Nursing Discussion Post Your patient has just been diagnosed with Diabetes Type 2 and the doctor prescribed metformin. 1. Describe the mechanism of action of metformin and potential contraindications. 2. What education that the registered nurse would have provided would you reinforce? 3. Explain lifestyle changes a person should if diagnosed with diabetes type 2? Include in-text citations and two references from the last 5 yrs.
1. Mechanism of Action and Contraindications of Metformin
Metformin is an oral medication commonly prescribed for patients with Type 2 diabetes. It falls under the category of biguanide drugs and works by lowering blood glucose levels through multiple mechanisms of action.
The primary mechanism of action of metformin is its ability to decrease hepatic glucose production. It does so by inhibiting the enzyme hepatic glucose output, which then leads to reduced glucose release from the liver. By reducing hepatic glucose production, metformin helps to control fasting blood glucose levels in patients with Type 2 diabetes.
Metformin also enhances insulin sensitivity, particularly in peripheral tissues such as muscle and fat. It improves the uptake and utilization of glucose by these tissues, thereby increasing glucose disposal and reducing hyperglycemia. Additionally, metformin inhibits intestinal glucose absorption, further contributing to its glucose-lowering effects.
In terms of contraindications, metformin is generally well-tolerated by most patients. However, there are a few important considerations to keep in mind. Metformin should not be prescribed to individuals with compromised renal function, as it may increase the risk of lactic acidosis, a rare but serious side effect. Therefore, it is crucial to assess renal function prior to initiating metformin therapy and monitor it periodically afterwards.
Furthermore, metformin should be temporarily discontinued in patients undergoing certain radiologic procedures involving contrast media, as these agents may have adverse effects on renal function and increase the risk of lactic acidosis. In such cases, it is advisable to hold metformin therapy for 48 hours before the procedure and resume it only after renal function has been confirmed to be normal.
2. Reinforcement of Education Provided by the Registered Nurse
Education plays a vital role in the management of diabetes, and the registered nurse has an important role in providing education regarding the use of metformin to the patient. Key points that should be reinforced include:
a) Dosage and Administration: Emphasize the importance of taking metformin as prescribed by the healthcare provider, typically with meals to minimize gastrointestinal side effects. Encourage the patient to adhere to the prescribed dosing schedule and reinforce the need for regular follow-up visits to assess treatment response.
b) Blood Glucose Monitoring: Highlight the importance of regular self-monitoring of blood glucose levels using a glucometer. Teach the patient how to interpret and respond to blood glucose readings, including the appropriate actions to take if levels are outside the target range.
c) Adverse Effects and Cautionary Measures: Discuss the potential side effects of metformin, such as gastrointestinal symptoms (e.g., diarrhea, nausea, abdominal discomfort) that are usually transient and resolve with time. Encourage the patient to report any severe or persistent side effects to their healthcare provider. Furthermore, emphasize the need to avoid excessive alcohol consumption while taking metformin, as it may increase the risk of lactic acidosis.
d) Hypoglycemia Awareness and Management: Educate the patient on the signs and symptoms of hypoglycemia and the appropriate steps to take if it occurs. Emphasize the importance of carrying a source of fast-acting sugar (e.g., glucose tablets or gel) at all times and to inform others about their condition to ensure prompt assistance if needed.
e) Medication Interactions and Avoidance: Discuss the importance of informing healthcare providers about all medications, over-the-counter products, and herbal supplements the patient is taking, as certain medications or substances may interact with metformin and alter its effectiveness or increase the risk of side effects.
3. Lifestyle Changes for Diabetes Type 2
In addition to medication therapy, the management of Type 2 diabetes requires significant lifestyle modifications. These changes focus on achieving and maintaining a healthy body weight, adopting a balanced diet, engaging in regular physical activity, and effectively managing stress.