Some MD's will not draw lactic acid levels on people because "the condition is rare". However, I spent 10 years in an Endocrine practice where the MD DID do testing..We found our share of increased/elevated(NOT CRITICAL LEVEL)lactic acid levels after description of similar symptomatology.

Liz Cappalli,RD,LDN,CDE,CDOE

Thanks for sharing that information,Liz.  It is something to think about....especially since so many children with type 2 diabetes are now being treated with metformin. Staying hydrated is something that I feel needs to be stressed with people on metformin to assist the kidneys in excreting lactic acid.  This is especially true in very dry climates like Arizona for instance. 
I find it interesting to see reports that lactic acidosis is rare. If subclinical lactic acidosis is never looked for how can we know for sure if it is rare.When it is detected, it is usually severe.

This is an interesting conversation. I was discussing this in my medication class for patients yesterday and learned that the signs that used to be in X-ray depts asking people to report if they are on metformin are no longer present. I wonder when those were removed. We also evaluate patients respiratory status before putting them on metformin to make sure they have good oxygen exchange. Anyone doing respiratory testing before putting patients on metformin? So many people do so well on metformin that I have not seen alot of outpatients with lactic acid issues.

Patricia:
I agree with you, and believe it or not,thats what I told a Primary Care Doc when he told me how "rare" it is. I also had the same discussion w/my primary care doc. I reminded him"if you dont look for it,then you're not going to find it..."
Liz Cappalli,RD,LDN

Thanks for your comment, Liz.