After the diagnosis of Type 2 diabetes is confirmed, patients should be given advice on diet, exercise and also started on a low dose of Tab Metformin. The recommended starting dose is either 500mg OD or 500mg BD of the generic tablet. Sustained release tablets are available and need be given only once daily. It can be given before food if there is no gastric discomfort or after food if the tablets cause gastric discomfort. It is always better to start with a low dose and gradually increase the dose (do not increase doses more frequently than every two to three weeks) in order to minimise the risk of gastric intolerance.
There are some things you should know about Metformin. The maximum efficacy comes with a dose of 2000 to 2500mg per day (given in divided doses two or three times a day) for the generic version. So there is no use in giving higher doses. Do not prescribe Metformin if you feel that the patient is prone to lactic acidosis. These are the people who have conditions like congestive heart failure, advanced renal failure and those who have significant liver dysfunction. Metformin can predispose to contrast induced nephropathy. So it is recommended that Metformin be stopped a few days before any procedure that involves injection of a contrast dye (like coronary angiography or IVP for example).

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