Decreased production of glucose from the liver

This is correct! Metformin activates AMPK-dependent protein kinase (AMPK) due to a reduction in cellular energy stores. AMPK reduces hepatic glucose production (gluconeogenesis) through inhibition of expression of genes that are important in gluconeogenesis. Remember that gluconeogenesis contributes to hyperglycaemia in diabetes.


Further Developments

Five years later, Mr. Green reports progressive exertional dyspnoea over several months, now short of breath after one flight of stairs, with new orthopnoea requiring two pillows and intermittent paroxysmal nocturnal dyspnoea. The medical notes show lack of follow-up over the past 18 months, which Mr. Green explains were due to a job change. He reports that his home blood pressure readings have been on the high side.

On examination his blood pressure is 132/78 mm/Hg and his BMI is now 30 kg/m2; physical examination shows bibasilar rales. Mr. Green is scheduled for an echocardiogram and invasive coronary angiography with a contrast agent to assess for obstructive coronary artery disease.

What is the most appropriate advice for Mr. Green for use of metformin during this time?  

  • Increased secretion of insulin from the pancreas [undo]
  • Amnestic exam [undo]
  • Ξεκινάτε σίτιση με τυποποιημένο γάλα [undo]
  • Preparation of liquid cultures [undo]
  • Learn about cognitive decline and aging [undo]
  • Αντιβιοτικά - Φουροσεμίδη [undo]
  • Metabolismo y Enzimas [undo]
  • Γονότυπος [undo]
  • Dobutamine (beta agonist) [undo]
  • Rely on physical traits [undo]
  • Alelă [undo]
  • Sacubitril-valsartan (ARNI) [undo]
  • METABOLISM OF THE CELL ENZYMES [undo]
  • Αλληλόμορφα [undo]
  • Basic Enzyme Definitions [undo]
  • Διάλειμμα μετά από περπάτημα κατά τη διάρκεια καύσωνα [undo]
  • Glipizide [undo]
  • Option 1: A and C are correct [undo]
  • new node [undo]
  • Presentation [undo]
  • Η συμβολή του εικονικού ασθενή (virtual patient) ως εκπαιδευτικό εργαλείο στη διαχείριση και την αντιμετώπιση ραγέντων ανευρυσμάτων κοιλιακής αορτής [undo]
  • Root Node [undo]
  • Furosemide (loop diuretic) [undo]
  • [undo]
  • Introduction to the profession and to other students [undo]
  • You suggest that we go for coffee with the doctors. [undo]
  • Start by selecting the pipette appropriate for your volume. [undo]
  • Increased entry of fatty acids into adipocytes [undo]
  • Increased entry of fatty acids into adipocytes [undo]
  • Decreased entry of glucose into muscle cells [undo]
  • Start [undo]
  • Root Node [undo]
  • B, C, F [undo]
  • Protein Synthesis [undo]
  • Intro [undo]
  • Pipettes [undo]
  • Decreased production of glucose from the liver [undo]

Map: Michael Green_GEMD_1 (1115)
Node: 21093
Score:

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