Hi. I wouldn't be too alarmed by the use of metformin in your partner's case. there is currently much debate about whether or not it is advisable in kidney transplant patients - and this because, while it is a very good drug to improve glucose control and reduce the incidence of "diabetic complications" in the general population...and has other benefits related mainly to the health of the heart, it can case severe lactic acidosis in patients with poorer kidney function. With lactic acidosis, lactate is built up in the body causing a low pH- and this means higher acid level the blood. That can cause nausea, vomiting, fatigue, rapid breathing, palpitations..and can become quite a serious problem for some. As kidney transplant patients are prone to big problems if their graft rejects, it is maintained that such patients are therefore risk group for poor kidney function. That said, modern approaches to post-transplant treatment and the individual monitoring and balancing of drugs like tacrolimus (prograf) and MMF - which your partner is probably taking - make rejection less and less likely, and this is only improving. So, some now believe that metformin is appropriate even for kidney transplant patients. My kidney function for example is now around 65% (better than some "normal" people's function), and the better the function the less risk of lactic acidosis etc etc. So what I am saying is...because of these issues and past concerns that metformin was what's called "contraindicted" in relation to transplant patients, and so it's not going to be first choice as a treatment for new onset diabetes (probably caused by any steroids your partner takes...I'm thinking he will be on quite a wee pile of drugs). Renal specialists would not put your partner on this drug if they were particularly concerned about it. I suggest you print out this..and show it to a doctor who will probably agree with what I'm saying. It's what all my real doctors are saying. I was placed on Gliclazide rather than metformin for these reasons, but it's more the case that it is not perfect..what is..rather than it being necessarily a problem. I came off Gliclazide because I got my diabetes under control through a very low carb diet. I'm not on meds for it now and my steroid (to help fight rejection) has been cut right down. Ask the doctors about the impact of any steroid he is on, and if its safe to reduce it further (as this would further lower the blood sugar level). It is hard to control blood sugar while on a high dose of a steroid (like prednisolone). In the past this was unthinkable, but that was before we had drugs like tacrolimus and MMF etc to combat rejection effectively (without steroids). Anyway, I'm trying to tell you not to worry and I hope my explanation makes sense. Talk it through with a renal doctor, raising these points, and I'm sure he or she will be happy to do so, and will reassure you as to the reasons why they are content to use metformin. it's just not the usual first choice is all. I would add, just for the sake of it - make sure he is drinking plenty of fluid to prevent dehydration (this will help both kidney function, helping the creatinine level to stay lower, and will also assist him in lowering blood sugar. since my transplant over a year ago now, I drink about 3 litres a day of water with a very small amount of diluting juice (Robinsons) for taste. I hope it all goes well. Do let me know how things are. If there is anything I can help with at all, don't hesitate to ask. I hope I haven't ranted on and on to the point of total boredom! I can do a power of talking!! Paul
