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Diabetes mellitus
Contrast x-rays in people on metformin: instructions for referring
clinicians
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Essential information required by your radiologist
- Check creatinine if a normal result not obtained in previous 12 months.
- Tick the "ON METFORMIN FOR DIABETES" box on the "Request
For Radiological Opinion" form.
- Document the serum creatinine and the date obtained on both the
"Request For Radiological Opinion" form and or the
"Information for Patients" form.
Further action depending on serum creatinine:
If creatinine <110 mmol/l:
- tell the patient to stop metformin (Glucophage) on the day of the test and
restart after 48 hours.
- give a completed copy of the "information for Patients" form
with the innepropriate parts deleted to ensure the patient has a written
record of what to do.
If creatinine> 110 mmol/l but < 200mmol/l:
- tell the patient to stop metformin (Glucophage) on the day of the test.
- give the patient a form for creatinine to be checked at pathology lab 48
hours following the test.
- give a completed copy of the "Information for Patients" form
with the inappropriate sections deleted to ensure that the patient has a
written record of what to do.
- write a reliable contact number on the "Information for
Patients" form in order that the patient can ring for confirmation to
restart metformin (metformin can be restarted once creatinine has returned
to the baseline value).
You must take responsibility for the post-test creatinine and advice to
restart metformin.
If creatinine> 200mmol/l:
- the referring clinician must discuss the patient with a named Consultant
Radiologist. These patients are most at risk from the interaction of
metformin and contrast medium.
Providing the radiologist agrees that the test be performed:
- the radiologist may decide metformin should be stopped 48 hours before the
test.
- give the patient a form for creatinine to be checked at pathology lab 48
hours following the test.
- give a completed copy of the "Information for Patients" form
with the inappropriate sections deleted to ensure that the patient has a
written record of what to do.
- write a reliable contact number on the "Information for Patients
form" in order that the patient can ring for confirmation to restart
metformin (metformin can be restarted once creatinine has returned to the
baseline value).
You must take responsibility for the post-test creatinine and advice to
restart metformin.
All patients
- Patients must be reminded to test blood or urine glucose twice a day
during the time metformin is stopped.
Source: Northumbria NHS Health Care Trust diabetes protocol