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Metformin is the drug of choice for type 2 diabetes and is the first drug proven to prevent diabetes or delay the onset of diabetes. However, metformin also has a relatively clear adverse reaction, in order to ensure the efficacy of hypoglycemic, try to reduce adverse reactions, the clinical attention should be paid to the following four medication details.

1. What is the preferred dosage form for metformin?

The most common adverse reaction to metformin is the gastrointestinal reaction. When starting to take the drug, about 10% to 25% of patients will develop nausea, vomiting, bloating, diarrhea and metallic taste; as time goes on, the gastrointestinal reaction can be alleviated, disappeared or tolerated.

Metformin adverse reactions in the gastrointestinal tract: ordinary tablets or capsules > enteric coated tablets or enteric coated capsules > sustained release tablets or sustained release capsules.

However, for patients with significantly elevated postprandial blood glucose, it is more appropriate to use ordinary tablets or enteric coated tablets. Because the plasma concentration of metformin tablets and enteric tablets is about 2~3 hours, and the peak time of metformin sustained-release tablets is about 7 hours.

2. Do you need to adjust the dose during aerobic exercise?

The insulin resistance of a sedator is greater than that of an athlete, and proper exercise can increase the sensitivity of insulin.

Diabetes patients who insist on aerobic exercise for no less than 10 minutes a day can effectively improve insulin resistance. Even short physical activity (walking or housework) can effectively reduce postprandial hyperglycemia.

Metformin monotherapy does not cause hypoglycemia, no need to adjust the dose before and after exercise; however, when combined with insulin, insulin secretagogue (glimepiride, glipizide, nateglinide, etc.), it is necessary to prevent Risk of hypoglycemia.

3. Long-term use, how to add vitamin B12?

Metformin inhibits the absorption of vitamin B12, but can be reversed by supplementation with calcium; metformin can cause a decrease in vitamin B12 levels, but it is rare for megaloblastic anemia.

Metformin drug instructions and foreign medical guidelines recommend: patients with long-term use of metformin, patients at least see the blood every year, especially patients with anemia, peripheral neuropathy.

The 2016 edition of “Metformin Clinical Application Expert Consensus” recommends that patients treated with long-term metformin should be supplemented with vitamin B12; patients with metformin are not recommended to routinely monitor vitamin B12 levels.

Tips: Mecobalamin can be used for the treatment of peripheral neuropathy, but also for the treatment of megaloblastic anemia, but should avoid abuse.

4. What interaction should be noted for metformin?

Metformin does not bind to plasma proteins and is not metabolized by the liver, so drug interactions rarely occur.

Metformin is mainly excreted by the kidneys as a prototype. When combined with digoxin, cimetidine, ranitidine, triamterene, trimethoprim and other cationic drugs secreted by the renal tubules, attention should be paid to monitoring blood sugar.

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