Akram Ayesha
Internal Medicine, Combined Military Hospital, Rawalpindi, PAK.
Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK.
Cureus. 2021 Jul 2;13(7):e16112. doi: 10.7759/cureus.16112. eCollection 2021 Jul.
Metformin rarely, if ever, causes hypoglycemia when it is used as labeled. A 55-year-old woman presented to the medicine ward with an altered level of consciousness. She had been reviewed in an outpatient department three days earlier and prescribed 500 mg two times per day of metformin immediate-release (Met IR) for newly diagnosed type 2 diabetes mellitus (T2DM), to which she had been adherent; however, she had been experiencing intermittent episodes of hypoglycemia after taking the medication prescribed to treat her T2DM. On physical examination, she was diaphoretic and disoriented but responsive to sensory stimuli. In the ward, she received 25 ml of intravenous dextrose as the initial blood glucose reading was low at 54 mg/dl, and 4 ounces of apple juice additionally two hours later as her blood glucose level fell below 70 mg/dl again. She was no longer hypoglycemic a few hours later, and there was a significant neurological improvement. The remainder of the laboratory results, including serum renal and liver function tests, were normal. Met IR was discontinued, and metformin extended-release (Met XR) 500 mg/day was initiated at discharge. The patient's hypoglycemic episodes resolved within days after the initiation of Met XR. Hypoglycemia is rarely associated with accidental or suicidal overdose of metformin, metabolic dysfunction (e.g., renal insufficiency), exercise, missed meal, acute illness, or the initiation of additional antidiabetic medication. Albeit even uncommon, metformin-associated hypoglycemia may occur with no obvious trigger. In this context, we determine to what extent Met IR may contribute to the development of hypoglycemia in an individual case, but also that the risk could be mitigated by a switch to Met XR. In a preferred embodiment, the Met XR dosage form can be administered once a day, ideally with or after a meal, preferably with or after the evening meal, and it provides therapeutic levels of the drug throughout the day with peak plasma levels being obtained between four to eight hours after the administration (T).
按照标签说明使用时，二甲双胍极少引发低血糖。一名55岁女性因意识水平改变入住内科病房。三天前她在门诊接受了检查，被诊断为新发性2型糖尿病（T2DM），并开始服用二甲双胍速释片（Met IR），每日两次，每次500毫克，她一直坚持服药；然而，服用治疗T2DM的药物后，她却出现了间歇性低血糖发作。体格检查时，她出汗且意识模糊，但对感觉刺激有反应。在病房里，由于初始血糖读数低至54毫克/分升，她接受了25毫升静脉注射葡萄糖，两小时后血糖水平再次降至70毫克/分升以下时，又额外喝了4盎司苹果汁。几小时后她不再低血糖，神经功能也有显著改善。其余实验室检查结果，包括血清肾功能和肝功能检查，均正常。停用了Met IR，出院时开始服用二甲双胍缓释片（Met XR），每日500毫克。开始服用Met XR几天后，患者的低血糖发作消失。低血糖很少与二甲双胍意外或自杀性过量、代谢功能障碍（如肾功能不全）、运动、未进食、急性疾病或开始使用其他抗糖尿病药物有关。尽管二甲双胍相关低血糖即使不常见，但也可能无明显诱因发生。在此背景下，我们既要确定在个别病例中Met IR在多大程度上可能导致低血糖的发生，也要确定改用Met XR可降低这种风险。在一个优选实施方案中，Met XR剂型可以每天给药一次，理想情况下在进餐时或进餐后给药，最好在晚餐时或晚餐后给药，并且它能在一天中提供治疗水平的药物，给药后（T）四至八小时达到血浆峰值水平。
