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Metformin counselling — GPhC CRA MCQ

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EasyEndocrine TherapeuticsMetformin counsellingGPhC CRA

A 56-year-old woman with type 2 diabetes presents with a prescription for metformin 500 mg once daily, increasing to 500 mg twice daily after one week. She has an eGFR of 68 mL/min/1.73m2. She asks about side effects. What is the most important counselling point?

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Correct answer: A — She may experience gastrointestinal side effects such as nausea and diarrhoea, which often improve with time and taking it with food

GI side effects (nausea, diarrhoea, abdominal discomfort) are the most common adverse effects of metformin, particularly when starting treatment. These often settle with gradual dose titration and taking the tablets with food. Metformin used as monotherapy carries a low risk of hypoglycaemia. It does not affect thyroid function and does not require liver function monitoring (though renal function should be monitored).

Reference: BNF; NICE NG28 Type 2 Diabetes