Remind Diabetic Patients: Stop Metformin When Using Contrast Medium

Metformin is the most widely used and oldest oral hypoglycemic agent in the treatment of type 2 diabetes. Because of its cheap price, better curative effect, and better safety during long-term use, it has become the first choice of hypoglycemic drugs for many type 2 diabetics. Although the incidence of metformin adverse reactions is low, they still occur.

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Lactic acidosis is one of the acute complications of sugar lovers, and it is also the most serious adverse reaction of biguanides. It is common in diabetic patients who take a large number of biguanides. Mild symptoms may only have nausea, abdominal pain, loss of appetite, etc., and severe or serious patients may be accompanied by nausea, vomiting, deep coma, or shock.

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In order to avoid lactic acidosis, if you encounter the following 6 situations, it is best to stop metformin first.

Within 48 hours before and after the use of contrast media. If a contrast agent is used for the test, the doctor will usually ask the patient about the medication. For patients who are taking metformin, they are often asked to stop using the contrast agent within 48 hours before and after using it. This is because contrast agents are iodine-containing chemicals injected into human tissue to enhance image observation, which may cause acute kidney injury or aggravate existing kidney injury; if you are taking metformin, it can cause drug accumulation and cause lactic acidosis .

Renal insufficiency. Although metformin has no liver or kidney toxicity, 90% of the drug will be excreted from the kidneys. If the patient has renal insufficiency, it will hinder the drug excretion and accumulate in the body, thereby inducing lactic acidosis. Therefore, metformin should be discontinued in patients with severe hepatic and renal insufficiency, such as severe diabetes, elevated creatinine, blood urea nitrogen and other indicators, or severe abnormal liver indicators.

Recent gastrointestinal bleeding. The main side effect of metformin is gastrointestinal discomfort. Metformin needs to be stopped when there are diseases such as severe peptic ulcer and gastrointestinal bleeding.

Pregnancy, lactation. Although metformin belongs to category B drugs in the drug classification during pregnancy, it does not increase the risk of fetal malformation and neonatal complications, but it can enter the placenta, umbilical cord, and milk, and it is speculated that it may affect the cell function and embryonic development of the fetus. It has not been approved for use in pregnant women with diabetes. Therefore, metformin should also be discontinued during pregnancy and breastfeeding.

Dehydration, decreased urine output. Severe vomiting, diarrhea, and vomiting can easily lead to dehydration and electrolyte imbalance. The first manifestation is decreased urine output, which can lead to renal function damage and the risk of aggravating lactic acidosis.

Severe cardiopulmonary insufficiency. Metformin should be used with caution in patients with severe cardiopulmonary insufficiency. Insufficient oxygen supply can be caused by heart and lung dysfunction or vascular obstruction. Under hypoxic conditions, lactic acid production will increase significantly, which can easily lead to lactic acidosis.