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Before using this medication especially of: severe breathing problems (such as obstructive lung disease metabolic acidosis (such as diabetic ketoacidosis) vitamin B12 deficiency) liver disease. Before using this medication especially of: severe breathing problems (such as obstructive lung disease metabolic acidosis (such as diabetic ketoacidosis) vitamin B12 deficiency) liver disease. Patients who have been well controlled on metformin who develop illness or laboratory abnormalities should be assessed for ketoacidosis or lactic acidosis. Patients who have been well controlled on metformin who develop illness or laboratory abnormalities should be assessed for ketoacidosis or lactic acidosis. Type 2 diabetes causes elevated blood sugar levels which damages blood vessels leading to increased risk of heart attack, stroke and limb amputation. Type 2 diabetes causes elevated blood sugar levels which damages blood vessels leading to increased risk of heart attack, stroke and limb amputation. 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