The drug metformin is not recommended for people with
kidney disease. For this reason, some people think that metformin causes kidney disease. But new evidence
suggests that metformin might actually protect the kidneys.
For many people with type 2 diabetes , metformin is a very
effective drug. In everyone, the liver is a sort of "mother" organ. When blood
glucose (BG) levels go down, the liver releases some glucose into the blood to
make sure all the other organs get enough glucose energy to work properly.
When you eat and your BG levels start going up, the liver
is supposed to stop pushing all this glucose out into the bloodstream.
But for some reason, in people with type 2 diabetes, like
an oversolitous mother, the liver doesn't stop feeding the bloodstream after
meals. "Eat eat!" I can hear it say to a bloodstream already stuffed with
glucose. And this continued release of glucose into the bloodstream after
meals is one reason people with type 2 go high after me...
I received an interesting question by e-mail recently, which brought up several good points to review. The author asked: "Can a patient use metformin after a heart attack (after 12 years of using metformin) assuming the patient has good renal function? My question is if metformin should be avoided forever after an acute myocardial infarction or just temporarily withheld after the heart attack in a patient with an adequate renal and liver function (also without congestive heart failure or hypersensitivity to metformin)." I answered: "According to the USPI (the "label") for Glucophage brand of metformin, GLUCOPHAGE and GLUCOPHAGE XR are contraindicated [should not be used] in patients with: Renal disease or renal dysfunction (e.g., as suggested by serum creatinine levels =1.5 mg/dL [males], =1.4 mg/dL [females] or abnormal creatinine clearance) which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicem...
A recent report again reaffirms that metformin is the first medication to use when a patient with type 2 diabetes (T2D) needs help with lowering blood glucose levels. The 200+ page report, Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update , was prepared for the Agency for Healthcare Research and Quality by the Johns Hopkins University Evidence-based Practice Center. It is loaded with tables and discussions, but the conclusion is strikingly brief: "Although the long-term benefits and harms of diabetes medications remain unclear, the evidence supports use of metformin as a firstline agent. Comparisons of two-drug combinations showed little to no difference in HbA1c reduction, but some combinations increased risk for hypoglycemia and other adverse events."
To summarize the findings from the report: An older diabetes drug, metformin, works better, and has fewer side effects than newer drugs for T2D. It's also cheaper, as it's been available as a generic for y...
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