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Diabetes Gestational – Treatment – Metformin

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Diabetes Gestational Therapy – Metformin

Today we look at gestational diabetes in the treatment of it we will look at the metformin today we know that insulin is the best treatment for gestational diabetic patients because we can titrate the dose limitless metformin is the second second best option because here we have a tablet we can give a 500 milligram for example or 850 milligram once daily or

If needed then we can give it twice daily so that means that we cannot give 550 or 600 or 650 we can only give 500 or 850. insulin in the other hand we can give one unit 2 unit 3 unit limitless amount of units and that is the benefit of insulin one of them the other benefits is that it has the lowest risk of hypoglycemia so the side effect of having a low

Glucose in the blood meaning less than 60 milligram per deciliter that’s lowest with insulin as we know metformin can cause hypoglycemia rather low risk so metronome is pretty good it’s a very very good tablet with very good medication glubarite is another medication that is also good if we have side effects or contraindications against metformin and these

Two together have similar side effects of hypoglycemia which is a little bit higher than insulin so what happens now we want to give metformin and we start with metformin because the pregnant woman does not want to inject because that’s the difference between insulin and tablets or of metroman because insulin is injected metformin is given tablet form so the

Pregnant woman is uh having troubles with injections we start with oral tablets of metformin and unfortunately 30 of cases will need insulin anyway that’s the problem with metformin or other tablets but the pregnant woman will tell you that but i will maybe be in the 70 so i will take the risk we start with metformin and then in 70 of cases we can follow through

With metformin during the whole pregnancy and we don’t need any insulin that’s the good thing about it so how does a metro me work let’s look at the mechanism we have then reduced output from the liver of glucose so glucose is reduced output from the liver and also it will increase the sensitivity of insulin increased insulin sensitivity which is very important

For us in diabetes glubaride on the other hand will increase and stimulate the insulin secretion so this is the difference between metformin in metformin increase the insulin sensitivity glubaride will increase the insulin secretion so that’s the two main differences why do we use glubarite as we said today we’re discussing metformin yes but if we have side

Effects and contraindications contraindications being intrauterine growth restriction of metroman that is meaning that the growth of the baby is restricted and if you see this correlation that we have a pregnant woman there is problem with the pregnancy because the pregnant woman is having an intrauterine growth restriction and we see that the pregnant woman

Is taking metformin then that can be the cause of it so we need to stop metformin it’s a contraindication and therefore we need to give insulin or glubaride instead and this is when glubroid comes in mind okay so glubarite can then be given 2.5 milligram in the beginning or up to 10 milligram you know up to 20 milligram maximum so 2.5 to 20 milligrams this is

The span then the side effects of metformin we don’t only have contraindicated we have side effects like metallic taste nausea abdominal discomfort diarrhea and even mild anorexia can be seen with metformin and if you see any of these and the patient the pregnant woman hates these symptoms she don’t want to do it she wants to switch to another medication then

Glubarite comes in mind as we said then what type of group does these containing methamine is a biguanido group it’s called and glubarite is contained in second generation sulfonylurea sulfonylurea is a very old drug a very old medication but the second generation is the newer type this is the gluburide and both of these have side effects of hypoglycemia we

Talked about this already so hypoglycemia being one the these two medications are not really good to be used together so these two should not be used together if you want to combine a medication you should combine metformin with insulin or glubaride with insulin and other thing that is not good to do no the other thing that is important to tell their mother is

That this can cross both metformin and glubride can cross the placenta into their fetus meaning it goes through the blood into the placenta into the fetus the short-term effects of these are nothing it’s very good they’re safe but the long-term effects we are we have no clue because we didn’t do such a long study the research is ongoing so this is pretty much it

We don’t need to discuss more about metformin we’ll do that in other videos today we i wanted to focus on the gestational diabetes part the treatment of it meaning insulin is the best then methamine comes next and the third we can use the glubaride so thank you very much for listening bye bye

Transcribed from video
Diabetes Gestational – Treatment – Metformin By Dr. Andras Fazakas