Exercise, metformin and hypoglycaemia: a neglected entity

Omari, Abdullah; Yue, Dennis K.; Twigg, Stephen M.

doi:10.1177/14746514050050021001

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…However, this required both participant reporting of the need for assistance and third party confirmation. Cases of severe hypoglycaemia in people on metformin (monotherapy) have previously been reported in the literature . Furthermore, for non‐severe hypoglycaemia, a recent model‐based meta‐analysis of trial data suggests a small increased risk for both metformin (RR ~2.0) and GLP1‐RAs (RR up to 3.1), compared with placebo …”

Section: Discussionmentioning

confidence: 96%

“…Cases of severe hypoglycaemia in people on metformin (monotherapy) have previously been reported in the literature. [21][22][23][24] Furthermore, for nonsevere hypoglycaemia, a recent model-based meta-analysis of trial data suggests a small increased risk for both metformin (RR~2.0) and GLP1-RAs (RR up to 3.1), compared with placebo. 25 In our study, adults aged ≥65 years were~50% less likely to have experienced most types of hypoglycaemia (with the exception of severe), compared with those aged <65 years.…”

Section: Figurementioning

confidence: 99%

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Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Dunkley

Fitzpatrick

Gray

et al. 2019

Diabetes Obesity Metabolism

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Aims To determine the incidence and severity of self‐reported hypoglycaemia in a primary care population with type 2 diabetes. The study also aimed to compare incidence by treatment regimen. Materials and methods A prospective observational study in 17 centres throughout the UK was conducted. Recruitment was based on treatment regimen (metformin alone, sulphonylurea‐, insulin‐ or incretin‐based therapy). Participants were asked to keep a blood glucose diary and self‐report hypoglycaemia episodes [non‐severe (self‐treated) and severe (requiring external help)] over a 12‐month period. Results Three hundred and twenty‐five participants were enrolled, of whom 274 (84%) returned ≥1 monthly diaries. Overall, 39% reported experiencing hypoglycaemia; 32% recorded ≥1 symptomatic, 36% ≥1 non‐severe, and 7% ≥1 severe episodes. By treatment, incidence (events per person/year) for any hypoglycaemia type was 4.39 for insulin, 2.34 for sulphonylurea, 0.76 for metformin, and 0.56 for incretin‐based therapy. Compared with metformin, risk of non‐severe hypoglycaemia was ~3 times higher for participants on sulphonylureas and > 5 times higher for those on insulin [incidence rate ratio (IRR) 3.02 (1.76‐5.18), P < 0.001, and IRR 5.96 (3.48‐10.2), P < 0.001, respectively]. For severe episodes, the incidence for sulphonylurea (0.09) was similar to metformin (0.07) and incretin‐based therapy (0.07); for insulin the risk remained almost 5 times higher than metformin [incidence 0.32; IRR 4.55 (1.28‐16.20), P = 0.019]. Conclusions Hypoglycaemia represents a substantial burden for people with type 2 diabetes. Sulphonylureas and insulin are both associated with a risk of reported non‐severe hypoglycaemia, but only insulin with severe episodes. This suggests the importance of the continued use of sulphonylureas in appropriate patients with type 2 diabetes.

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Section: Discussionmentioning

confidence: 96%

Section: Figurementioning

confidence: 99%

Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Dunkley

Fitzpatrick

Gray

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…A case of hypoglycemia secondary to metformin overdose and kerosene co-ingestion was reported by Rathnapala et al hypothesizing synergism, however, insulin use, or sulfonylurea co-ingestion could not be ruled out [ 13 ]. Other reported cases of metformin-related hypoglycemia were associated with heavy exercise, poor oral intake, sulfonylurea co-ingestion, or other comorbidities [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: a case report

2018

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BackgroundMetformin toxicity is well known to cause lactic acidosis. Multiple cases of hypoglycemia due to isolated metformin overdose have been reported. Increased glucose consumption secondary to anaerobic metabolism has been reported as a possible explanation.Case presentationA 23-year-old Arabic woman took 30 g of metformin. In the emergency department, 4 hours after of the event, she was fatigued but vitally stable. During her hospitalization, she had severe lactic acidosis, hypotension corrected with fluid boluses and vasopressors, and multiple episodes of hypoglycemia (6.3 mg/dL, 38 mg/dL, and 42 mg/dL), requiring multiple 50% dextrose-water boluses. The three hypoglycemic episodes occurred coincident with severe lactic acidosis. She improved after 24 hours of continuous renal replacement therapy.ConclusionsHypoglycemia can be induced by metformin toxicity in the absence of co-ingestants. A possible explanation of metformin-induced hypoglycemia is increased glucose consumption due to anaerobic metabolism, decreased oral intake, decreased liver glucose production, and decreased glucose absorption.

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Yawning and thermoregulation

Elo

2010

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Exercise, metformin and hypoglycaemia: a neglected entity

Cited by 4 publications

References 18 publications

Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Incidence and severity of hypoglycaemia in type 2 diabetes by treatment regimen: A UK multisite 12‐month prospective observational study

Recurrent hypoglycemia secondary to metformin toxicity in the absence of co-ingestions: a case report

Yawning and thermoregulation

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