It’s main use is in obese pt with NIDDM either alone or in combination with a sulfonylureas.Metformin has an anorexic effect which helps to reduce wt in the obese. Less used now a days .They causes sever lactic acidosis in pt with renal disease, hepatic disease,cardiopulmonary dysfunction,alcoholism.They also cause diarrhoea with vit  deficiency.

Mechanism of action:

[A]The activity of biguanide is not dependent on the presence of functioning pancreatic β cells for their hypoglycemia action.

[B]They are appropriately termed ‘englycemic agents’.Because they cause hypoglycemia in hyperglycemia condition.The effect on normal blood glucose level is more or less zero.

They act by:

1)      Direct stimulation of glycolysis in tissue which increase glucose removal from blood.

2)      Slowing of glucose absorption from gut.

3)      Increasing insulin binding to insulin receptor.

4)      ↓ Plasma glucogon level.

Indications of biguanides/Metformin:

1)      Type II.

2)      Obese patient.

3)      When Sulfonylurease fail.

Adverse effects Biguanide/Metformin:

  • Anorexia.
  • Nausea,vomting.
  • Diarrhoea.
  • Abdominal pain.
  • Lactic acidosis.
  • Erythema.
  • Hepatitis.
  • Pruritus and urticaria.
  • Derease Vitamin-B12 absorption.

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