Metformin

Nota:

• Increases activity of AMPK (AMP-activated protein kinase), usually activated by high AMP:ATP ratio, as seen in starvation or energy deprived states. In such condition, liver decreases gluconeogenesis in favour of glycolysis.

1. Increasing peripheral insulin sensitivity

Nota:

• Has a mild anorexic effect, so can help to reduce weight.

1. General anaesthesia or iodine containing contrast medium

   Nota:

   • Iodinated contrast media increase the risk of renal failure.
   1. Suspend on the morning of surgery and restart when renal function returns to baseline. Suspend prior to any test, restart at least 48 hours after the test if renal function has returned to baseline.
2. Renal failure
   1. Review dose if eGFR <45 and stop if eGFR <30.
3. Those at risk of tissue hypoxia or sudden deterioration in renal function. Dehydration, severe infection, shock, sepsis, acute heart failure, resp failure, or hepatic impairment or recent MI.

1. Nausea, Diarrhoea and metallic taste
2. Reduces with time or reduced dose
3. Prolonged use - B12 deficiency due to malabsorption
4. Ketonuria with normal blood sugars. Reduces with the dose, and not severe

Nota:

• 0.03 per 1000 patient years

1. Background of renal or liver failure, cardiogenic and septic shock
2. IV NaHCO3