One of the concerns with the use of metformin is that it has been associated with the development of potentially serious / life-threatening problem called lactic acidosis. This is especially true in adults with known kidney impairment, serious liver problems, or congestive heart failure. In addition, iodine x-ray dye can precipitate this. I try to forewarn my patients on metformin that if they need an x-ray they should inquire whether it will involve an iodine x-ray dye (e.g., IVP of the kidneys, CAT scan, arthrogram of a joint). If it will, they should reschedule the test about four days or so after temporarily stopping the metformin. However, emergencies occur and sometimes complex x-rays cannot be postponed.

In addition, real emergencies occur during which the patient is unable to speak for him/herself — such as head trauma. In order to make medical personnel aware that they should be on the lookout for lactic acidosis in that patient, I ask that my patients wear medical identification that states: "On metformin — risk of lactic acidosis."

I hope this approach seems reasonable to you and your doctor.

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You need to sit down with your doctor and have him/her take the time to explain why he placed you on metformin. In addition, if he confirms that you have diabetes, you should have him refer you to a diabetes educator for further information on managing this chronic disease. Metformin is a medication used for treatment of Type 2 diabetes, so you need to get this clarified with your doctor.

The advice on the metformin bottle is good advice for anyone with a chronic condition (such as diabetes, heart trouble, high blood pressure, etc.) — that advice is to always wear medical identification with your doctor's contact information and a list of your medical conditions and the treatments.

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