Diabetes Mellitus Q 52

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Jansen is receiving metformin (Glucophage). What will be the best plan of the nurse with regard to patient education with this drug? Select all that apply.

  

    A. It stimulates the pancreas to produce more insulin.

    B. It must be taken with meals.

    C. It decreases sugar production in the liver.

    D. It inhibits the absorption of carbohydrates.

    E. It reduces insulin resistance.

    

Correct Answer: B, C, & E.

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Metformin (Glucophage) reduces insulin resistance, decreases sugar production in the liver, and should be taken with meals for the best absorption and effect. Metformin, FDA-approved in 1994, is an antidiabetic agent used in type 2 diabetes mellitus. Metformin comes in both immediate-release and extended-release and is available in several combination products with other antidiabetic agents.

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Option A: It does not stimulate the pancreas to produce more insulin. Insulin secretion is governed by the interaction of nutrients, hormones, and the autonomic nervous system. Glucose, as well as certain other sugars metabolized by islets, stimulates insulin release.

Option B: Metformin is an oral medication typically dosed from 500 to 2550 mg per day and administered with a meal to decrease GI upset. The daily dose is often titrated weekly in increments of 500 mg or 850 mg to reduce this risk.

Option C: Metformin is a biguanide drug that reduces blood glucose levels by decreasing glucose production in the liver, decreasing intestinal absorption, and increasing insulin sensitivity. Metformin decreases both basal and postprandial blood glucose.

Option D: It does not inhibit the absorption of carbohydrates. Two alpha-glucosidase inhibitors, acarbose and voglibose, slow carbohydrate absorption and reduce postprandial glucose levels by inhibiting the alpha-glucosidase enzymes on the brush border of the small intestine.

Option E: Metformin, the most widely-prescribed insulin-sensitizing agent in current clinical use, improves blood glucose control mainly by improving insulin-mediated suppression of hepatic glucose production, and by enhancing insulin-stimulated glucose disposal in skeletal muscle.

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