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BIGUANIDES: (Phenformin, mtformin). They are completely different from the hypoglcaemic sulfonamides both in its structur and its mode of action. They cause little or not hypoglycaemia in non-dibetic. Possible mode of action suggested is that they interfere with mitochondrial respiratory chains-promote peripheral glucose utilizaton by enhancing anaerobic glycolysis or they enhance binding of insulin to its receptors & potentiate its action. other explanation is that they suppress hepatic glucon-eogenesis & inhibit intestinal absorption glucose.

Indications : Maturity onset (non-insulin dependt) obese diabetics in whom diet alone has failed very unstable juvenile or maturity onset (non-insulin dependent) diabetics, where a combinationof insulin and metformi is beneficial. In those diabetics where sulphonylurease and metformin, when given alone fail but a combination works.

Contra-indications: 1. Reanl failure. 2. Cardiovascular collapse. 3. Diabetic ketoacidosis. 4. severe heaptic insufficiency.

Special Precautions: Patients should not consume alcohol as there is an interaction between metfrmin and alcohol which could lead to increased risk of lactic acidosis.

Side-effects : G.l. disturabnces, tolerence, lactic acidosis.