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Related Concept Videos

Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Dipeptidyl Peptidase 4 Inhibitors01:23

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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Diabetes: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Metformin-associated lactic acidosis.

Emma Jane Fadden1, Christian Longley2, Tushar Mahambrey2

  • 1Critical Care, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK e.fadden@nhs.net.

BMJ Case Reports
|July 10, 2021
PubMed
Summary

Metformin-associated lactic acidosis is a rare but serious complication of type 2 diabetes management. Prompt recognition and supportive care, including renal replacement therapy, can lead to rapid recovery.

Keywords:
adult intensive carediabetesdialysisdrugs: endocrine systemunwanted effects / adverse reactions

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Area of Science:

  • Internal Medicine
  • Nephrology
  • Endocrinology

Background:

  • Type 2 diabetes mellitus management often involves metformin.
  • Concomitant use of ACE inhibitors and NSAIDs can increase risk.
  • Gastrointestinal distress (diarrhea and vomiting) can precipitate metabolic complications.

Observation:

  • A 58-year-old female with type 2 diabetes presented with severe lactic acidosis, cardiovascular instability, and acute kidney injury.
  • Her condition was exacerbated by diarrhea, vomiting, and ongoing use of metformin, ACE inhibitor, and NSAID.
  • Initial presentation included profound acidosis (pH 6.6) and elevated lactate (14 mmol/L), with a brief cardiac arrest.

Findings:

  • Supportive treatment and renal replacement therapy were initiated.
  • Rapid improvement in acid-base balance and hemodynamic parameters was observed.
  • The case highlights the critical nature of metformin-associated lactic acidosis.

Implications:

  • Metformin-associated lactic acidosis is a rare but life-threatening condition requiring prompt medical attention.
  • Patient education regarding medication risks during illness is crucial.
  • Clinician awareness is paramount for timely diagnosis and effective management of this diabetes complication.