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**Back of upper arm** -- may need assistance Rotate sites systematically to prevent lipodystrophy (tissue changes from repeated injection at the same spot)

The article specifies AMPK activation, through which metformin reduces liver glucose output and improves peripheral insulin sensitivity

More serious but less common risks include pancreatitis, gallbladder problems including gallstones, kidney issues including acute kidney failure in patients who experience severe vomiting or diarrhea, changes in vision, low blood sugar especially when combined with other diabetes medications, and increased heart rate

The rapid mobilization of stored fat can increase bile concentration, potentially forming gallstones