drugs was very rare and was associated with concurrent comorbidity. Hypoglycemic episodes were substantially more common among sulfonylurea users than among users of metformin. Metformin plays a pivotal role in the treatment of patients with t Continue reading >>

Oral Hypoglycemic Agent Toxicity

Oral Hypoglycemic Agent Toxicity

Practice Essentials Oral hypoglycemic agents—sulfonylureas—which are used to treat patients with type 2 diabetes, [1] are among the most widely prescribed medications in the world. Wide availability of these medications increases the potential for either intentional or unintentional overdose in pediatric and adult populations. [2] First-generation sulfonylurea compounds became widely available in 1955. They are acetohexamide, chlorpropamide, tolazamide, and tolbutamide. First-generation agents have long half-lives (eg, 49 hours for chlorpropamide). Second-generation sulfonylureas were introduced in 1984 and include glipizide, glyburide, and glimepiride. Second-generation sulfonylureas are more potent and have shorter half-lives than the first-generation sulfonylureas. Other agents besides sulfonylureas are used to treat type 2 diabetes, including biguanides, alpha-glucosidase inhibitors, and thiazolidinediones. Metformin (Glucophage in the United States), a biguanide, is one such agent. [3] Even in overdose, these agents do not decrease serum glucose below euglycemia; consequently, they are appropriately referred to as antihyperglycemic agents rather than hypoglycemic agents. Although overdose of antihyperglycemic agents can have dangerous adverse effects (for example, lactic acidosis from metformin [4] ), this article focuses on acute overdose of sulfonylureas. Hypoglycemia from sulfonylureas can result from small doses, can be delayed in onset, and can be persistent. Prolonged observation and intensive care to restore and maintain euglycemia may be required. [5] (See Treatment and Medication.) Continue reading >>

Metformin Overdose-induced Hypoglycemia In The Absence Of Other Antidiabetic Drugs

Metformin Overdose-induced Hypoglycemia In The Absence Of Other Antidiabetic Drugs

Context. Lactic acidosis is a well-recognized consequence of metformin. Hypoglycemia has been reported previously in metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. Case details. A 15-year-old girl ingested 75 g of metformin and 3 g of quetiapine. On examination in the emergency department 2 h later, she was drowsy but had normal vital signs. She developed lactic acidosis, hypotension, and recurrent and severe hypoglycemia (15 mg/dL and 20 mg/dL), requiring boluses of 50%dextrose. The first episode of hypoglycemia occurred approximately 4 h after ingestion. Serum metformin level 2 h after ingestion was 267 mg/L (therapeutic range, 0.465–2.5), and serum insulin was 2 mU/L (normal range, 6–35). Extensive laboratory investigation using high-resolution mass-spectrometry ruled out other possible hypoglycemic agents. She recovered after hemodialysis. Discussion.Metformin overdose can cause severe hypoglycemia in the absence of other antidiabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and poor oral intake. Continue reading >>

Metformin Overdose And Hypoglycemia

Metformin Overdose And Hypoglycemia

Metformin overdose-induced hypoglycemia in the absence of other antidiabetic drugs. Al-Abri SA et al. Clin Toxicol 2013 Apr 1 [Epub ahead of print] Hypoglycemia association with metformin overdose has been reported but is distinctly unusual. In cases published previously, it has not been clear if factors other than metformin toxicity — such as co-ingestion of other hypoglycemic agents or poor nutrition — have been present. This case report describes a 15-year-old girl who ingested an estimated 75 g of metformin and 3 g of quetiapine (Seroquel). On arrival at hospital, her glucose level was normal but she was drowsy, possibly due to the effects of quetiapine. Initial metformin level was 267 mg/L (therapeutic 0.465 – 2.5 mg/L). Several hours after arrival, she developed lactic acidosis and profound hypoglycemia (serum glucose 15 mg/dL) treated with dextrose infusion and hemodialysis. By the second hospital day, her mental status improved and hypoglycemia resolved. Extensive laboratory testing did not reveal the presence of any other hypoglyeemic agents. The authors conclude that: Metformin overdose can cause hypoglycemia in the absence of other glucose-lowering drugs, and blood glucose levels should be monitored closely. They are probably right, but I wish they had discussed the possibility that quetiapine could have caused or contributed to the hypoglycemia. This has been described before. Continue reading >>

Metformin

Metformin

A popular oral drug for treating Type 2 diabetes. Metformin (brand name Glucophage, Glucophage XR, Glumetza, Riomet) is a member of a class of drugs called biguanides that helps lower blood glucose levels by improving the way the body handles insulin — namely, by preventing the liver from making excess glucose and by making muscle and fat cells more sensitive to available insulin. Metformin not only lowers blood glucose levels, which in the long term reduces the risk of diabetic complications, but it also lowers blood cholesterol and triglyceride levels and does not cause weight gain the way insulin and some other oral blood-glucose-lowering drugs do. Overweight, high cholesterol, and high triglyceride levels all increase the risk of developing heart disease, the leading cause of death in people with Type 2 diabetes. Another advantage of metformin is that it does not cause hypoglycemia (low blood glucose) when it is the only diabetes medicine taken. Metformin is typically taken two to three times a day, with meals. The extended-release formula (Glucophage XR) is taken once a day, with the evening meal. The most common side effects of metformin are nausea and diarrhea, which usually go away over time. A more serious side effect is a rare but potentially fatal condition called lactic acidosis, in which dangerously high levels of lactic acid build up in the bloodstream. Lactic acidosis is most likely to occur in people with kidney disease, liver disease, or congestive heart failure, or in those who drink alcohol regularly. (If you have more than four alcoholic drinks a week, metformin may not be the best medicine for you.) Unfortunately, many doctors ignore these contraindications (conditions that make a particular treatment inadvisable) and prescribe metformin to people Continue reading >>

Hypoglycemia Induced By Therapeutic Doses Of Metformin In The Absence Of Other Anti-diabetic Drugs

Hypoglycemia Induced By Therapeutic Doses Of Metformin In The Absence Of Other Anti-diabetic Drugs

Abstract Context: Hypoglycemia due to metformin used in therapeutic dose is not frequently encountered. Metformin induced hypoglycemia has been linked previously to metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. Case details: A 64-year-old male ingested 750 mg of metformin. On examination in the emergency department 8 h later, he was drowsy; nevertheless he had normal vital signs. He developed severe hypoglycemia (21 mg/dL), requiring a bolus of 50%dextrose followed by resumption of oral intake. This episode of hypoglycemia occurred approximately 8 h after ingestion. Discussion: Metformin ingestion in therapeutic doses can cause hypoglycemia in the absence of other glucose-lowering drugs, there for blood glucose levels should be monitored closely. Mechanisms via which metformin can induce hypoglycemia include reduction in hepatic glucose production, decreased glucose absorption, and poor oral intake. Discover the world's research 14+ million members 100+ million publications 700k+ research projects Join for free Context: Hypoglycemia due to metformin used in therapeutic dose is not frequently encountered. Metformin induced hypoglycemia has been linked previously to metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. Case details: A 64-year-old male ingested 750 mg of metformin. On examination in the emergency department 8 h later, he was drowsy; nevertheless he had normal vital signs. He developed severe hypoglycemia (21 mg/dL), requiring a bolus of 50%dextrose followed by resumption of oral intake. This episode of hypoglycemia occurred approximately 8 h after ingestion. Discussion: Metformin ingestion in therapeutic doses can cause hypoglycem Continue reading >>

Oral Hypoglycemic Drugs

Oral Hypoglycemic Drugs

Oral hypoglycemic drugs are used only in the treatment of type 2 diabetes which is a disorder involving resistance to secreted insulin. Type 1 diabetes involves a lack of insulin and requires insulin for treatment. There are now four classes of hypoglycemic drugs: Sulfonylureas Metformin Thiazolidinediones Alpha-glucosidase inhibitors. These drugs are approved for use only in patients with type 2 diabetes and are used in patients who have not responded to diet, weight reduction, and exercise. They are not approved for the treatment of women who are pregnant with diabetes. SULFONYLUREAS – Sulfonylureas are the most widely used drugs for the treatment of type 2 diabetes and appear to function by stimulating insulin secretion. The net effect is increased responsiveness of ß-cells (insulin secreting cells located in the pancreas) to both glucose and non-glucose secretagogues, resulting in more insulin being released at all blood glucose concentrations. Sulfonylureas may also have extra-pancreatic effects, one of which is to increase tissue sensitivity to insulin, but the clinical importance of these effects is minimal. Pharmacokinetics – Sulfonylureas differ mainly in their potency & their duration of action. Glipizide, glyburide (glibenclamide), and glimepiride are so-called second-generation sulfonylureas. They have a potency that allows them to be given in much lower doses. Those drugs with longer half-lives (particularly chlorpropamide, glyburide, and glimepiride) can be given once daily. This benefit may be counterbalanced by a substantially increased risk of hypoglycemia. Side effects – Sulfonylureas are usually well tolerated. Hypoglycemia is the most common side effect and is more common with long-acting sulfonylureas. Patients recently discharged from hospit Continue reading >>

Hypoglycemia

Hypoglycemia

Glucose is a chief energy source for cells throughout the body. However, too much or too little of it can cause serious adverse consequences (Berber 2013; Shrayyef 2010). Despite the rampant, interrelated epidemic of obesity and type 2 diabetes, most Americans remain regrettably unaware of the long-term damage from chronically elevated glucose levels, also called hyperglycemia. Conditions like kidney damage, nerve damage, and often irreparable damage to the eyes that result from continuously elevated glucose take time to manifest (Campos 2012). However, even less well-appreciated than the long-term risks due to chronically elevated blood sugar is that very low blood sugar, termed hypoglycemia, can cause significant, acute, life-threatening consequences if not treated immediately (Berber 2013). Blood sugar levels at or below 40 mg/dL characterize severe hypoglycemia (Desouza 2010; Tsai 2011; Carey 2013; Lacherade 2009). Low blood sugar levels in this range can cause a variety of symptoms ranging from weakness, sweating, fast heart rate, and tremors to confusion, irritability, or in severe cases, even coma and death (Sprague 2011; Berber 2013; McCrimmon 2012). With overly aggressive pharmaceutical treatment, patients with diabetes, both type 1 and type 2, are at risk for episodes of severe hypoglycemia. For type 1 diabetics, hypoglycemia can result from overtreatment with injectable insulin (Cryer 2010). In fact, hypoglycemia represents a serious barrier to successful management of type 1 diabetes; about 2-4% of acute death among type 1 diabetics are likely caused by hypoglycemia (Briscoe 2006; Cryer 2008). Type 2 diabetics can also develop hypoglycemia as a result of overtreatment with glucose-lowering drugs, in particular the class of drugs known as sulfonylureas (Kalra Continue reading >>

Recurrent Lactic Acidosis And Hypoglycemia With Inadvertent Metformin Use: A Case Of Look-alike Pills

Recurrent Lactic Acidosis And Hypoglycemia With Inadvertent Metformin Use: A Case Of Look-alike Pills

Recurrent lactic acidosis and hypoglycemia with inadvertent metformin use: a case of look-alike pills We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Recurrent lactic acidosis and hypoglycemia with inadvertent metformin use: a case of look-alike pills Tess Jacob, Renee Garrick, and Michael D Goldberg Metformin is recommended as the first-line agent for the treatment of type 2 diabetes. Although this drug has a generally good safety profile, rare but potentially serious adverse effects may occur. Metformin-associated lactic acidosis, although very uncommon, carries a significant risk of mortality. The relationship between metformin accumulation and lactic acidosis is complex and is affected by the presence of comorbid conditions such as renal and hepatic disease. Plasma metformin levels do not reliably correlate with the severity of lactic acidosis. We present a case of inadvertent metformin overdose in a patient with both renal failure and hepatic cirrhosis, leading to two episodes of lactic acidosis and hypoglycemia. The patient was successfully treated with hemodialysis both times and did not develop any further lactic acidosis or hypoglycemia, after the identification of metformin tablets accidentally mixed in with his supply of sevelamer tablets. Early initiation of renal replacement therapy is key in decreasing lactic acidosis-associated mortality. When a toxic ingestion is suspected, direct visualization of the patients pi Continue reading >>

Side Effects Of Metformin: What You Should Know

Side Effects Of Metformin: What You Should Know

Metformin is a prescription drug used to treat type 2 diabetes. It belongs to a class of medications called biguanides. People with type 2 diabetes have blood sugar (glucose) levels that rise higher than normal. Metformin doesn’t cure diabetes. Instead, it helps lower your blood sugar levels to a safe range. Metformin needs to be taken long-term. This may make you wonder what side effects it can cause. Metformin can cause mild and serious side effects, which are the same in men and women. Here’s what you need to know about these side effects and when you should call your doctor. Find out: Can metformin be used to treat type 1 diabetes? » Metformin causes some common side effects. These can occur when you first start taking metformin, but usually go away over time. Tell your doctor if any of these symptoms are severe or cause a problem for you. The more common side effects of metformin include: heartburn stomach pain nausea or vomiting bloating gas diarrhea constipation weight loss headache unpleasant metallic taste in mouth Lactic acidosis The most serious side effect metformin can cause is lactic acidosis. In fact, metformin has a boxed warning about this risk. A boxed warning is the most severe warning from the Food and Drug Administration (FDA). Lactic acidosis is a rare but serious problem that can occur due to a buildup of metformin in your body. It’s a medical emergency that must be treated right away in the hospital. See Precautions for factors that raise your risk of lactic acidosis. Call your doctor right away if you have any of the following symptoms of lactic acidosis. If you have trouble breathing, call 911 right away or go to the nearest emergency room. extreme tiredness weakness decreased appetite nausea vomiting trouble breathing dizziness lighthea Continue reading >>

Severe Hypoglycemia In An Elderly Patient Treated With Metformin.

Severe Hypoglycemia In An Elderly Patient Treated With Metformin.

1. Int J Clin Pharmacol Ther. 2002 Mar;40(3):108-10. Severe hypoglycemia in an elderly patient treated with metformin. (1)Clinic of Internal Medicine I, Sophien-und-Hufeland-Kliniken GmbH, Weimar, Germany. The following case of severe hypoglycemia was reported during a systematicevaluation of hospital admissions caused by adverse drug reactions (supported by BfArM).HISTORY AND FINDINGS ON ADMISSION: A 79-year-old diabetic woman wasadmitted to hospital in a stuporous and unresponsive state. The initial physical examination revealed no other abnormal findings. Serum blood glucose was found tobe 2.0 mmol/l and HbA1c was 4.6%. The patient had been started on antidiabetictherapy with metformin 2 months earlier. Treatment with other drugs being takenat that time, an ACE inhibitor, an NSAID and nitrofurantoin, remained unchanged. DIAGNOSIS, TREATMENT AND FOLLOW-UP: Laboratory tests excluded lactic acidosis andrenal insufficiency. Cerebral computed tomography findings were normal. Thepatient improved dramatically following administration of glucose. Otherlaboratory findings confirmed the diagnosis of hypoglycemia. Blood glucoseconcentrations ranged between 4.0 and 10.0 mmol/l in the subsequent days and the patient could be discharged in full health.CONCLUSIONS: Drug-induced hypoglycemia is possible even in diabetics notreceiving insulin or oral antidiabetic agents increasing insulin secretion. Therisk of drug-induced hypoglycemia should be particularly considered when drugscontaining blood glucose-lowering components are combined. Metformin does notusually cause hypoglycemia when administered as monotherapy. We suspected thathypoglycemia in this patient was caused by additional blood glucose-loweringeffects of the ACE inhibitor and the NSAID possibly combined with a suboptimal Continue reading >>

Metformin Does Not Adversely Affect Hormonal And Symptomatic Responses To Recurrent Hypoglycemia

Metformin Does Not Adversely Affect Hormonal And Symptomatic Responses To Recurrent Hypoglycemia

Metformin Does Not Adversely Affect Hormonal and Symptomatic Responses to Recurrent Hypoglycemia Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Address all correspondence and requests for reprints to: Bernd Fruehwald-Schultes, M.D., Medical Department of Internal Medicine I, University Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany. Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: Departments of Internal Medicine I and Neuroendocrinology, University of Luebeck, D-23538 Luebeck, Germany Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 86, Issue 9, 1 September 2001, Pages 41874192, Bernd Fruehwald-Schultes, Werner Kern, Kerstin M. Oltmanns, Stefan Sopke, Barbara Toschek, Jan Born, Horst L. Fehm, Achim Peters; Metformin Does Not Adversely Affect Hormonal and Symptomatic Responses to Continue reading >>

Metformin Overdose-induced Hypoglycemia In The Absence Of Other Antidiabetic Drugs.

Metformin Overdose-induced Hypoglycemia In The Absence Of Other Antidiabetic Drugs.

Abstract CONTEXT: Lactic acidosis is a well-recognized consequence of metformin. Hypoglycemia has been reported previously in metformin overdose, but the presence of other co-ingestions (e.g., a sulfonylurea) was not definitively excluded. CASE DETAILS: A 15-year-old girl ingested 75 g of metformin and 3 g of quetiapine. On examination in the emergency department 2 h later, she was drowsy but had normal vital signs. She developed lactic acidosis, hypotension, and recurrent and severe hypoglycemia (15 mg/dL and 20 mg/dL), requiring boluses of 50%dextrose. The first episode of hypoglycemia occurred approximately 4 h after ingestion. Serum metformin level 2 h after ingestion was 267 mg/L (therapeutic range, 0.465-2.5), and serum insulin was 2 mU/L (normal range, 6-35). Extensive laboratory investigation using high-resolution mass-spectrometry ruled out other possible hypoglycemic agents. She recovered after hemodialysis. DISCUSSION: Metformin overdose can cause severe hypoglycemia in the absence of other antidiabetic drugs. Potential mechanisms of metformin-induced hypoglycemia include decreased hepatic glucose production, decreased glucose absorption, and poor oral intake. Continue reading >>

Risk Of Hypoglycaemia In Users Of Sulphonylureas Compared With Metformin In Relation To Renal Function And Sulphonylurea Metabolite Group: Population Based Cohort Study

Risk Of Hypoglycaemia In Users Of Sulphonylureas Compared With Metformin In Relation To Renal Function And Sulphonylurea Metabolite Group: Population Based Cohort Study

Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study Risk of hypoglycaemia in users of sulphonylureas compared with metformin in relation to renal function and sulphonylurea metabolite group: population based cohort study BMJ 2016; 354 doi: (Published 13 July 2016) Cite this as: BMJ 2016;354:i3625 Judith van Dalem, PhD candidate and hospital pharmacist in training 1 2 3 , Martijn C G J Brouwers, medical specialist internal medicine 4 , Coen D A Stehouwer, professor of internal medicine 5 , Hubert G M Leufkens, professor of pharmacoepidemiology 6 , Johanna H M Driessen, PhD candidate 1 3 6 , Frank de Vries, associate professor 1 6 , Andrea M Burden, postdoctoral researcher 1 3 6 1Department of Clinical Pharmacy, Maastricht University Medical Centre, Maastricht, Netherlands 2Department of Clinical Pharmacy, Zuyderland MC, Heerlen, Netherlands 3Care and Public Health Research Institute (CAPHRI), Maastricht, Netherlands 4Department of Internal Medicine, Division of Endocrinology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands 5Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, Netherlands 6Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences Utrecht University, PO Box 80082, 3508 TB Utrecht, Netherlands Correspondence to: F de Vries f.devries{at}uu.nl ObjectiveTo determine the association between use of sulphonylureas and risk of hypoglycaemia in relation to renal function and sulphonylurea metabolic group compared with use of metformin. DesignPopulation Continue reading >>

Metformin

Metformin

Metformin, marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes,[4][5] particularly in people who are overweight.[6] It is also used in the treatment of polycystic ovary syndrome.[4] Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes.[7][8] It is not associated with weight gain.[8] It is taken by mouth.[4] Metformin is generally well tolerated.[9] Common side effects include diarrhea, nausea and abdominal pain.[4] It has a low risk of causing low blood sugar.[4] High blood lactic acid level is a concern if the medication is prescribed inappropriately and in overly large doses.[10] It should not be used in those with significant liver disease or kidney problems.[4] While no clear harm comes from use during pregnancy, insulin is generally preferred for gestational diabetes.[4][11] Metformin is in the biguanide class.[4] It works by decreasing glucose production by the liver and increasing the insulin sensitivity of body tissues.[4] Metformin was discovered in 1922.[12] French physician Jean Sterne began study in humans in the 1950s.[12] It was introduced as a medication in France in 1957 and the United States in 1995.[4][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] Metformin is believed to be the most widely used medication for diabetes which is taken by mouth.[12] It is available as a generic medication.[4] The wholesale price in the developed world is between 0.21 and 5.55 USD per month as of 2014.[15] In the United States, it costs 5 to 25 USD per month.[4] Medical uses[edit] Metformin is primarily used for type 2 diabetes, but is increasingly be Continue reading >>

More in diabetes