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Diabetes

Microalbumin/Creatinine Level and Metformin

11/02/2009

Question:

I am 50 yr old female w/diabetes since 2004. My fasting BC=170H; A1c=7.7H; LDL=134; HDL=58; TriGly=177; BP=106/67; Micro-albumin/Creatinine level=32.51 (1st time). Diabetes was mainly controlled by diet. Doctor has prescribed Metformin. Can Metformin damage kidneys further? According to my research MF should not be taken if you have kidney disease. Also, should I be seeing a neurologist instead of intern for my diabetes maintenance? I would appreciate your feedback greatly. I have currently started to workout 3-4 days a week cardio and weights. Hope to change my behavior. Thank you!

Answer:

The concern with taking metformin in people with kidney damage is that the kidney damage reduces the metabolism and removal of metformin, increasing the risk of toxicity to other systems from metformin - a rare metabolic problem called lactic acidosis.  I am not aware of evidence that metformin causes kidney damage itself. 

Specialists in diabetes include endocrinologists and diabetologists as physicians and nurses, dieticians, pharmacists and occasional physicians who are trained as certified diabetes educators.  There are also nurse practitioners who specialize in diabetes and/or endocrinology.  Specialists may have more knowledge in the area, have special expertise with certain techniques not necessarily adopted by non-specialists and may bring a different degree of aggressiveness or different attitude to diabetes management - whether an individual needs those is an individual decision, depending in part on the complexity of the diabetes and its interaction with other problems.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati