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Metformin Contraindications Creatinine Clearance

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What is ADRENAL INSUFFICIENCY? What does ADRENAL INSUFFICIENCY mean? ADRENAL INSUFFICIENCY meaning - ADRENAL INSUFFICIENCY definition - ADRENAL INSUFFICIENCY explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Adrenal insufficiency is a condition in which the adrenal glands do not produce adequate amounts of steroid hormones, primarily cortisol; but may also include impaired production of aldosterone (a mineralocorticoid), which regulates sodium conservation, potassium secretion, and water retention. Craving for salt or salty foods due to the urinary losses of sodium is common. Addison's disease and congenital adrenal hyperplasia can manifest as adrenal insufficiency. If not treated, adrenal insufficiency may result in severe abdominal pains, vomiting, profound muscle weakness and fatigue, depression, extremely low blood pressure (hypotension), weight loss, kidney failure, changes in mood and personality, and shock (adrenal crisis). An adrenal crisis often occurs if the body is subjected to stress, such as an accident, injury, surgery, or severe infection; death may quickly follow. Adrenal insufficiency can also occur when the hypothalamus or the pituitary gland does not make adequate amounts of the hormones that assist in regulating adrenal function. This is called secondary or tertiary adrenal insufficiency and is caused by lack of production of ACTH in the pituitary or lack of CRH in the hypothalamus, respectively. There are three major types of adrenal insufficiency. Primary adrenal insufficiency is due to impairment of the adrenal glands. 80% are due to an autoimmune disease called Addison's disease or autoimmune adrenalitis. One subtype is called idiopathic, meaning of unknown cause. Other cases are due to congenital adrenal hyperplasia or an adenoma (tumor) of the adrenal gland. Secondary adrenal insufficiency is caused by impairment of the pituitary gland or hypothalamus. Its principal causes include pituitary adenoma (which can suppress production of adrenocorticotropic hormone (ACTH) and lead to adrenal deficiency unless the endogenous hormones are replaced); and Sheehan's syndrome, which is associated with impairment of only the pituitary gland. Tertiary adrenal insufficiency is due to hypothalamic disease and a decrease in the release of corticotropin releasing hormone (CRH). Causes can include brain tumors and sudden withdrawal from long-term exogenous steroid use (which is the most common cause overall). Signs and symptoms include: hypoglycemia, dehydration, weight loss, and disorientation. Additional signs and symptoms include weakness, tiredness, dizziness, low blood pressure that falls further when standing (orthostatic hypotension), cardiovascular collapse, muscle aches, nausea, vomiting, and diarrhea. These problems may develop gradually and insidiously. Addison's disease can present with tanning of the skin that may be patchy or even all over the body. Characteristic sites of tanning are skin creases (e.g. of the hands) and the inside of the cheek (buccal mucosa). Goitre and vitiligo may also be present. Causes of acute adrenal insufficiency are mainly Waterhouse-Friderichsen syndrome, sudden withdrawal of long-term corticosteroid therapy, and stress in patients with underlying chronic adrenal insufficiency. The latter is termed critical illnessrelated corticosteroid insufficiency. For chronic adrenal insufficiency, the major contributors are autoimmune adrenalitis (Addison's Disease), tuberculosis, AIDS, and metastatic disease. Minor causes of chronic adrenal insufficiency are systemic amyloidosis, fungal infections, hemochromatosis, and sarcoidosis. Autoimmune adrenalitis may be part of Type 2 autoimmune polyglandular syndrome, which can include type 1 diabetes, hyperthyroidism, and autoimmune thyroid disease (also known as autoimmune thyroiditis, Hashimoto's thyroiditis, and Hashimoto's disease). Hypogonadism and pernicious anemia may also present with this syndrome. Adrenoleukodystrophy can also cause adrenal insufficiency. Adrenal insufficiency can also result when a patient has a craniopharyngioma, which is a histologically benign tumor that can damage the pituitary gland and so cause the adrenal glands not to function. This would be an example of secondary adrenal insufficiency syndrome.....

Use Of Metformin In The Setting Of Mild-to-moderate Renal Insufficiency

Go to: HISTORICAL PERSPECTIVE Despite these proven benefits, metformin remains contraindicated in a large segment of the type 2 diabetic population, largely because of concerns over the rare adverse effect of lactic acidosis. For these reasons, the drug has been restricted to individuals with normal creatinine levels as a surrogate for renal competence. Other contraindications (e.g., any significant hypoxemia, alcoholism, cirrhosis, a recent radiocontrast study) also increase the risk for or the consequences of lactic acidosis, but these are not the topic of this review. Metformin belongs to the biguanide drug class (previous members include phenformin and buformin), developed for lowering glucose in the 1950s. Initial enthusiasm for biguanides was tempered over the next two decades by the growing recognition of their risk of lactic acidosis. A marked reduction in biguanide use occurred in the mid-1970s because phenformin, extensively adopted in clinical practice, was implicated in a number of fatal cases of this severe metabolic decompensation (17). The association with lactic acidosis eventually led to its withdrawal from the market. Importantly, lactic acidosis with phenformin s Continue reading >>

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  1. megan

    I recently got the flu and was feeling awful with a temperature and all the fun that comes with it!. I knew I had to keep eating and taking in fluids though. I could barely get out of bed but I did what I had to. On the 3rd day in the night I checked and found I had high levels of ketones in my urine but in my blood it was 0.9. I checked again a little while later and it was 1.1 in my blood. Then 1.4. My sugars weren't too bad. As the ketones were rising and it was getting later I was worried at what point I would need help. The rule of thumb being getting advice at 1.5 and above and if higher and vomiting then going to A & E.
    I rang 111 as I didn't have anywhere else I could ring at that time. Then a paramedic phoned back to chat. She felt a dr was needed. A dr came round and said Id done the right thing. He found I had a UTI so prescribed antibiotics straight away.
    I was in a state but he said the ketones didn't concern him at this point particularly as they'd come down a bit since he arrived. Down to 1.1.
    He was very kind.
    I have since been in touch with my diabetic nurse during work hours and we have an appointment soon. She told me to check my pump Manual for sick days. I did and can't find any mention of ketones with normal blood sugars.
    She told me the treatment is the same. Go to hospital, get put on a glucose drip and double the insulin.
    We are 3 weeks on and I still have the tail end if this horrible flu virus thing. I live with ME and fibromyalgia too.
    I would rather avoid hospital at all costs. Last time I went in years ago for unrelated reasons I had to get my own blankets and meds back to deal with myself. I prefer to feel in some semblance of control in my own home than relying on others.
    What I'd like to know is others experiences and knowledge. Thanks

  2. ME_Valentijn

    megan said: ↑
    My sugars weren't too bad. What's not too bad? Hyperglycemia can result in excess ketone production starting at 13.3.
    There can be a fairly big delay between hyperglycemia and urine ketones ... maybe there's a similar delay with blood ketones? I had an 18.5 spike during the afternoon while at the GP's office with only "small" amounts of ketones in my urine, but measured "large" amounts of ketones in the evening when my blood sugar was already down to 10-11.
    Maybe you missed a spike in your blood sugar, but caught the after-effects in your ketones?
    megan said: ↑
    We are 3 weeks on and I still have the tail end if this horrible flu virus thing. I live with ME and fibromyalgia too.
    I would rather avoid hospital at all costs. Last time I went in years ago for unrelated reasons I had to get my own blankets and meds back to deal with myself. I prefer to feel in some semblance of control in my own home than relying on others. I have ME/CFS too, and totally understand where you're coming from. I stayed home with a likely case of lactic acidosis induced by metformin, because I felt way too sick to deal with calling anyone or going anywhere, much less a hospital. Probably wasn't thinking too clearly either, due to the severe acid-frying-my-brain headache that came with it
    But the noise, the lights, the food, uncomfortable beds ... it would be torture.

  3. megan

    My bloods were between 5 and 11... got to 13 at one point but I also didn't want to go hypo when I was sick at one point. I got very shaky and weak and hot.... I always got told that blood ketone testing was what was going on currently so more correct where as urine test was hours behind .
    There doesn't seem to be much information about this

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Metformin And Renal Function

etformin is first-line therapy for the management of type 2 diabetes mellitus, based on the American Diabetes Association and American College of Clinical Endocrinology guidelines. Unless there is a contraindication, metformin should be considered part of a patient’s regimen for type 2 diabetes mellitus. A controversial contraindication for metformin is renal disease or dysfunction. Absolute cut-offs in serum creatinine has been published as times to discontinue metformin therapy (≥1.4 mg/dL for women; ≥1.5 mg/dL for men). Lipska KL, et al, published recommendations for metformin among patients with mild to moderate renal dysfunction. This publication has been used in clinical practice to support “relaxed” dosing of metformin. Based on this publication in Diabetes Care (2011), the following recommendations were suggested: For patients with estimated glomerular filtration rate (eGFR) above 60, then metformin can be continued and renal function should be monitored on an annual basis. For patients with eGFR between 45 and 60, then metformin can be continued but the frequency of monitoring increases to every 3 or 6 months. For patients with eGFR between 30 and 45, there are s Continue reading >>

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  1. chitownmom

    That is really good that you can see the pattern. Be sure to write everything down for the doctor. Maybe you can talk to your daughter so that she can be sure the sit down if she experiences this at school.
    Good Luck!
    ChiTownMom Just A Mom Doing Her Best For Her Child

  2. sarahandbray

    My 4.5 year old daughter has had 3 or 4 small seizures and was in status epilepticus last July for 45 minutes....the entire morning before that episode, she was flushed and nauseous...wouldn't eat at all (which is very unlike her) and threw up about 20 minutes before her first seizure that day. I also pulled her shirt up that day and she had a red rash all over her for a few minutes that then went away and a low-grade fever. She tends to get very tired as well before a seizure.
    So far, (7 months), she's been seizure free on 500mg of Keppra 2X day.
    Good luck.
    Sarah

  3. Sara Z.

    YES!!! Those are my daughter's symptoms, though she is older (11). She was just diagnosed last week with complex partial seizures. I've been wanting to ask if anyone else has the constant nausea? She has been nauseous for over a month now . . . kind of like a morning sickness feeling 24/7. She has no appetite and only eats when I put food in front of her. She doesn't want to think about food, and often feels like she is going to throw up, but she never does. Now, of course, she is on Keppra, so I don't know if the meds are adding to her nausea. She has not had any more seizures since on Keppra, but she still has the constant nausea and sick feeling. Oh, by the way, my daughter's cheeks get really flushed too. Good luck to you . . . is the Keppra helping?

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Kidney Function Cutoffs For Safe Metformin Use

Volume: 46 Urologic Diseases The risk of complications (such as lactic acidosis) that can be associated with metformin increases in patients with renal insufficiency. At what creatinine clearance should this agent be discontinued? — Ivanka Vassileva, MD Lawton, Okla Currently, the contraindication for metformin use in patients with renal insufficiency is rigidly defined as a serum creatinine level of 1.5 mg/dL or higher in men and 1.4 mg/dL or higher in women. As you know, the serum creatinine level is often not a precise indicator of renal function. Measuring creatinine clearance, which is most often done using the Modification of Diet in Renal Disease (MDRD) equation, is probably a better way to assess for renal insufficiency. Current prescribing guidelines suggest confirming that creatinine clearance is normal in older persons and in others in whom the serum creatinine level may be misleading. Metformin appears to accumulate once the creatinine clearance falls below 60 mL/min. Thus, it would be unwise to use metformin in any patient whose creatinine clearance is lower than this. — Silvio Inzucchi, MD Professor of Medicine Division of Endocrinology Yale University School of M Continue reading >>

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  1. Michael Simpson

    Diabetic ketoacidosis (the formal name, and the one most diabetics use, abbreviating it as DKA) can happen in Type 2 diabetics, but as you implied it is rare.
    Type 1 diabetics totally lack or have insufficient amounts of insulin. So the body produces the antagonistic hormone, glucagon, because there's no insulin, which to the body means there's low glucose. Glucagon then induces the liver to use fat as energy, producing ketone bodies while also forcing the liver to convert glycogen to glucose. Unfortunately, the blood glucose levels are high because the Type 1 Diabetic has no insulin. This causes the blood osmolarity to skyrocket, and the kidneys try to compensate by removing ketones and glucose from the blood.
    Since the kidneys have a maximum capacity to clear excess glucose from the blood, the blood becomes more acidotic and ketone bodies rise at the same time. And that leads to more serious issues like coma and death.
    The feedback systems are all broken, so the body spins out of control. It is often the first sign of Type 1 diabetes.
    So the one difference between Type 1 and Type 2 diabetics is that Type 1 has no insulin, but Type 2 generally has insulin in the blood to suppress the release of glucagon. And this is why it's rare in Type 2 diabetics.

  2. Liang-Hai Sie

    We need insulin to be able to utilize glucose, type 2 has some insulin, not enough because of the insulin resistance, type 1 don't, so in type one ketosis can develop because the lack of insulin causes the body to burn fat that forms ketones if no inslin is administered. I knew a man who every time he was arrested by intent "forgot" to inject his insulin so ended in hospital with a keto-aciditic diabetic coma, out of jail.

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