Metformin

Question 1

Class

Answer 1

• Biguanides

Question 2

Mechanism

Answer 2

• Activate AMPK:

Inhibits gluconeogenesis, increase insulin sensitivty

Question 3

Indications

Answer 3

• First line therapy in overweight patients (BMI>25) with type II diabetes mellitus (who have failed on diet/exercise measures)
• Adjuvant therapy in normal weight patients (BMI<25) who do not achieve adequate glycaemic control on sulphonylureas

Question 4

SE

Answer 4

Common: Weight loss, vomiting

Important: lactic acidosis

N.B. does NOT affect the secretion of insulin – it only increases the body’s response to the insulin which is already present

Question 5

CI

Answer 5

• Ketoacidosis, Renal impairment - increased risk lactic acidosis

Question 6

Interactions

Answer 6

ACE I; increased hypoglycaemic effect