BIOMEDICINE – ENDOCRINOLOGY: Anti-diabetic (biguanides)
ACTION: Decreases hepatic production of glucose. Decreases intestinal absorption of glucose, improves insulin sensitivity. Therapeutic Effect: Improves glycemic control, stabilizes/decreases body weight, improves lipid profile.
INDICATIONS: Management of type 2 diabetes mellitus as monotherapy or concomitantly with oral sulfonylurea or insulin.
OFF-LABEL:. Polycystic ovarian syndrome, gestational diabetes mellitus. Prevention of type 2 diabetes.
SIDE EFFECTS:
Occasional (greater than 3%): GI disturbances (diarrhea, nausea, vomiting, abdominal bloating, flatulence, anorexia).
Rare (3%–1%): Unpleasant/metallic taste that resolves spontaneously during therapy.
ADVERSE EFFECTS/TOXIC REACTIONS: Lactic acidosis occurs rarely (0.03 cases/1,000 pts) but is a serious and often fatal (50%) complication. Lactic acidosis is characterized by increase in blood lactate levels, decrease in blood pH, electrolyte disturbances. Symptoms include unexplained hyperventilation, myalgia, malaise, drowsiness, cardiovascular collapse (shock)
INTERACTIONS:
DRUG: Furosemide may increase concentration. Cationic medications (e.g., digoxin, morphine, quinine, ranitidine, vancomycin) may increase concentration/effects. Contrast agents may increase risk of metformin-induced lactic acidosis, acute renal failure (discontinue metformin 24–48 hrs prior to and up to 72 hrs after contrast exposure).
HERBAL: Garlic may cause hypoglycemia.
LAB VALUES: May alter cholesterol, LDL, HDL, triglycerides.
NUTRIENTS DEPLETED: B12, Folic Acid, CoQ10, B6
Symptoms that may be caused by nutrient depletion: Anemia, tiredness, fatigue, weakness, increased cardiovascular risk, depression, paresthesia, birth defects, cervical dysplasia, increased cancer risk, muscle weakness, blood-sugar dysregulation, weakened immunity
(Glucophage)
TCM – Chapter 14a: Substances that drain dampness
Enters: SP, LV, K
Temperature: neutral
Taste: bland, slightly pungent
ACTIONS: Drain damp
INDICATIONS: Damp accumulation
Tongue: scalloped, swollen, thicker coat.
Pulse: soggy, slippery.
RATIONALE: its bland taste and downward direction drain damp. Its addresses only symptom of damp accumulation but does not address a cause of Sp deficiency. Pungent taste being dispersing in nature may deplete Sp Qi even more. Also if overused it may cause deficient heat. Qi deficiency in combination with deficient heat in severe cases can cause lactic acidosis.
CAUTION: Deficient heat
NOTE: none
MODIFICATIONS: To support Sp Qi add Dang Shen