PMID- 34350076
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210806
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 7
DP  - 2021 Jul
TI  - Reactive Hypoglycemia From Metformin Immediate-Release Monotherapy Resolved by a 
      Switch to Metformin Extended-Release: Conceptualizing Their Concentration-Time 
      Curves.
PG  - e16112
LID - 10.7759/cureus.16112 [doi]
LID - e16112
AB  - 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(max)).
CI  - Copyright (c) 2021, Akram et al.
FAU - Akram, Ayesha
AU  - Akram A
AD  - Internal Medicine, Combined Military Hospital, Rawalpindi, PAK.
AD  - Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK.
LA  - eng
PT  - Case Reports
DEP - 20210702
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC8325947
OTO - NOTNLM
OT  - adverse reactions
OT  - glycemic control
OT  - hypoglycemia
OT  - metformin extended release
OT  - metformin immediate release
OT  - therapeutic indications
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/08/06 06:00
MHDA- 2021/08/06 06:01
PMCR- 2021/07/02
CRDT- 2021/08/05 06:29
PHST- 2021/07/02 00:00 [accepted]
PHST- 2021/08/05 06:29 [entrez]
PHST- 2021/08/06 06:00 [pubmed]
PHST- 2021/08/06 06:01 [medline]
PHST- 2021/07/02 00:00 [pmc-release]
AID - 10.7759/cureus.16112 [doi]
PST - epublish
SO  - Cureus. 2021 Jul 2;13(7):e16112. doi: 10.7759/cureus.16112. eCollection 2021 Jul.