Drug General Information (ID: DDIVIGBSX5)
Drug Name			Metformin		Drug Info		Insulin glulisine		Drug Info
Drug Type		Small molecule				Hormones
Therapeutic Class		Antidiabetic Agents				Antidiabetic Agents
Structure

Mechanism of Metformin-Insulin glulisine Interaction (Severity Level: Moderate)
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Metformin				Insulin glulisine
Mechanism		Increase the risk of hypoglycemia combined with insulin/insulin secretagogue				Insulin/insulin secretagogue
Key Mechanism Factor 1
		Factor Name		Hypoglycemia
		Factor Description		Hypoglycemia is a condition in which your blood sugar (glucose) level is below the standard range. It causes irregular or rapid heartbeat, pale skin, numbness of the lips, tongue or cheeks, and sweating.
Mechanism Description		Increased risk of hypoglycemia by the combination of Metformin and Insulin glulisine

Recommended Action
Management		A lower dosage of the insulin secretagogue or insulin may be required when used with metformin. Blood glucose should be closely monitored, and patients should be educated on the potential signs and symptoms of hypoglycemia (e.g., headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, tachycardia) and appropriate remedial actions to take if it occurs. Patients should also be advised to take precautions to avoid hypoglycemia while driving or operating hazardous machinery.

References
1	Product Information. Jardiance (empagliflozin). Boehringer Ingelheim, Ridgefield, CT.
2	Wiernsperger N, Rapin JR "Metformin-insulin interactions: from organ to cell." Diabetes Metab Rev 11 Suppl (1995): s3-12
3	Okada S, Ishii K, Hamada H, Tanokuchi S, Ichiki K, Ota Z "Can alpha-glucosidase inhibitors reduce the insulin dosage administered to patients with non-insulin-dependent diabetes mellitus?" J Int Med Res 23 (1995): 487-91