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?  

  • Option 1 [undo]
  • νεφρική λειτουργία [undo]
  • Βιοψία γονάδων [undo]
  • Spre se z mamo. [undo]
  • Κλινική εξέταση. [undo]
  • Surfactant [undo]
  • Τις ημερήσιες ανάγκες + τις απώλειες; [undo]
  • Send home, to return if other symptoms develop [undo]
  • Ігнорувати симптоми. [undo]
  • CT κοιλιάς [undo]
  • Τις ημερήσιες ανάγκες; [undo]
  • Άνδρας 64 ετών με δυσουρικά ενοχλήματα [undo]
  • Зачекати, коли настане черговий приступ симптомів та звернутися за медичною допомогою. [undo]
  • Snakker jeg med styrer om dette [undo]
  • Παραμονή στα εξωτερικά ιατρεία_ [undo]
  • Give an immediate diagnosis without exploring the patient’s narrative. [undo]
  • new node [undo]
  • Ignora a su madre. [undo]
  • Assistenten viser forståelse om at hun har ofte reagert ikke så pedagogisk mot barna og ønskes å få veiledning både fra meg og styren [undo]
  • Πορεία νόσου [undo]
  • визначення та зупинка критичної кровотечі [undo]
  • Εισαγωγή στο νοσοκομείο [undo]
  • Εκ νέου παραπομπή [undo]
  • Έχει συνοδά νοσήματα; [undo]
  • send to LP [undo]
  • Επεμβάσεις στην κοιλιά; [undo]
  • Παίρνεις ιστορικό [undo]
  • Προγεννητικός έλεγχος- αμνιοπαρακέντηση [undo]
  • Θα κάνουμε διαφανοσκόπηση οσχέου [undo]
  • Θα κάνουμε ένα stick ούρων. [undo]
  • Decreased production of glucose from the liver [undo]

Map: Michael Green_GEMD_2 (1116)
Node: 21117
Score:

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