In clinical work, patients often ask questions about metformin, and some even talk about “metformin”, which is due to the prejudice and lack of understanding of metformin. How is metformin metabolized in the body? Metformin, whether it is enteric tablets or extended-release tablets, oral metformin is mainly absorbed in the small intestine, after absorption, mainly the highest concentration in the gastrointestinal tract, the concentration in the liver and kidneys is very low, and finally metformin is excreted by the kidneys, generally speaking, within 24 hours 90% of metformin can be excreted out of the body. What are the advantages of metformin? Metformin has the following features: Metformin improves insulin resistance and avoids hyperinsulinemia. Metformin also has an improvement on body weight, especially for those patients with diabetes who are obese and predominantly insulin resistant. Metformin also has a beneficial effect on blood lipids, which can have a beneficial effect on cardiovascular disease. Is metformin suitable for those patients? In our clinical work, our medication experience suggests that oral metformin treatment is generally indicated as long as there are no contraindications to metformin oral administration. The most suitable people include: obese patients with type 2 diabetes mellitus, who have been controlled by exercise, exercise, and diet with poor glycemic control. Apply insulin to control blood glucose, but poorly controlled blood glucose, or blood glucose fluctuations, you can use metformin, both to play a hypoglycemic effect, but also to stabilize blood glucose, so that blood glucose does not fluctuate too much. People with elevated blood sugar, but not enough to qualify for a diagnosis of diabetes, can use metformin to slow down the process of developing diabetes. Who should not take metformin? It is generally accepted that metformin should be discontinued or the dose of metformin should be reduced in the following cases. type 1 diabetes, as a rule, should not take metformin orally, but in some cases, such as when blood sugar fluctuates greatly and the patient is not too thin, metformin can be added in moderation. Complications such as ketoacidosis and lactic acidosis are combined in diabetic patients. Severe hepatic and renal insufficiency, such as combined with severe diabetic nephropathy with elevated creatinine and urea nitrogen, or combined with severe abnormal liver indicators, metformin should be discontinued. What is the most fatal adverse effect of metformin? Older people, especially combined with cardiovascular, cerebrovascular disease, or old slow branch, liver and kidney insufficiency and other diseases, metformin can increase the accumulation of lactic acid in the body, thus lactic acidosis, lactic acidosis is fatal, rescue is not timely most of the prognosis is poor, the elderly should pay particular attention. However, it is found in the clinic that metformin is safe for elderly patients under 75 years old without combined cardiovascular or cerebrovascular diseases, or liver and kidney diseases.