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I am from Bangladesh.It is most prestigious country of world.There are plathora of problems in our country.

I am from Bangladesh. It is most prestigious country of world. There are plathora of problems in our country. 5aLwe
reatment of type 2 diabetes mellitus, particularly in overweight patients when dietary management and exercise alone does not result in adequate glycaemic control. In adults: Metformin may be used as monotherapy or in combination with other oral antidiabetic agents or with insulin. In children from 10 years of age and adolescents: Metformin may be used as monotherapy or in combination with insulin. A reduction of diabetic complications has been shown in overweight type 2 diabetic adult patients treated with metformin as first-line therapy after diet failure. Pharmacology Metformin is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization. Dosage & Administration Metformin immediate release tablet: Dosage of Metformin Hydrochloride must be individualized on the basis of both effectiveness and tolerance, while not exceeding the maximum recommended daily doses. Adult: The usual starting dose of Metformin is 500 mg twice a day or 850 mg once a day, given with meals. Dosage increases should be made in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day, given in divided doses. For those patients requiring additional glycemic control, Glucomin may be given to a maximum daily dose of 2550 mg per day. Doses above 2000 mg may be better tolerated given three times a day with meals. Children: The usual starting dose of Metformin is 500 mg twice a day, given with meals. Dosage increases should be made in increments of 500 mg weekly up to a maximum of 2000 mg per day, given in divided doses. Metformin extended release tablet: Swallow Metformin XR tablet whole and never crush, cut or chew. Adult: The usual starting dose of Metformin XR is 500 mg once daily with the evening meal. Dose should be increased in increments of 500 mg weekly, up to a maximum of 2000 mg once daily with the evening meal, alternatively increased to 1000 mg twice daily taken with meal. Patient receiving Metformin immediate release tablet may be switched to Metformin extended release tablet up to a maximum recommended daily dose. Children: Metformin extended release tablet has not been studied in children. Renal impaired patient: Do not use Metformin in patients with eGFR below 30 mL/min/1. 73 m2. Asses risk/benefit of counting if eGFR falls below 45 mL/min/1. 73 m2. * চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন' Interaction Co-administration with Carbonic anhydrase (Topiramate, Zonisamide) may increase risk of lactic acidosis. Drugs (Ranolazine, Dolutegravir, Cimetidine) that reduce Metformin clearance may increase the accumulation of Metformin. Alcohol can potentiate the effect of Metformin on lactate metabolism. Contraindications Hypersensitivity to the active substance or to any of the excipients. Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis). Severe renal failure (GFR <30 mL/min). Acute conditions with the potential to alter renal function such as: dehydration, severe infection, shock. Acute or chronic disease, which may cause tissue hypoxia such as: cardiac or respiratory failure, recent myocardial infarction, shock, Hepatic insufciency, acute alcohol intoxication, alcoholism. Side Effects Blood and lymphatic system disorders: Not known: Hemolytic anemia Metabolism and nutrition disorders: Very rare: Lactic acidosis. Decrease of vitamin B12 absorption with a decrease of serum levels during long-term use of metformin. Consideration of such etiology is recommended if a patient presents with megaloblastic anemia. Cases of peripheral neuropathy in patients with vitamin B12 deficiency have been reported in post-marketing experience (frequency not known) Nervous system disorders: Common: Taste disturbance. Not known: Encephalopathy Gastrointestinal disorders: Very common: Gastrointestinal disorders, such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. These undesirable effects occur most frequently during the initiation of therapy and resolve spontaneously in most cases. To prevent them, it is recommended that metformin be taken in 2 or 3 daily doses during or after meals. A slow increase of the dose may also improve gastrointestinal tolerability. Hepatobiliary disorders: Very rare: Isolated reports of liver function test abnormalities or hepatitis resolving upon metformin discontinuation. Skin and subcutaneous tissue disorders: Very rare: Skin reactions, such as erythema, pruritus, urticaria. Pregnancy & Lactation Pregnancy: Uncontrolled diabetes during pregnancy (gestational or permanent) is associated with an increased risk of congenital abnormalities and perinatal mortality. When the patient plans to become pregnant and during pregnancy, it is recommended that diabetes is not treated with metformin but insulin be used to maintain blood glucose levels as close to normal as possible, to reduce the risk of malformations of the foetus. Breastfeeding: Metformin is excreted into human breast milk. No adverse efects were observed in breastfed newborns/infants. However, as only limited data are available, breastfeeding is not recommended during metformin treatment. A decision on whether to discontinue breastfeeding should be made, taking into account the benefit of breastfeeding and the potential risk to adverse effects on the child. Precautions & Warnings Metformin Hydrochloride is known to be substantially excreted by the kidney and the risk of Metformin accumulation and lactic acidosis increases with the degree of impairment of renal function. Metformin may lower vitamin B12 level. It also increases risk of hypoglycemia when use in combination with insulin or insulin secretagogue. Use in Special Populations Elderly: Due to the potential for decreased renal function in elderly subjects, the metformin dosage should be adjusted based on renal function. Regular assessment of renal function is necessary. Pediatric population: The diagnosis of type 2 diabetes mellitus should be confirmed before treatment with metformin is initiated. No effect of metformin on growth and puberty has been detected during controlled clinical studies of one-year duration but no long-term data on these specific points are available. Therefore, a careful follow-up of the effect of metformin on these parameters in metformin-treated children, especially prepubescent children, is recommended. Children aged between 10 and 12 years: Particular caution is recommended when prescribing to children aged between 10 and 12 years. Renal function: As metformin is excreted by the kidney, creatinine clearance (this can be estimated from serum creatinine levels by using the Cockcroft-Gault formula) should be determined before initiating treatment and regularly thereafter: At least annually in patients with normal renal function, At least two to four times a year in patients with creatinine clearance at the lower limit of normal and in elderly subjects. Decreased renal function in elderly subjects is frequent and asymptomatic. Special caution should be exercised in situations where renal function may become impaired, for example when initiating antihypertensive therapy or diuretic therapy and when starting therapy with a non-steroidal anti-inflammatory drug (NSAID). GFR should be assessed before treatment initiation and regularly thereafter. Metformin is contraindicate in patients with GFR<30 ml/min and should be temporarily discontinued in the presence of conditions that alter renal function. Overdose Effects Hypoglycemia has not been seen with Metformin doses up to 85 gm, although lactic acidosis has occurred in such circumstances. Lactic acidosis is a medical emergency and must be treated in hospital. The most effective method to remove lactate and Metformin is hemodialysis. Therapeutic Class Biguanides Storage Conditions Keep below 30°C temperature, protected from light & moisture. Keep out of the reach of children. © Medex ™ About Us Privacy Policy Disclaimer Terms of Use Mobile App ↑
This sentence does not start with an uppercase letter
reatment
of
You use this word too often, consider replacing it with
type
2 diabetes mellitus,
particularly
in overweight
You use this word too often, consider replacing it with
patients
when dietary management and exercise alone does not result in adequate
Possible spelling mistake found.
glycaemic
control.

In adults: Metformin may be
This phrase/word (depending on the context) can be potentially replaced with :
used
as
Possible spelling mistake found.
monotherapy
or in combination with other oral
Possible spelling mistake found.
antidiabetic
agents or with insulin.

In
You use this word too often, consider replacing it with
children
from 10 years of age and adolescents: Metformin may be
This phrase/word (depending on the context) can be potentially replaced with :
used
as
Possible spelling mistake found.
monotherapy
or in combination with insulin.

A reduction of diabetic complications has
been shown
in overweight
You use this word too often, consider replacing it with
type
2 diabetic adult
You use this word too often, consider replacing it with
patients
treated with metformin as
first
-line
You use this word too often, consider replacing it with
therapy
after diet failure.

Pharmacology

Metformin is a
Possible spelling mistake found.
biguanide
You use this word too often, consider replacing it with
type
oral
Possible spelling mistake found.
antihyperglycemic
drug
This phrase/word (depending on the context) can be potentially replaced with :
used
in the management of
You use this word too often, consider replacing it with
type
2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is
This phrase/word is too simple and can be replaced with:
different
from those of
Possible spelling mistake found.
sulfonylureas
and it does not produce hypoglycemia. Metformin
You use this word too often, consider replacing it with
decreases
hepatic glucose production,
You use this word too often, consider replacing it with
decreases
intestinal absorption of glucose and
This phrase/word (depending on the context) can be potentially replaced with :
improves
insulin sensitivity by an
You use this word too often, consider replacing it with
increase
in peripheral glucose uptake and utilization.

Dosage & Administration

Metformin immediate
You use this word too often, consider replacing it with
release
tablet:
You use this word too often, consider replacing it with
Dosage
of Metformin Hydrochloride
This phrase/word (depending on the context) can be potentially replaced with :
must
be individualized
on the basis of both effectiveness and tolerance, while not exceeding the maximum
You use this word too often, consider replacing it with
recommended
You use this word too often, consider replacing it with
daily
doses.

Adult: The usual starting
You use this word too often, consider replacing it with
dose
of Metformin is 500 mg twice a day or 850 mg once a day,
This phrase/word (depending on the context) can be potentially replaced with :
given
with
You use this word too often, consider replacing it with
meals
.
You use this word too often, consider replacing it with
Dosage
You use this word too often, consider replacing it with
increases
should
be made
in increments of 500 mg weekly or 850 mg every 2 weeks, up to a total of 2000 mg per day,
This phrase/word (depending on the context) can be potentially replaced with :
given
in divided
You use this word too often, consider replacing it with
doses
. For those
You use this word too often, consider replacing it with
patients
requiring additional
Possible spelling mistake found.
glycemic
control,
Possible spelling mistake found.
Glucomin
may be
This phrase/word (depending on the context) can be potentially replaced with :
given
to a maximum
You use this word too often, consider replacing it with
daily
You use this word too often, consider replacing it with
dose
of 2550 mg per day.
You use this word too often, consider replacing it with
Doses
above 2000 mg may be better tolerated
This phrase/word (depending on the context) can be potentially replaced with :
given
three times a day with meals.

Children: The usual starting
You use this word too often, consider replacing it with
dose
of Metformin is 500 mg twice a day,
This phrase/word (depending on the context) can be potentially replaced with :
given
with
You use this word too often, consider replacing it with
meals
.
You use this word too often, consider replacing it with
Dosage
You use this word too often, consider replacing it with
increases
should
be made
in increments of 500 mg weekly up to a maximum of 2000 mg per day,
This phrase/word (depending on the context) can be potentially replaced with :
given
in divided doses.

Metformin extended
You use this word too often, consider replacing it with
release
tablet: Swallow Metformin XR tablet whole and never crush,
This phrase/word (depending on the context) can be potentially replaced with :
cut
or chew.

Adult: The usual starting
You use this word too often, consider replacing it with
dose
of Metformin XR is 500 mg once
You use this word too often, consider replacing it with
daily
with the evening
You use this word too often, consider replacing it with
meal
.
You use this word too often, consider replacing it with
Dose
should
be increased
in increments of 500 mg weekly, up to a maximum of 2000 mg once
You use this word too often, consider replacing it with
daily
with the evening
You use this word too often, consider replacing it with
meal
,
alternatively
increased to 1000 mg twice
You use this word too often, consider replacing it with
daily
taken with
You use this word too often, consider replacing it with
meal
.
You use this word too often, consider replacing it with
Patient
receiving Metformin immediate
You use this word too often, consider replacing it with
release
tablet may
be switched
to Metformin extended
You use this word too often, consider replacing it with
release
tablet up to a maximum
You use this word too often, consider replacing it with
recommended
You use this word too often, consider replacing it with
daily
dose.

Children: Metformin extended
You use this word too often, consider replacing it with
release
tablet has not
been studied
in children.

Renal impaired
You use this word too often, consider replacing it with
patient
: Do not
This phrase/word (depending on the context) can be potentially replaced with :
use
Metformin in
You use this word too often, consider replacing it with
patients
with
Possible spelling mistake found.
eGFR
below 30 mL/min/1. 73 m2. Asses
This phrase/word (depending on the context) can be potentially replaced with :
risk
/benefit of counting if
Possible spelling mistake found.
eGFR
falls below 45 mL/min/1. 73 m2.

*
Possible spelling mistake found.
চিকিৎসকের
Possible spelling mistake found.
পরামর্শ
Possible spelling mistake found.
মোতাবেক
Possible spelling mistake found.
ঔষধ
Possible spelling mistake found.
সেবন
Possible spelling mistake found.
করুন
'

Interaction

Co-administration with Carbonic
Possible spelling mistake found.
anhydrase
(
Possible spelling mistake found.
Topiramate
,
Possible spelling mistake found.
Zonisamide
) may
You use this word too often, consider replacing it with
increase
You use this word too often, consider replacing it with
risk
of lactic
You use this word too often, consider replacing it with
acidosis
. Drugs (
Possible spelling mistake found.
Ranolazine
,
Possible spelling mistake found.
Dolutegravir
,
Possible spelling mistake found.
Cimetidine
) that
This phrase/word (depending on the context) can be potentially replaced with :
reduce
Metformin clearance may
You use this word too often, consider replacing it with
increase
the accumulation of Metformin. Alcohol can potentiate the
You use this word too often, consider replacing it with
effect
of Metformin on lactate metabolism.

Contraindications

Hypersensitivity to the active substance or to any of the
Possible spelling mistake found.
excipients
.

Any
You use this word too often, consider replacing it with
type
of acute metabolic
You use this word too often, consider replacing it with
acidosis
(such as lactic
You use this word too often, consider replacing it with
acidosis
, diabetic ketoacidosis).

Severe renal failure (GFR <30 mL/min).

Acute conditions with the potential to alter renal
You use this word too often, consider replacing it with
function
such as: dehydration, severe infection, shock.

Acute or chronic disease, which may cause tissue hypoxia such as: cardiac or respiratory failure, recent myocardial infarction, shock, Hepatic
Possible spelling mistake found.
insufciency
, acute alcohol intoxication, alcoholism.

Side Effects

Blood and lymphatic system disorders: Not known:
Possible spelling mistake found.
Hemolytic
anemia

Metabolism and nutrition disorders:
This phrase/word is too simple and can be replaced with:
Very
rare: Lactic
You use this word too often, consider replacing it with
acidosis
.
You use this word too often, consider replacing it with
Decrease
of vitamin B12 absorption with a
You use this word too often, consider replacing it with
decrease
of serum
You use this word too often, consider replacing it with
levels
during long-term
This phrase/word (depending on the context) can be potentially replaced with :
use
of metformin. Consideration of such etiology is
You use this word too often, consider replacing it with
recommended
if a
You use this word too often, consider replacing it with
patient
presents with
Possible spelling mistake found.
megaloblastic
anemia. Cases of peripheral neuropathy in
You use this word too often, consider replacing it with
patients
with vitamin B12 deficiency have
been reported
in post-marketing experience (frequency not known)

Nervous system disorders: Common: Taste disturbance. Not known:
Please add a punctuation mark at the end of paragraph
Encephalopathy


Gastrointestinal disorders:
This phrase/word is too simple and can be replaced with:
Very
common: Gastrointestinal disorders, such as nausea, vomiting, diarrhea, abdominal pain, and loss of appetite. These undesirable effects occur most
frequently
during the initiation of
You use this word too often, consider replacing it with
therapy
and resolve
spontaneously
in most cases
. To
This phrase/word (depending on the context) can be potentially replaced with :
prevent
them, it is
You use this word too often, consider replacing it with
recommended
that metformin
be taken
in 2 or 3
You use this word too often, consider replacing it with
daily
You use this word too often, consider replacing it with
doses
during or after
You use this word too often, consider replacing it with
meals
. A slow
You use this word too often, consider replacing it with
increase
of the
You use this word too often, consider replacing it with
dose
may
also
This phrase/word (depending on the context) can be potentially replaced with :
improve
gastrointestinal
Possible spelling mistake found.
tolerability
.

Possible spelling mistake found.
Hepatobiliary
disorders:
This phrase/word is too simple and can be replaced with:
Very
rare: Isolated reports of liver
You use this word too often, consider replacing it with
function
This phrase/word (depending on the context) can be potentially replaced with :
test
abnormalities or hepatitis resolving upon metformin discontinuation.

Skin and subcutaneous tissue disorders:
This phrase/word is too simple and can be replaced with:
Very
rare: Skin reactions, such as erythema,
Possible spelling mistake found.
pruritus
, urticaria.

Pregnancy & Lactation

Pregnancy: Uncontrolled diabetes during pregnancy (gestational or permanent)
is associated
with an increased
You use this word too often, consider replacing it with
risk
of congenital abnormalities and perinatal mortality. When the
You use this word too often, consider replacing it with
patient
plans to become pregnant and during pregnancy, it is
You use this word too often, consider replacing it with
recommended
that diabetes is not treated with metformin
This phrase/word is too simple and can be replaced with:
but
insulin be
This phrase/word (depending on the context) can be potentially replaced with :
used
to maintain blood glucose
You use this word too often, consider replacing it with
levels
as close to normal as possible, to
This phrase/word (depending on the context) can be potentially replaced with :
reduce
the
You use this word too often, consider replacing it with
risk
of malformations of the
Possible spelling mistake. 'foetus' is British English.
foetus
.

Breastfeeding: Metformin
is excreted
into human breast milk. No adverse
Possible spelling mistake found.
efects
were observed
in breastfed newborns/infants.
However
, as
This phrase/word (depending on the context) can be potentially replaced with :
only
limited data are available, breastfeeding is not
You use this word too often, consider replacing it with
recommended
during metformin
You use this word too often, consider replacing it with
treatment
. A decision on whether to discontinue breastfeeding should
be made
, taking into account the benefit of breastfeeding and the potential
You use this word too often, consider replacing it with
risk
to adverse effects on the child.

Precautions & Warnings

Metformin Hydrochloride
is known
to be
substantially
excreted by the kidney and the
You use this word too often, consider replacing it with
risk
of Metformin accumulation and lactic
You use this word too often, consider replacing it with
acidosis
You use this word too often, consider replacing it with
increases
with the degree of impairment of renal
You use this word too often, consider replacing it with
function
. Metformin may lower vitamin B12
You use this word too often, consider replacing it with
level
. It
also
You use this word too often, consider replacing it with
increases
You use this word too often, consider replacing it with
risk
of hypoglycemia when
This phrase/word (depending on the context) can be potentially replaced with :
use
in combination with insulin or insulin
Possible spelling mistake found.
secretagogue
.

This phrase/word (depending on the context) can be potentially replaced with :
Use
in Special Populations

Elderly: Due to the potential for decreased renal
You use this word too often, consider replacing it with
function
in elderly subjects, the metformin
You use this word too often, consider replacing it with
dosage
should
be adjusted
based on renal
You use this word too often, consider replacing it with
function
. Regular assessment of renal
You use this word too often, consider replacing it with
function
is necessary.

Pediatric population: The diagnosis of
You use this word too often, consider replacing it with
type
2 diabetes mellitus should
be confirmed
This phrase/word is too simple and can be replaced with:
before
You use this word too often, consider replacing it with
treatment
with metformin
is initiated
. No
You use this word too often, consider replacing it with
effect
of metformin on growth and puberty has
been detected
during controlled clinical studies of one-year duration
This phrase/word is too simple and can be replaced with:
but
no long-term data on these specific points are available.
Therefore
, a careful follow-up of the
You use this word too often, consider replacing it with
effect
of metformin on these parameters in metformin-treated
You use this word too often, consider replacing it with
children
,
especially
prepubescent
You use this word too often, consider replacing it with
children
,
is recommended
.

Children aged between 10 and 12 years: Particular caution is
You use this word too often, consider replacing it with
recommended
when prescribing to
You use this word too often, consider replacing it with
children
aged between 10 and 12 years.

Renal
You use this word too often, consider replacing it with
function
: As metformin
is excreted
by the kidney, creatinine clearance (this can
be estimated
from serum creatinine
You use this word too often, consider replacing it with
levels
by using the
Possible spelling mistake found.
Cockcroft-Gault
formula) should
be determined
This phrase/word is too simple and can be replaced with:
before
initiating
You use this word too often, consider replacing it with
treatment
and
regularly
thereafter:

At least
annually
in
You use this word too often, consider replacing it with
patients
with normal renal function,

At least two to four times a year in
You use this word too often, consider replacing it with
patients
with creatinine clearance at the lower limit of normal and in elderly subjects.

Decreased renal
You use this word too often, consider replacing it with
function
in elderly subjects is frequent and asymptomatic. Special caution should
be exercised
in situations where renal
You use this word too often, consider replacing it with
function
may become impaired,
for example
when initiating
Possible spelling mistake found.
antihypertensive
You use this word too often, consider replacing it with
therapy
or diuretic
You use this word too often, consider replacing it with
therapy
and when starting
You use this word too often, consider replacing it with
therapy
with a non-steroidal anti-inflammatory drug (NSAID). GFR should
be assessed
This phrase/word is too simple and can be replaced with:
before
You use this word too often, consider replacing it with
treatment
initiation and
regularly
thereafter. Metformin is
Consider using a past participle here: "contraindicated".
contraindicate
in
You use this word too often, consider replacing it with
patients
with GFR<30 ml/min and should be
temporarily
discontinued in the presence of conditions that alter renal function.

Overdose Effects

Hypoglycemia has not been
This phrase/word (depending on the context) can be potentially replaced with :
seen
with Metformin
You use this word too often, consider replacing it with
doses
up to 85 gm, although lactic
You use this word too often, consider replacing it with
acidosis
has occurred in such circumstances. Lactic
You use this word too often, consider replacing it with
acidosis
is a medical emergency and
This phrase/word (depending on the context) can be potentially replaced with :
must
be treated
in hospital. The most effective method to remove lactate and Metformin is hemodialysis.

Therapeutic
This phrase/word (depending on the context) can be potentially replaced with :
Class


Possible spelling mistake found.
Biguanides


Storage Conditions

This phrase/word (depending on the context) can be potentially replaced with :
Keep
below
Insert a space between the numerical value and the unit symbol "30 °C"
30°C
temperature, protected from light & moisture.
This phrase/word (depending on the context) can be potentially replaced with :
Keep
out of the reach of
You use this word too often, consider replacing it with
children. ©
Possible spelling mistake found.
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™

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IELTS speaking I am from Bangladesh. It is most prestigious country of world. There are plathora of problems in our country.

Speaking
  American English
38 paragraphs
1234 words
5.5
Overall Band Score
Coherence and Cohesion: 5.5
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  • ?
    One main idea per paragraph
  • ?
    Include an introduction and conclusion
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    Support main points with an explanation and then an example
  • Use cohesive linking words accurately and appropriately
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    Vary your linking phrases using synonyms
Lexical Resource: 5.0
  • Try to vary your vocabulary using accurate synonyms
  • Use less common question specific words that accurately convey meaning
  • Check your work for spelling and word formation mistakes
Grammatical Range: 6.0
  • Use a variety of complex and simple sentences
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Task Achievement: 5.0
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