Diabetes

Are you pregnant, breast feeding or intending to become pregnant?

Has your GP or specialist consultant diagnosed the condition for which you intend to take this medication and is happy for you take it?

Are there any other symptoms or underlying medical conditions the prescribing doctor needs to be aware of?

Do you have any allergies, side effects or adverse reactions with any medications in the past?

Have you been diagnosed with diabetes by your doctor?

Have you been using Metformin/Glucophage for more than 12 months?

Have you suffered from any unusual side effects from Metformin/Glucophage?

Do you currently have a fever or are you feeling unwell?

Are you taking any of the following: 

• Other medicines used to lower blood sugar i.e. insulin
• Medicines for asthma such as salbutamol 
• Diuretics (water tablets) such as furosemide or bendrofluazide.
• ACE-inhibitors such as captopril, ramipril used for heart problems and high blood pressure 
• Beta-blockers such as atenolol 
• Steroids such as prednisolone, used to treat inflammatory and allergic disorders.

Do any of the following apply to you: 

• You are allergic ( hypersensitive) to metformin/Glucophage or any of the ingredients in the tablet. 
• You have had serious complication with your diabetes or other serious condition which resulted in rapid weight loss, nausea, vomiting or dehydration and you had fainted or suffered a coma due to your diabetes.

Do any of the following apply to you? 

• You are suffering from severe infection or have recently suffer a severe injury.
• You have any problem with your liver or kidneys. 
• You have been treated for heart problems or have recently had a heart attack or have problem with your circulation including shock or breathing difficulty. 
• You are likely to have a surgery, or as scan or an X-Ray

Do you agree to have regular reviews with your doctor?

I agree to the following:

• I will read the patient information leaflet supplied with my medication
• I will contact my GP or MyMedsUK if I experience any side effects
• The treatment is for my use only
• I have answered the assessment questions truthfully and accurately
• I agree to the Terms and Conditions and I confirm that I am over 18 years old
• I am aware that I may be contacted to give further information via phone or email and if I am not contactable this will lead to a delay in receipt of my prescription