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Examples Metformin Dosage Immediate release Initial: 500 mg once or twice daily OR 850 mg once daily Maximum: 2,550 mg daily (dosages above 2,000 mg daily are typically administered in three divided doses) Extended release Initial: 500–1,000 mg once daily Maximum: 2,000 mg daily Possible side effects include: Gastrointestinal: diarrhea, nausea, and/or abdominal discomfort Vitamin B12 deficiency (and elevated homocysteine) Testosterone reduction (blood tests can measure this and natural testosterone prescription creams may be considered) Oral glucagon-like peptide-1 (GLP-1) receptor agonist Primary mechanism(s) of action Enhance incretin signaling to increase glucose-dependent insulin secretion, reduce post-prandial glucagon, and delay gastric emptying (resulting in reduced after-meal glucose levels and increased satiety) Examples Semaglutide (Rybelsus) is the only approved medication in this class as of early 2022

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