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Biguanide for T2DM
doesn't cause hypoglyc or weight gain
also for PCOS and non-alcoholic fatty liver
start low dose and titrate up slowly (>1/52 between increments) to avoid GI Sx

''Mechanism''
inc insulin sensitivity
dec hepatic gluconeognesis
?dec GI absorption of CHO

''SE''
GI (nausea, diarrhoea, anorexia) - intolerable in 20%
dec vit b12 absorption (rarely clinical problem)
lactic acidosis - in liver or renal disease - rare

''CI''
CKD - review at Cr 130, eGFR 45 and stop at 150, 30
beware of lactic acidosis if tissue hypoxia - MI, sepsis, AKI, dehydration
contrast nephropathy inc - iodine containing (IVP, angio) - stop on day and for 48hr post
alcohol abuse
sometimes used in pregnancy eg PCOS