Metformin is widely prescribed for patients with type 2 diabetes mellitus (DM). Its use for patients with type 1 has been considered a contraindication because of possible adverse effects such as lactic acidosis. However, metformin has been recently used with insulin therapy to reduce insulin-dose requirements in Type 1 DM.
An 81-year-old Japanese woman with type 1 DM was treated with insulin and metformin. She was admitted to our hospital due to altered mental state and hypotensive shock via a referral from her primary care physician. The patient had severe lactic acidosis and acute kidney injury with hyperkalemia with the suspected cause being the use of metformin. She was treated successfully with hemodialysis (HD).
Although the independent predictive factor of mortality due to metformin-associated lactic acidosis is a prothrombin time (PT) activity of less than 50% in 24 hours, we recommend that HD should be performed for a patient with severe lactic acidosis even if the initial PT activity is normal.

The new community-based curriculum in Shimane Medical University, Japan, which are mainly based on family health practice and community health approach, is useful for students to understand the comprehensive medicine and holistic approach to community-based primary health care.
It is important to introduce district health workers in the preventive education for medical students to obtain to humanistic attitude and to change their value and behavior.
The importance of the exposure to the community health activities organized with man power and social resources should be more stressed in the improvement of the medical education curriculum and also of educational methodology to learn the essential physicians' nature such as humanity, responsibility, cooperation, positive attitude, and ability of problem solving.