Discover and read the best of Twitter Threads about #Metformin

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Insulin is NOT a first choice medicine in type 2 diabetes mellitus (T2DM).

- Short-term use in #T2DM:
(1) ketosis
(2) sepsis
(3) extremely high blood glucose
- Long-term use in #T2DM:
(4) secondary oral medication failure (also called ß-cell failure)

The guideline chart attached above is very clear - lifestyle modifications should be the first choice ± #metformin. Metformin is cheap.
I am least influenced by industry, and use long-term insulin in <5% T2DM, mostly for reason (4), usually after exhausting other options.

Those <5% are at a secondary level care hospital, and not at primary care. In primary care, that number will be even lower.

For those who NEED, both biphasic insulin and glargine are available in @pmbjpbppi #JanAushadhi kendras too. Insulin is quite inexpensive there.

Read 7 tweets
💥Current American Diabetes Association guidelines recommend Metformin as the 1st line therapy for all T2DM patients👇🏽
⚡️But should Metformin be the 1st line therapy in T2DM patients with cardiovascular disease?
💥Let’s review the following about

⚡️Mechanism of action
⚡️Safety profile
⚡️Cardiovascular benefits
💥How does Metformin work?

⚡️It inhibits gluconeogenesis in the liver by mitochondrial inhibition & by ⬆️ activation of AMP-kinase👇🏽
⚡️It ⬆️ insulin sensitivity
⚡️It may have additional pleiotropic
Read 12 tweets

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