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In addition, in Complex I, metformin directly down-regulates mitochondrial glycerol 3 phosphate dehydrogenase (mGPDH), leading to an increased cytosolic redox state—with a reduction in nicotinamide adenine dinucleotide reduced form (NADH) and increased nicotinamide adenine dinucleotide (NAD)—to reduced gluconeogenesis from lactate, and to a decrease in the activity of the glycerol–phosphate shuttle (which transfers NADH from the cytosol to mitochondria)
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That mix explains why monitoring and clear documentation matter more than informal memory
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