Once I started Sertraline, it interacted with my metformin and blood pressure pills.  Both conditions, hyperglycemia, and hypertension, were stress induced.  The sertraline was releaving the stress, the mechanism I cannot say.  The blood pressure meds, at regular doses for high pressures, were now overdosing, same as metformin.  As a result, I blacked out from hypotensive event due to the overdose.  I also ended up with lactic acidosis, despite having high sugars.  The mechanism I do not understand.  I suffered from the lactic acidiosis until I stopped my metformin, against Drs. advice.  She said, "we dont mess with metformin regimen".  I could not convince an expert Internal Medicine Doctor that my maladies were stress induced and we needed to titrate my meds according to Sertraline increases.  But she would not even consider it.  i stopped the metformin, still have high sugars, but feel so much better. No bed ridden lethargy.  I was almost comatose.

So please, PTSD and broken sympathetic response messes with metabolism.  No different than Gestational Diabetes.  There should be another classification of Diabetes, Type 3, stress induced.  Which would capture all these anomalies that are not well understood.  In this way, meds can be better managed with a view to stop, not keep going.  thank you!