Metformin can potentiate the hypoglycemic effects of insulin. The mechanism may involve either increases in cellular mechanisms controlled by insulin or effects on complementary biochemical reactions. While this interaction can be used to clinical advantage, clinicians should be aware that coadministration of metformin increases the risk of hypoglycemia associated with insulin.MANAGEMENT: Close monitoring for the development of hypoglycemia is recommended if metformin is coadministered with insulin, particularly in patients with advanced age and/or renal impairment. Patients should be apprised of the signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nausea, hunger, tremor, weakness, sweating, palpitations), how to treat it, and to contact their physician if it occurs.
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