Metabolic effects of glucocorticoid and ethanol administration in phenformin- and metformin-treated obese diabetics.
Glucocorticoid administration for 24 hours to phenformin-treated obese diabetics increased blood lactate and lactate/pyruvate (L/P) ratio to higher levels than those found when only one drug was given. In one of 10 subjects, a metabolic acidosis with a blood lactate of 6.2 mmol developed during simultaneous administration of the two drugs. Diabetics treated with phenformin or metformin in equipotent dosages exhibited the highest blood lactate, L/P ratio, and beta-hydroxybutyrate levels during phenformin treatment, both before and during glucocorticoid administration. Ethanol administration to biguanide-treated diabetics resulted in identical increases in blood lactate and L/P ratio during phenformin and metformin treatment. These findings are consistent with the hypothesis that phenformin has a stronger inhibitory effect of gluconeogenesis than metformin. This may be one reason why lactic acidosis is seen much more often in phenformin- than metformin-treated patients.
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D004357:Drug Synergism; D000431:Ethanol / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000494:pharmacology*; D007773:Lactates / Q000097:blood*; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009765:Obesity; D010629:Phenformin / Q000627:therapeutic use*; D011773:Pyruvates / Q000097:blood*
D001786:Blood Glucose; D007773:Lactates; D011773:Pyruvates; D000431:Ethanol; D008687:Metformin; D010629:Phenformin; D006854:Hydrocortisone