WK 9: Type 2 Diabetes

Question 1

Metformin - Mechanism of Action

Answer 1

Biguanide Class: Metformin belongs to the biguanide class of antidiabetic medications.

Glucose Lowering Effect: It primarily works by reducing hepatic glucose production (gluconeogenesis).
Increased Insulin Sensitivity: Metformin enhances insulin sensitivity, allowing peripheral tissues (muscles and fat) to better respond to insulin.

Decreased Intestinal Glucose Absorption: It reduces intestinal glucose absorption, contributing to lower postprandial glucose levels.

Question 2

Metformin - Indication

Answer 2

Type 2 Diabetes Mellitus: Metformin is a first-line oral antidiabetic medication for the treatment of type 2 diabetes.
Monotherapy or Combination: It can be used as monotherapy or in combination with other antidiabetic agents, including sulfonylureas or insulin.
Gestational Diabetes: In some cases, metformin may be used in gestational diabetes, particularly when dietary modifications alone are insufficient.

Question 3

Metformin - Monitoring

Answer 3

Renal Function: Before initiating metformin, assess renal function, and continue to monitor periodically. Metformin is contraindicated in severe renal impairment due to the risk of lactic acidosis.
Blood Glucose Levels: Regularly monitor fasting and postprandial blood glucose levels to assess the effectiveness of metformin.
Vitamin B12 Levels: Long-term use of metformin may be associated with decreased vitamin B12 absorption, so monitor B12 levels periodically.

Question 4

Metformin - Nursing Consideration

Answer 4

Administration with Meals: Administer metformin with meals to reduce gastrointestinal side effects.
Renal Function Assessment: Assess renal function before starting metformin and periodically thereafter, as impaired renal function can increase the risk of lactic acidosis.
Hold Before Radiologic Studies: Metformin should be temporarily withheld before contrast studies or surgery to minimize the risk of lactic acidosis.
Symptoms of Lactic Acidosis: Educate the patient about the symptoms of lactic acidosis, including weakness, muscle pain, trouble breathing, and abdominal discomfort.
Vitamin B12 Supplementation: Consider monitoring vitamin B12 levels and providing supplementation, if necessary, especially in patients on long-term metformin therapy.