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Incidence Of Metformin Induced Lactic Acidosis

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in this videoclip dr. Pietro Addamo and dr Simona Polemi illustrate metabolic and pathophysiological pathways that lead to lactic acidosis caused by metformin. The short video ends with a case report.

Is Metformin Associated With Lactic Acidosis?

Is Metformin Associated With Lactic Acidosis? The use of metformin in patients with renal impairment is associated with an increased risk for lactic acidosis. Why is this and what is the mechanism? Are sulfonylureas associated with lactic acidosis? Adjunct Faculty, Albany College of Pharmacy, Albany, New York; Clinical Pharmacy Specialist, VA Medical Center, Bath, New York Metformin is one of most commonly prescribed medications for the treatment of type 2 diabetes mellitus. Metformin exerts its activity by increasing peripheral glucose uptake and utilization, and decreasing hepatic gluconeogenesis. By decreasing pyruvate dehydrogenase activity and mitochondrial reducing agent transport, metformin enhances anaerobic metabolism and increased production of tricarboxylic acid cycle precursors. Inhibition of pyruvate dehydrogenase subsequently decreases the channeling of these precursors into aerobic metabolism and causes increased metabolism of pyruvate to lactate and ultimately lactic acid production.[ 1 ] In a patient with normal renal function, the excess lactic acid is simply cleared through the kidneys. However, in a patient with renal impairment, both metformin and lactic acid Continue reading >>

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  1. The3Macks

    Hello everyone! I just checked my ketones a little while ago after I returned from my 3.5 mile walk to discover my ketosis level is back down to pink, or "small" as it calls it on the chart. I admit I haven't checked for well over a week, maybe two, so I've no clue if the ketones were higher within the last two weeks or not. The time I cheated was over three weeks ago and I felt the results as well as witnessed them on my test strip. And I figured out what it was I consumed to put me there and appropriatley got back on track and my energy levels went up again a couple of days later. In the last few days I've kept pretty good track of my carb intake and it remains around 19-20 per day. I still have plenty of energy, though. That's what puzzles me.........I still have lots of energy all day long, but the ketone density is down?? I was really excited a few weeks ago during induction to see the test strip at almost the darkest purple. Can anyone explain this phenomenon to me? I admit I really need to educate myself more on the Atkins site, also.

  2. spydermary

    The color of the strip does not matter, as long as there are some ketones present. A darker color does NOT mean that you are burning more fat than a lighter color. If you drink a lot of water your urine will be diluted and the strip will be more pink, not purple.
    I have only once had a purple color and it was first thing in the AM. Mine are usually small or medium and I have lost 20lbs in about 6 weeks.

  3. The3Macks

    Thank you, so much spydermary!! That makes me feel a lot better....... I am drinking much more water these days, and that's another goal I've achieved! Maybe I should try testing first thing in the morning and see if I have similar results as you have.
    Adorable baby you have in the photo!

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https://www.facebook.com/drinkhealthy... - Do you want to learn how to get rid of lactic acid as an athlete, and start recovering quicker with more energy? Learn how to reduce lactic acid symptoms and increase your performance. Getting rid of lactic acid may be easier than you have imagined. Many professional athletes know the importance of eliminating lactic acid so they can recover quicker and perform at an optimal level. Start flushing out that lactic acid today! Many people suffer from lactic acidosis symptoms and are rigorously searching for a lactic acid treatment. More and more athletes are searching for solutions on how to get rid of lactic acid. In this video you will learn what a professional football player from the Seattle Seahawks is using to eliminate lactic acid after his workouts, practices, and NFL games. Learn how to make lactic acid a symptom of the past. Begin your journey to faster recovery today. See what the pro's are using to reduce lactic acid, recover quicker, and have more energy. Uncertain of what lactic is? Here is the definition https://en.wikipedia.org/wiki/Lactic_... Contact me for more information on getting rid of lactic acid FB: http://www.facebook.com/duncan.fraser... IG: http://www.instagram.com/kangendunc [email protected] See a full demonstration of this solution that helps get rid of lactic acid https://www.youtube.com/watch?v=MTxR9... Duncan Fraser 0:00 - 0:13 - Introduction 0:14 - 2:11 - Shan Stratton and Michael Robinson Discuss how to get rid of lactic acid 2:11 - 2:21 - 4 benefits of this incredible technology 2:21 - 2:39 - Conclusion Get in contact with me if you have problems with lactic acid and learn more on my FB page. Visit my Facebook page below. https://www.facebook.com/drinkhealthy...

Lactic Acidosis In A Patient With Type 2 Diabetes Mellitus

Introduction A 49-year-old man presented to the emergency department complaining of dyspnea for 2 days. He had a history of hypertension, type 2 diabetes mellitus, atrial fibrillation, and a severe dilated cardiomyopathy. He had been hospitalized several times in the previous year for decompensated congestive heart failure (most recently, 1 month earlier). The plasma creatinine concentration was 1.13 mg/dl on discharge. Outpatient medications included insulin, digoxin, warfarin, spironolactone, metoprolol succinate, furosemide (80 mg two times per day; increased from 40 mg daily 1 month earlier), metolazone (2.5 mg daily; added 1 month earlier), and metformin (2500 mg in three divided doses; increased from 1000 mg 1 month earlier). Physical examination revealed an obese man in moderate respiratory distress. The temperature was 36.8°C, BP was 119/83 mmHg, and heart rate was 96 per minute. Peripheral hemoglobin oxygen saturation was 97% on room air, with a respiratory rate of 26 per minute. The heart rhythm was irregularly irregular; there was no S3 or murmur. Jugular venous pressure was about 8 cm. There was 1+ edema at the ankles. A chest radiograph showed cardiomegaly and central Continue reading >>

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  1. welcometothejungle66

    long time lurker, first time poster. i've been doing keto for about a week and a half now and been thinking deeply about everything i've seen (i'm in the life sciences too, so i've been endlessly fascinated)
    what do you guys think about this: the logic behind keto makes sense to me, and i've already lost some pounds. but i have some questions

    does research suggest following a keto diet will cause weight loss up until a certain body fat % is reached? or is the period where weight loss ceases arbitrary? (my experience says things are rarely arbitrary)

    if it does stop at a certain BF% (or other body stat), atkins (later stages) seems to make sense as the logical next time, no? that way, if you so desire, reintroducing carbs would be ok.
    i guess what i'm trying to figure out is maybe.. keto = excess fat loss and healthy diet, with fibrous carbs in moderation, with decent exercise = weight maintenance
    i'd love to hear your thoughts or share your anecdotes or anything!

  2. gogge

    It seems like the increased volume of food (and decreased calorie density) makes people eat a more "sensible" amount of food on Low Carb diets:
    Patients spontaneously reduced their mean energy intake to approximately 2200 kcal/d, which is approximately the caloric intake of normal-weight individuals with the same height as our patients.
    Boden G, et al. "Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients with Type 2 Diabetes". Ann Intern Med. 2005 Mar 15;142(6):403-11.
    Even so it usually takes around a 15% higher caloric deficit to lose a pound of fat than it does to put it on, here's a table. Taken from:
    Wells JC, Siervo M. "Obesity and energy balance: is the tail wagging the dog?". Eur J Clin Nutr. 2011 Jul 20. doi: 10.1038/ejcn.2011.132. [Epub ahead of print]
    It's likely that your body has evolved a way to balance the intake when you eat food that has a proper energy density. When we have processed food that's very energy dense, but not all that filling, we tend to overeat (from a study that let people eat as much vending machine food as they wanted):
    Ad libitum intake resulted in a 7-d overfeeding of 6468 +/- 3824 kJ/d above weight-maintenance requirements, leading to a 2.3 +/- 1.2-kg gain.
    Rising R, et al. "Food intake measured by an automated food-selection system: relationship to energy expenditure". Am J Clin Nutr. 1992 Feb;55(2):343-9.
    Translated to calories that's between 631 to 2459 (1545 +/- 914) kcal extra per day. Compare that to the low carb diet where people spontaneously reduced their intake to a level appropriate for their natural weight/height. Stephan Guyenet has a really nice write up on how people react to refined carbs called "Humans on a Cafeteria Diet ", a short but very interesting read.
    A maintenance diet with carbs is probably not a problem as long as you avoid the refined carbs and sugars, the Kitavans eat 70% carbs (including fruit) and are very healthy.

  3. ICOrthogonal

    Awesome response!

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These are the potential side effects of the drug Metformin If you would like to set up a free 15 min. consult with Dr. Miller to find out if your a good fit for his program please clink the link below http://bit.ly/15MinConsultDrM For more information on how to treat the causes of diabetes visit the Diabetes series playlist http://bit.ly/TheDiabetesSeries Subscribe to the Channel channel for more symptoms and side effects videos http://bit.ly/Sub2MillpondY2be In 2010, there were 25 million people in America diagnosed with Diabetes. Since then that has increased to 29 million, a 10%. increase in just 5 years. Diabetes is an epidemic. Treatment should be designed to treat the cause, not the symptom. Do you know someone with Diabetes or considering Metformin? Share this video with them directly https://youtu.be/4d0qkp8R-1s Thank you for watching! __________ Our mission is to educate the world and empower people to know health and healing are possible and to teach how to take control of the health in their lives. Serving Lexington, KY since 2012. Millpond Integrative now services the continental United States. Dr. Justice Pearce, Dr. Shannyn Pearce and Dr. Miller offer you something different; results that are long-lasting, side-effect free, gentle and non-invasive. __________ Have you been looking for solutions to chronic health issues outside the modern medical approach but youre not sure where to start and you're scared of wasting time, money and energy? Let Millpond be your guide! We'll show you how to take control of your health again through natural and safe alternatives. Sign up for a free consultation here http://bit.ly/FreeConsult5zy3 Join our active Facebook community and Facebook Group here http://bit.ly/FBMillpondHealth __________ Follow us on social: Facebook: http://bit.ly/FBMillpondHealth Twitter: http://bit.ly/MillPondTwt Instagram: http://bit.ly/2NO19wq #diabetes #metformin #sideeffects

Metformin-associated Lactic Acidosis: Current Perspectives On Causes And Risk.

Metformin-associated lactic acidosis: Current perspectives on causes and risk. University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. Elcelyx Therapeutics, Inc., San Diego, CA, USA. Elcelyx Therapeutics, Inc., San Diego, CA, USA. Electronic address: [email protected] Metabolism. 2016 Feb;65(2):20-9. doi: 10.1016/j.metabol.2015.10.014. Epub 2015 Oct 9. Although metformin has become a drug of choice for the treatment of type 2 diabetes mellitus, some patients may not receive it owing to the risk of lactic acidosis. Metformin, along with other drugs in the biguanide class, increases plasma lactate levels in a plasma concentration-dependent manner by inhibiting mitochondrial respiration predominantly in the liver. Elevated plasma metformin concentrations (as occur in individuals with renal impairment) and a secondary event or condition that further disrupts lactate production or clearance (e.g., cirrhosis, sepsis, or hypoperfusion), are typically necessary to cause metformin-associated lactic acidosis (MALA). As these secondary events may be unpredictable and the mortality rate for MALA approaches 50%, metformin has been contraindicated in moderate an Continue reading >>

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  1. juliebugs

    Hi All,
    I am wondering about when we actually lose the weight. I read somewhere that most weight comes off while you are sleeping??? I have been sweating a lot while I sleep and I am wondering if that is a sign that I am sweating some of the pounds off? I know this is a strange question, but thought I would run it by you for some idea's. Thanks, julie

  2. Arrow

    Hi all,
    Julie, I have absolutely no idea where lost weight goes.
    But, during the night when you are drinking nothing your kidneys are working to remove water. Sweating removes water. Even when you breathe you lose water through a small amount of moisture lose every time you exhale. Also at night there is nothing in your stomach.
    I step on the scale right after my morning's shower, and I'm guessing that's when a person weighs the least.
    But I have no idea where "real" lost weight goes. Sigh. I do know that sometimes it doesn't go.
    Interesting question though.

  3. WillDuke

    I don't know about sweating, but my first couple of weeks on the Atkins diet I felt that my body temperature increased. I just felt hot at night. I assumed it was the whole Ketosis thing.

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