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Metformin And Dka

Diabetes Mellitus

Diabetes Mellitus

Case Scenario 52 male presents to GP with 3/12 lethargy and 2/52 thirsty and drinking more than normal. PMH HTN Drinks alcohol socially, non-smoker BMI 32 Urine Dip: glucose +++ Random Blood Sugar = 13 Contents Diagnosis Risk Factors Complications Investigations Management DKA + HONK Type 1 vs Type 2 Type 1 = Inability to produce insulin (autoimmune process against beta islet pancreas cells) Type 2 = insensitivity to insulin over time Gestational Diabetes = decreased insulin sensitivity during pregnancy Secondary Diabetes: Pancreatic Disease/CF/Chronic Pancreaitis/Pancreatic Ca Steroid use/ antipsychotics/ thiazide diuretics Diagnosis Random Glucose >11.1 mmol/L Fasting Glucose >7 mmol/L 2x Fasting glucose samples to confirm Or presence of symptoms HbA1c >6.5% (48mmol/L) OGTT – two hour glucose after 75g glucose IGT = normal fasting glucose and OGTT between 7-11 IFG = OGTT <7.8 but fasting glucose 6.1 – 6.9 Risk Factors T1: Family Hx, Caucasian/Scandinavian, Juvenile onset T2: High BMI Physical inactivity South Asian/Afro-carribean/middle-eastern Hx of gestational diabetes, IGT, IFG Steroid use PCOS Family Hx Presentation Polyuria Polydipsia Lethargy Recurrent infections Complications DKA (T1) HONK (T2) Presentation - case 67 male admitted feeling generally unwell, SOB, sweating and lethargic over last 2 days. He is a known Type 2 diabetic on insulin with PVD, peripheral neuropathy and previous CVA. His BM is 5.6. ECG showed residual ST elevation in anterior leads with Q wave and reciprocal changes. Echo showed new septal hypokinesia The patient had no history of chest pain Complications Macrovascular: Stroke, MI, PVD Retinopathy, Xanthelasma, Cataracts, Opthalmoplegia, maculopathy Peripheral Neuropathy, Diabetic amyotrophy, neuropathic pain, Autonomic neu Continue reading >>

Contraindications To Metformin Therapy In Patients With Niddm.

Contraindications To Metformin Therapy In Patients With Niddm.

Abstract OBJECTIVE: Treatment with metformin is occasionally associated with the development of severe lactic acidosis. However, this is usually observed in patients with major contraindications to the drug. In this study, we aimed to determine the prevalence of conditions currently regarded as either contraindications or cautions to the use of metformin in patients with NIDDM. RESEARCH DESIGN AND METHODS: The case notes of metformin-treated NIDDM patients (mean age 62 years) attending a United Kingdom university hospital diabetes clinic over a 3-month period were reviewed according to criteria reflecting a pragmatic view of current prescribing recommendations. RESULTS: Of 89 consecutive patients whose notes could be evaluated in detail, only 41 (46%) had no contraindications or cautions to metformin whatsoever. Concomitant chronic disorders associated with a potentially increased risk of hyperlactatemia were renal impairment (n = 2; plasma creatinine concentrations 1.7 and 2.3 mg/dl, respectively), cardiac failure (n = 2), and chronic liver disease (n = 2). Other potentially relevant disorders included ischemic heart disease (n = 20), clinical proteinuria (n = 14), peripheral vascular disease (n = 22), and pulmonary disease (n = 7). Multiple conditions (i.e., two, three, or four) were present in eight, five, and one patient(s), respectively. CONCLUSIONS: More than half the patients in our series had concomitant conditions or complications conventionally regarded as cautions or contraindications to metformin; approximately 10% had a multiplicity of such conditions. Regular surveillance is necessary to detect the development of complications such as renal impairment. Vigilance is also required in view of the increased risk of major intercurrent illnesses, which may indep Continue reading >>

Dka Vs Hhns Nclex Questions

Dka Vs Hhns Nclex Questions

This quiz on DKA vs HHNS (Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome) will test you on how to care for the diabetic patient who is experiencing these conditions. As the nurse, you must know typical signs and symptoms of DKA and HHNS, patient teaching, and expected medical treatments. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are differences between the two complications that you must know as a nurse. This endocrine teaching series will test your knowledge on how to differentiate between the two conditions, along with a video lecture. This quiz will test you on the following for the NCLEX exam: Signs and Symptoms of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Causes of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Patient education for DKA vs HHNS Treatments of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Lecture on DKA vs HHS (NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.) DKA vs HHS Quiz 1. This complication is found mainly in Type 2 diabetics? 2. A patient is found to have a blood glucose of 375 mg/dL, positive ketones in the urine, and blood pH of 7.25. Which condition is this? 3. Hyperglycemic Hyperosmolar Nonketotic Syndrome would have all of the following signs and symptoms EXPECT? A. Dry mucous membranes B. Polyuria C. Blood glucose >600 mg/dL D. Kussmaul breathing 4. This condition happens gradually and is more likely to affect older adults? 5. A patient has an infection and reports not checking their blood glucose or regularly taking Metformin. What condition is this patient MOST at risk for? A. DKA B. HHNS C. Metabol Continue reading >>

New Diabetes Drugs May Bring On Ketoacidosis

New Diabetes Drugs May Bring On Ketoacidosis

SGLT2 inhibitors, which are some of the newest diabetes drugs on the market, may increase the risk of a serious condition. A new study concludes that these medications actually double the likelihood of developing diabetic ketoacidosis. Because diabetes is becoming more prevalent in the United States, the hunt for new and more effective medication is in full flow. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are the most recent additions to the list of available medicines. SGLT2 inhibitors reduce blood glucose levels by encouraging the kidneys to increase sugar excretion in urine. These drugs are often given in combination with other diabetes medications, such as metformin and insulin. The new class of drugs has become relatively popular, but the latest research finds that they could increase the risk of a serious diabetes-related complication. Rare but dangerous Diabetic ketoacidosis is relatively uncommon but potentially life-threatening. It occurs when acids called ketones build up in the body, increasing the acidity of the blood, or when the body does not produce enough insulin. When insulin is absent, glucose cannot enter cells and provide them with the energy they need. Therefore, the body falls back on its secondary fuel source: fat. Ketones are byproducts of burning fat. Symptoms of diabetic ketoacidosis include increased thirst, abdominal pain, nausea and vomiting, and confusion. It can also cause swelling in the brain, and, if left unchecked, can be fatal. Although diabetic ketoacidosis is more likely to occur in people with type 1 diabetes, it does occasionally appear in individuals with type 2 diabetes. Examining the interaction The new study, carried out by Dr. Michael Fralick and a team from Brigham and Women’s Hospital in Boston, set out to examine Continue reading >>

Viewer Comments: Diabetic Ketoacidosis - Symptoms

Viewer Comments: Diabetic Ketoacidosis - Symptoms

I didn't know anything about diabetic ketoacidosis (DKA) until I was admitted into the ICU. Learning about DKA now, I've had moderate DKA on and off for years. I thought my vomiting, stomach pain were the result of metformin and switched to Invokana. I experienced extreme weight loss and dehydration but thought these were normal (Invokana shown to help diabetics lose weight). I have been under extreme financial and emotional stress for the past few years as well. What I would want others to know is that it is difficult to identify DKA from medication side effects; until DKA is at the ICU level. I was given so much potassium and other electrolytes. Stress is also a huge factor for me. While in the ICU my ex-husband (knowing I was in the ICU) started more harassment. The nurses documented an over 100 jump in my blood sugar after a phone call to deal with the harassment. I've started tracking stress and my blood sugar. It is impossible to get control of my blood sugar during high stress. If I add more insulin, I have a dangerous crash later. Keeping a calm environment as much as I can helps. I have type 2 diabetes. I gave myself more than 300 shots. My doctor put me on metformin. This takes the place of insulin shots. There are three different doses. What made it for me was 850 mg per meal. I count my carbohydrates, 60 per meal, and take my pill. I have seen here, folks that have 200, 300, 695 mg/dl of glucose. It is tough to manage, but if you keep to it, you will do well. Check the bottoms of your feet daily. If you are ticklish, you are doing fine. Give up cakes, pies, ice cream and other things high in carbohydrates. If you do, you will be fine. By the way, my average glucose reading is less than 120. Set that as your goal. Have good days! I have been having really dif Continue reading >>

Sglt2 Inhibitors [invokana (canagliflozin), Forxiga (dapagliflozin), Xigduo (dapagliflozin/metformin), Jardiance (empagliflozin)] - Risk Of Diabetic Ketoacidosis

Sglt2 Inhibitors [invokana (canagliflozin), Forxiga (dapagliflozin), Xigduo (dapagliflozin/metformin), Jardiance (empagliflozin)] - Risk Of Diabetic Ketoacidosis

Report a Concern Audience Healthcare professionals including internal medicine specialists, endocrinologists, cardiologists, nephrologists, general or family practitioners, emergency healthcare professionals, critical care physicians, certified diabetes educators and pharmacists. Key messages Serious, sometimes life-threatening and fatal cases of diabetic ketoacidosis (DKA) have been reported in patients on sodium glucose co-transporter 2 (SGLT2) inhibitors for type 1 and type 2 diabetes. In a number of these cases, the presentation of the condition was atypical with only moderately increased blood glucose levels observed. SGLT2 inhibitors are NOT indicated for treatment of type 1 diabetes mellitus and should not be used in type 1 diabetes. It is recommended that: if DKA is suspected or diagnosed, treatment with SGLT2 inhibitors should be discontinued immediately. SGLT2 inhibitors should not be used in patients with a history of DKA. in clinical situations known to predispose to ketoacidosis (e.g. major surgical procedures, serious infections and acute serious illness), consideration be given to temporarily discontinuing SGLT2 inhibitor therapy. patients be informed of the signs and symptoms of DKA and be advised to immediately seek medical attention if they develop them. caution be used before initiating SGLT2 inhibitor treatment in patients with risk factors for DKA. The Canadian Product Monographs of these products will be updated to reflect this safety information. Issue Clinical trial and post-market cases of DKA, a serious, life-threatening condition requiring urgent hospitalization have been reported in patients with type 1 and type 2 diabetes mellitus on SGLT2 inhibitor treatment. In a number of these reports, the presentation of the condition was atypical with Continue reading >>

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Metformin: An Old But Still The Best Treatment For Type 2 Diabetes

Abstract The management of T2DM requires aggressive treatment to achieve glycemic and cardiovascular risk factor goals. In this setting, metformin, an old and widely accepted first line agent, stands out not only for its antihyperglycemic properties but also for its effects beyond glycemic control such as improvements in endothelial dysfunction, hemostasis and oxidative stress, insulin resistance, lipid profiles, and fat redistribution. These properties may have contributed to the decrease of adverse cardiovascular outcomes otherwise not attributable to metformin’s mere antihyperglycemic effects. Several other classes of oral antidiabetic agents have been recently launched, introducing the need to evaluate the role of metformin as initial therapy and in combination with these newer drugs. There is increasing evidence from in vivo and in vitro studies supporting its anti-proliferative role in cancer and possibly a neuroprotective effect. Metformin’s negligible risk of hypoglycemia in monotherapy and few drug interactions of clinical relevance give this drug a high safety profile. The tolerability of metformin may be improved by using an appropiate dose titration, starting with low doses, so that side-effects can be minimized or by switching to an extended release form. We reviewed the role of metformin in the treatment of patients with type 2 diabetes and describe the additional benefits beyond its glycemic effect. We also discuss its potential role for a variety of insulin resistant and pre-diabetic states, obesity, metabolic abnormalities associated with HIV disease, gestational diabetes, cancer, and neuroprotection. Introduction The discovery of metformin began with the synthesis of galegine-like compounds derived from Gallega officinalis, a plant traditionally em Continue reading >>

Glossary

Glossary

A1C A test that gives you a picture of your average blood sugar level over the past 2 to 3 months. The results show how well your diabetes is being controlled. The A1C test does this by measuring the amount of sugar (glucose) that has attached to the hemoglobin in your red blood cells. More sugar (glucose) means a higher A1C. autoimmune “Autoimmune" refers to diseases in which the body thinks its own cells and tissues don't belong and attacks them. Type 1 diabetes is an autoimmune disease. The immune system wrongly destroys the insulin-producing cells in the pancreas. This leads to lower-than-normal insulin in the body. The causes of autoimmune diseases are not known. basal insulin See long-acting insulin. beta cells Special cells in the pancreas (in the islets of Langerhans) that make and release insulin in response to sugar (glucose) levels. In people with diabetes, the beta cells release less insulin than normal or none at all. biguanide See metformin. blood sugar (or blood glucose) The main sugar (glucose) found in the blood, and the body’s main source of energy. blood sugar readings (or blood glucose readings) The amount of sugar in a given amount of blood. It is measured in milligrams per deciliter, or mg/dL. A blood glucose goal for people with type 2 diabetes is 80 to 130 mg/dL before meals, less than 180 mg/dL 2 hours after meals. bolus insulin (prandial or mealtime insulin) An extra amount of insulin taken to cover an expected rise in blood sugar during or after a meal or snack. It can also be taken when blood sugar is high. carbohydrates Carbohydrates are the main kind of food that raise blood sugar levels. Your digestive system changes carbohydrates into glucose (sugar), and then uses this sugar as a source of energy for your cells. There are three main Continue reading >>

Metformin In Type 1 Diabetes

Metformin In Type 1 Diabetes

Is this a good or bad idea? The article by Meyer et al. (1) revives a debate regarding the appropriateness of metformin use for people with type 1 diabetes. Given the potential for coexisting lactic acidosis and diabetic ketoacidosis, how can one justify its use? Indeed, there was little reason to expect a benefit in patients who were studied: nonobese type 1 diabetic subjects with HbA1c <9.0% who were taking ∼0.7 units · kg insulin−1 · day−1. A modest average reduction of daily insulin requirements, 4.3 units, as compared with an increase of 1.7 units for placebo, does not seem to be worth the trade-off of increased risk for severe hypoglycemia (19 events in metformin group vs. 8 events in placebo group). There was no differential effect in terms of HbA1c. Only 7 of 31 patients (23%) treated with metformin responded in terms of a significant (20%) reduction in insulin requirement. Furthermore, it is likely that the incidence of hypoglycemia would be much greater if more aggressive metabolic targets of HbA1c had been applied. Despite the failure to observe diabetic ketoacidosis, the limited number and short period of observation does not permit the conclusion that metformin is safe in ketosis-prone diabetic subjects. We have seen a number of type 1 diabetic patients who have received metformin prescriptions by other practitioners. It appears that these prescriptions were given because of a failure to identify latent autoimmune diabetes in adults or because the physician believed that the potential for insulin dose reduction and lipid improvement justified a putative small risk for diabetic ketoacidosis and lactic acidosis. The temptation to prescribe metformin is increased because of the high prevalence of metabolic syndrome among U.S. adults (2). Indeed, the di Continue reading >>

Sglt2 Inhibitors Side Effects

Sglt2 Inhibitors Side Effects

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are intended to treat Type 2 diabetes along with diet and exercise. They have also been prescribed for off-label, or unapproved, uses including weight loss. The active ingredients in the drugs are different gliflozin compounds. SGLT2 inhibitors approved for use in the U.S. include: In addition, some medications combine SGLT2 inhibitors with other diabetes drugs. These include: Metformin decreases glucose production in the liver while increasing the body’s ability to absorb glucose. It is often used in conjunction with insulin as well as SGLT2 inhibitors to treat Type 2 diabetes. It carries additional risks of side effects. Linagliptin works by regulating insulin levels after meals. When first approved, SGLT2 inhibitors took a revolutionary approach to controlling blood sugar in diabetic patients. The drugs cause the body to direct excess glucose to the kidneys. From there, it is expelled through a patient’s urine. SGLT2 Inhibitor Side Effects Range from Minor to Life-Threatening While the way SGLT2 drugs work is unique, this can also lead to unique side effects. For example, because the drugs cause excess sugar to escape the body in urine, it can also lead to yeast infections and urinary tract infections. The drugs primarily work in the kidneys, so these drugs are not for people with weak kidney function. Some studies also show these drugs may lead to dangerous kidney infections and kidney failure. Side effects can lead from simple annoyances such as dry mouth to more serious complications including kidney injuries. Common SGLT2 Inhibitor Side Effect Symptoms: Abdominal pain Back pain Constipation Dry mouth Fatigue Increased cholesterol Increased urination Influenza Male and female yeast infections Nausea Thirst Urin Continue reading >>

Chapter 220. Diabetic Ketoacidosis

Chapter 220. Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus. The incidence and prevalence of diabetes are rising; as of 2005, an estimated 7% of the U.S. population had diabetes. In patients age 60 or older, the prevalence is estimated to be 20.9%.1 DKA occurs predominately in patients with type 1 (insulin-dependent) diabetes mellitus, but unprovoked DKA can occur in newly diagnosed type 2 (non–insulin-dependent) diabetes mellitus, especially in blacks and Hispanics.2 Between 1993 and 2003, the yearly rate of ED visits for DKA per 10,000 U.S. population with diabetes was 64, with a trend toward an increased rate of visits among the black population compared with the white population.3 Europe has a comparable incidence. A better understanding of pathophysiology and an aggressive, uniform approach to diagnosis and management have reduced mortality to <5% of reported episodes in experienced centers.4 However, mortality is higher in the elderly due to underlying renal disease or coexisting infection and in the presence of coma or hypotension. DKA is a response to cellular starvation brought on by relative insulin deficiency and counterregulatory or catabolic hormone excess (Figure 220-1). Insulin is the only anabolic hormone produced by the endocrine pancreas and is responsible for the metabolism and storage of carbohydrates, fat, and protein. Counterregulatory hormones include glucagon, catecholamines, cortisol, and growth hormone. Complete or relative absence of insulin and the excess counterregulatory hormones result in hyperglycemia (due to excess production and underutilization of glucose), osmotic diuresis, prerenal azotemia, worsening hyperglycemia, ketone formation, and a wide-anion gap metabolic acidosis.4 Insulin deficiency. Patho Continue reading >>

Glyburide / Metformin Disease Interactions

Glyburide / Metformin Disease Interactions

Major Metformin (Includes Glyburide/metformin) ↔ Lactic Acidosis Severe Potential Hazard, High plausibility Applies to: Renal Dysfunction, Liver Disease, Congestive Heart Failure, Dehydration, Shock, Myocardial Infarction, Asphyxia, Acidosis, Diarrhea, Vomiting, Anemia, Alcoholism The use of metformin is contraindicated in patients with renal dysfunction (serum creatinine >= 1.5 mg/dL in males and 1.4 mg/dL in females, or above the upper limit of normal for age); congestive heart failure requiring pharmacologic treatment (especially unstable or acute CHF where there is risk of hypoperfusion and hypoxemia); and any condition associated with hypoxemia (e.g., severe anemia, myocardial infarction, asphyxia, shock), dehydration (e.g., severe diarrhea or vomiting), or sepsis. Patients with these conditions may be at increased risk for the development of lactic acidosis, which is a rare but serious metabolic complication associated with metformin accumulation in plasma usually at levels exceeding 5 mcg/mL. Metformin should also not be administered to patients with acute or chronic metabolic acidosis. In addition, metformin should generally be avoided in alcoholics and patients with clinical or laboratory evidence of hepatic disease, since alcohol potentiates the effects of metformin on lactate metabolism and impaired hepatic function may significantly limit the ability to clear lactate. All patients treated with metformin should have renal function monitored regularly (at least annually or more frequently if necessary) and be advised of the significance of nonspecific symptoms such as malaise, myalgias, respiratory distress, increasing somnolence, and gastrointestinal disturbances that arise after stabilization of metformin dosage. More marked acidosis may be associated with Continue reading >>

Metformin, Sitagliptin Prolong Normoglycemia Remission In Dka

Metformin, Sitagliptin Prolong Normoglycemia Remission In Dka

(HealthDay)—For patients with new-onset diabetic ketoacidosis (DKA) and severe hyperglycemia, metformin and sitagliptin treatment after normoglycemia remission correlate with increased relapse-free survival and prolonged remission, according to a study published online Aug. 29 in Diabetes Care. Priyathama Vellanki, M.D., from the Emory University School of Medicine in Atlanta, and colleagues conducted a prospective four-year study involving 48 African-American subjects with DKA and severe hyperglycemia. Participants were randomized to metformin (17 participants), sitagliptin (16 participants), or placebo (15 participants) after normoglycemia remission. Oral glucose tolerance tests were conducted at randomization, at three months, and every six months for a median of 331 days. The researchers found that the metformin and sitagliptin groups had significantly higher relapse-free survival compared with placebo (P = 0.015), and significantly prolonged mean time to relapse (480 versus 305 days; P = 0.004). Compared with placebo, the probability of relapse was significantly lower for metformin and sitagliptin (hazard ratios, 0.28 and 0.31, respectively). Compared with those with hyperglycemia relapse, individuals who remained in remission had a higher disposition index and incremental area under the curve for insulin, with no significant changes in insulin sensitivity. "This study shows that near-normoglycemia remission was similarly prolonged by treatment with sitagliptin and metformin," the authors write. "The prolongation of remission was due to improvement in β-cell function." Several authors disclosed financial ties to pharmaceutical companies, including Merck, which manufactures sitagliptin. More information: Full Text (subscription or payment may be required) Continue reading >>

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

Ketoacidosis In A Patient With Type 2 Diabetes – Flatbush Diabetes

There is increasing recognition of a group of patients with type 2 diabetes who can present with ketoacidosis. Most reports have been of patients of African descent; however, the condition has been reported in other groups. This is a case of a Caucasian patient who has had three presentations with ketoacidosis and whose diabetes is not usually insulin-dependent. A patient, aged 48 years, presented with diabetic ketoacidosis (DKA) in a semi-comatose condition. She had a 3-day history of vomiting and loss of appetite. In the previous weeks she had undergone radiotherapy for metastatic squamous cell carcinoma (skin primary). The patient had two similar episodes of DKA, one 20 months and another 3 months earlier. Two of the patient’s brothers had type 2 diabetes. The patient was not abusing alcohol and did not have a history of pancreatitis. Three years prior to this admission the patient had been diagnosed elsewhere with type 2 diabetes, for which she had been on metformin and a small dose of insulin glargine. Two months after stopping her insulin glargine she developed her first episode of DKA while visiting our town. DKA, was diagnosed on the basis of arterial pH 7.03, blood glucose level 25.9 mmol/L, bicarbonate level of 5 mmol/L and positive urinary ketones. It was felt that infected skin lesions may have precipitated the DKA. Eleven days later, she was discharged on metformin 250 mg twice daily and a falling dose of insulin glargine (26 units a day). She was then lost to follow-up in our centre, but apparently soon after did not require insulin and maintained adequate gylcaemic control for 18 months until just prior to her next admission solely on metformin 1 g twice daily. The next admission for DKA occurred while living in a city. She was discharged on insulin but Continue reading >>

(sitagliptin And Metformin Hcl) Tablets Or

(sitagliptin And Metformin Hcl) Tablets Or

JANUMET tablets contain 2 prescription medicines: sitagliptin (JANUVIA®) and metformin. Once-daily prescription JANUMET XR tablets contain sitagliptin (the medicine in JANUVIA®) and extended-release metformin. JANUMET or JANUMET XR can be used along with diet and exercise to lower blood sugar in adults with type 2 diabetes. JANUMET or JANUMET XR should not be used in patients with type 1 diabetes or with diabetic ketoacidosis (increased ketones in the blood or urine). If you have had pancreatitis (inflammation of the pancreas), it is not known if you have a higher chance of getting it while taking JANUMET or JANUMET XR. Selected Risk Information About JANUMET and JANUMET XR Metformin, one of the medicines in JANUMET and JANUMET XR, can cause a rare but serious side effect called lactic acidosis (a buildup of lactic acid in the blood), which can cause death. Lactic acidosis is a medical emergency that must be treated in a hospital. Call your doctor right away if you get any of the following symptoms, which could be signs of lactic acidosis: feel cold in your hands or feet; feel dizzy or lightheaded; have a slow or irregular heartbeat; feel very weak or tired; have unusual (not normal) muscle pain; have trouble breathing; feel sleepy or drowsy; have stomach pains, nausea, or vomiting. Most people who have had lactic acidosis with metformin have other things that, combined with the metformin, led to the lactic acidosis. Tell your doctor if you have any of the following, because you have a higher chance of getting lactic acidosis with JANUMET or JANUMET XR if you: have severe kidney problems or your kidneys are affected by certain x-ray tests that use injectable dye; have liver problems; drink alcohol very often, or drink a lot of alcohol in short-term “binge” drinkin Continue reading >>

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