In general, metformin is well tolerated, although may cause nausea, vomiting or diarrhoea in some patients, especially if introduced at a high dose or taken on an empty stomach. Vitamin B12 deficiency is a less common side effect, and occasional measurement of Vitamin B12 levels in patients on long-term metformin therapy is prudent. Lactic acidosis is a spectre that has hung over metformin ever since its introduction because other biguanides, phenformin and buformin (long since withdrawn from the market) were clearly associated with an increased rate of lactic acidosis. This association has resulted in application of restrictions on use of metformin, not taking into account the different pharmacokinetics. The question arises as to whether metformin can induce lactic acidosis on its own, and in the normal course of events the answer is probably no, or if it does, it is exceedingly rare. However, metformin is known to raise lactate levels in humans but magnitude of this increase is small. Overdose of metformin can result in raised lactic acid levels and in serious overdose, lactic acidosis may occur even in healthy individuals. Metformin is a prescription drug used to treat type 2 diabetes. It belongs to a class of medications called biguanides. People with type 2 diabetes have blood sugar (glucose) levels that rise higher than normal. Instead, it helps lower your blood sugar levels to a safe range. This may make you wonder what side effects it can cause. Metformin can cause mild and serious side effects, which are the same in men and women. Here’s what you need to know about these side effects and when you should call your doctor. Find out: Can metformin be used to treat type 1 diabetes? These can occur when you first start taking metformin, but usually go away over time. Tell your doctor if any of these symptoms are severe or cause a problem for you. 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It works in a number of ways to lower blood sugar levels in people with type 2 diabetes. Firstly, it increases the sensitivity of muscle cells to insulin. Vildagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor available fully subsidised from 1 October, 2018. DPP-4 inhibitors have been approved for the treatment of type 2 diabetes in New Zealand for some time, however, this is the first time a medicine of this class has been subsidised for use in the community. Vildagliptin is an option for a second-line pharmacological treatment, for patients who have not achieved sufficient lowering of Hb A This article focuses on the place of vildagliptin in the treatment of type 2 diabetes in New Zealand. For more extensive information on the management of type 2 diabetes, including advice on lifestyle interventions, managing cardiovascular risk and escalating pharmacological treatment, see: GLP-1 signals to the pancreas to increase insulin release, and reduce glucagon release, after a meal. 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