This conclusion is also supported in reviews (133, 142), and by clinical data from T2DM patients treated with metformin that show normal mitochondrial complex 1 respiration in skeletal muscle biopsies (143)
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However, this is also where the glucagon activation threshold likely sits, making it the worst dose at which to reduce peak concentrations through splitting
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Clinical trials consistently used 1 mg (or occasionally 2 mg) as the entry point, and starting higher significantly increases the risk of gastrointestinal side effects
A persistent criticism of this mechanism has been the high extracellular concentrations (mmol/l) required to observe rapid effects, although lower concentrations of metformin (50100 mol/l) do inhibit Complex I in rat hepatoma (H4IIE) cells after several hours