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A screen that includes a plasma ceruloplasmin level and an ophthalmology examination for K-F rings would be prudent.30 The renal dysfunction that results from copper accumulation in the kidneys includes proximal renal tubular dysfunction, and decreased glomerular filtration rate.31 The renal tubular dysfunctional is manifested by presence of blood, protein, glucose, phosphate, and amino acids in the urine and decreased ability to acidify the urine.19 Renal stones can be seen in up to 16% of Wilsons patients

Metformin is thought to exert its primary antidiabetic action through the suppression of hepatic glucose production