Practice · Interactions

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Practice › Interactions insulin metformin hypoglycaemia

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j.mwangiTL4 Moderator22 Feb 2026#1

Community wiki post. Any member at trust level 3 or above can edit this post; every edit is recorded. Last edited by mira.patel on 3 Apr 2026.

3 Apr 2026 — j.mwangi: Plain-language pass on the opening paragraph.
3 Apr 2026 — mira.patel: Corrected an arithmetic slip in the second example.

Editors: j.mwangi, mira.patel, hana.sato

Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Drug, supplement and food interactions — separating timing inconveniences from clinically important ones.

This post is a community wiki: any member at trust level 3 or above can edit it, and every edit is recorded with its author and a note. If the scope described here has drifted from what actually gets posted, edit it rather than starting a topic about it.

What belongs here

Questions specific to interactions, with the units and the context stated.
Reports and datasets, with the collection method stated.
Disagreement about the substance, conducted in public.

What belongs elsewhere

Anything urgent belongs in Safety, immediately, and not here.
Anything about how this site works belongs in Meta.
Requests for a maintained page belong in Wiki requests.

Before posting, it is worth checking the documentation commons and this category's tag pages. A great deal of what gets asked here has a maintained answer with a review date on it, which is more reliable than a two-year-old reply.

0 likes 5mo

KLindqvistTL4 Moderator11 Mar 2026#2

Staff post. Actions described here are recorded in the public moderation log and may be challenged in Meta.

Moderation notes for this category, so that nothing about how it is run is a surprise.

Topics get moved into and out of here regularly. A move is not a judgement — the category tree is not obvious from outside and putting a question in the wrong place is expected. When I move something I say so in the topic and the action appears in the public log with the guideline cited.

The two guidelines that come up most often in this category are R2, on supplying a source when asked, and R7, on category placement. Neither is used punitively.

25 likes 5mo

c.wijnbergTL2Member23 Mar 2026#3

As a member rather than staff: the most useful thing I did when I started reading this category was to work through the tag pages rather than the topic list. The topic list shows you what is recent. The tags show you what is settled.

12 likes 4mo

da.bakkerTL23 Apr 2026#4

Suggestion for the wiki post above: it would be worth linking the two or three most-referenced topics in this category directly, since new members reliably ask for exactly those. Happy to make the edit myself if nobody objects, with a revision note.

4 likes 4mo

m.steinerTL213 Apr 2026#5

Right — I had this wrong and I am glad to have read it before it mattered.

0 likes 3mo

bias_varianceTL4Biostatistician22 Apr 2026#6

Food interactions: most interactions are absorption interactions. Some medications absorb better with food, others better on an empty stomach. With an incretin agonist that already slows gastric emptying, food effects interact with the drug effect as well.

The variance between people here is larger than the effect being discussed.

18 likes 3mo

j.moreauTL21 May 2026#7

j.mwangi, post #1: Drug, supplement and food interactions — separating timing inconveniences from clinically important ones. This post is a community wiki: any member at trust level 3 or above can edit it, and every edit is recorded with its author and a note. If the scope described here has drifted from what actually gets posted, edit it rather than… Go to post

Delayed gastric emptying is the mechanism behind most of the plausible interactions in this class: anything whose absorption depends on how quickly the stomach empties can behave differently.

Speaking for myself and not for anyone else who has posted here.

7 likes in reply to #1 3mo

impurity_tableTL3Analytical chemist10 May 2026#8

Narrowing post #7, because the general version has more than one answer.

Mechanistic reasoning about interactions has a poor predictive record. It is a good way to generate a question and a bad way to answer one.

Not the whole picture, but the part of it I can speak to.

1 like 3mo

r.nakamuraTL218 May 2026#9

Post #7 put the caveat in the right place and I want to underline it.

SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.

26 likes 2mo

Suggested topics

Topic	Participants	Replies	Views	Activity
Coming back to: Delayed gastric emptying and oral medication absorption: which drugs matter Practice › Interactions hypoglycaemia metformin insulin needs a source Solved Delayed gastric emptying and oral medication absorption: which drugs matter Writing it up because I had to work it out twice and would rather nobody else did. Reading back through what has been written here…	+63	74	11k	1d
Warfarin and altered intake: the monitoring argument Practice › Interactions hypoglycaemia needs a source insulin Solved Warfarin and altered intake: the monitoring argument — setting out what I have, and where I think it stops being reliable. Proposing that warfarin and altered intake deserves a maintained page rather than a…		2	11k	4mo
Metformin co-administration and additive GI effects Practice › Interactions insulin hypoglycaemia metformin delayed gastric emptying Metformin co-administration and additive GI effects Writing it up because I had to work it out twice and would rather nobody else did. Trying to work out what would count as evidence on metformin…	+28	32	2.1k	15mo
Insulin combinations and hypoglycaemia risk Practice › Interactions metformin needs a source hypoglycaemia insulin Closed On the subject in the title: Insulin combinations and hypoglycaemia risk Working notes rather than a conclusion. I was wrong about insulin combinations and hypoglycaemia risk in a thread last spring and I…	+18	22	7.8k	13mo
Grapefruit: why this class is not the class that cares Practice › Interactions needs a source hypoglycaemia metformin delayed gastric emptying Grapefruit: why this class is not the class that cares Writing it up because I had to work it out twice and would rather nobody else did. I was wrong about grapefruit in a thread last spring and I would like…	+126	139	4k	4mo

Related topics — sharing the tags insulin, metformin, hypoglycaemia

Topic	Participants	Replies	Views	Activity
Levothyroxine timing: a real interaction with a simple fix Practice › Interactions needs a source metformin hypoglycaemia delayed gastric emptying Levothyroxine timing: a real interaction with a simple fix Writing it up because I had to work it out twice and would rather nobody else did. A narrow question about levothyroxine timing, deliberately narrow,…	+20	24	60k	18mo
Metformin co-administration and additive GI effects Practice › Interactions insulin hypoglycaemia metformin delayed gastric emptying Metformin co-administration and additive GI effects Writing it up because I had to work it out twice and would rather nobody else did. Trying to work out what would count as evidence on metformin…	+28	32	2.1k	15mo
A widely repeated interaction claim that turns out to be unsupported Practice › Interactions metformin hypoglycaemia delayed gastric emptying needs a source On the subject in the title: A widely repeated interaction claim that turns out to be unsupported Working notes rather than a conclusion. I was wrong about widely repeated interaction claim in a thread last…	+47	51	37k	3mo
Common supplements people ask about, assessed one at a time Practice › Interactions insulin needs a source hypoglycaemia metformin Common supplements people ask about, assessed one at a time — setting out what I have, and where I think it stops being reliable. A follow-up question about common supplements that I did not know to ask the…	+101	107	28k	12h
Antibiotics and a course of something with delayed emptying Practice › Interactions insulin hypoglycaemia needs a source metformin Antibiotics and a course of something with delayed emptying — setting out what I have, and where I think it stops being reliable. Something about antibiotics does not reconcile and I would like a second pair…	+99	108	1.4k	12mo

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