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Not every single patient is a candidate for surgical treatment, and now we have these medicines that are out there that are fantastic, Davisson said

For example, consider a 150-200 kcal protein pudding or a small savory broth with soft protein, rather than large meals that may trigger fullness

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Risk factors for metformin-associated lactic acidosis include renal impairment, concomitant use of certain drugs (e.g., carbonic anhydrase inhibitors such as topiramate), age 65 years old or greater, having a radiological study with contrast, surgery and other procedures, hypoxic states (e.g., acute congestive heart failure), excessive alcohol intake, hepatic impairment, and mitochondrial diseases [see Warnings and Precautions (5.1)]