Metformin is the first line therapeutic drug used for Type 2 Diabetes. A drug in the biguanide class, metformin controls blood sugar in several ways. These include decreasing hepatic gluconeogenesis, increasing glycolysis, and increasing peripheral glucose uptake and insulin sensitivity. Notably, metformin can increase production of lactate in the body, leading to lactic acidosis. This is particularly common in patients with impaired kidney function, which is why metformin is contraindicated in renal failure. Other side effects to note are GI upset and vitamin B12 deficiency

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