Health Alterations - NUR241: Metformin Medication Report Analysis

This report focuses on Metformin, a biguanide medication used to treat Type 2 Diabetes mellitus. It details the drug's mechanism of action, which includes inhibiting hepatic glucose production and increasing peripheral tissue sensitivity to insulin. The report explains the pathophysiology of Type 2 Diabetes, highlighting the role of insulin and glucagon in glucose regulation and the impact of beta-cell dysfunction and insulin resistance. It then examines how Metformin works to decrease glucose production by the liver, reduce glucose absorption in the intestines, and improve insulin sensitivity. The report also covers clinical applications of Metformin, including its consideration as a first-line treatment for overweight patients and those whose diabetes is not well-controlled by diet or other medications. It further addresses nursing considerations, such as contraindications (renal impairment, pregnancy, and breastfeeding), potential side effects (gastrointestinal issues, headache, and lactic acidosis), and patient education regarding administration (with meals) and monitoring (creatinine levels). References from the American Diabetes Association and other sources support the information provided.

METFORMIN
• Pathophysiological basis of metformin
• It is a biguanide indicated clinically for treating Diabetes mellitus type 2. Its
mechanism of action is inhibiting the production of hepatic glucose and
increasing the sensitivity of the peripheral tissues to insulin (Rena, Hardie &
Pearson, 2017). Taking note of the physiology of a normal human body,
digestive enzymes and hormones (the insulin and glucagon) are secreted by the
pancreas into the bloodstream where they control the amount of the glucose
circulating. Insulin lowers blood glucose levels by enabling glucose to enter the
body cells. In type 2 diabetes, the beta cell function is altered and less insulin is
released or there is tissue insulin insensitivity whereby the cells ignore the less
insulin produced. The pancreas ability of insulin production is therefore
gradually decreased. When Metformin is administered it decreases the amount
of glucose produced by the liver into the bloodstream, it also decreases the
rate of absorption of glucose by the intestines and lastly it improves insulin
sensitivity by increasing the uptake of peripheral glucose and how it is utilized
(Kahn, Cooper & Del Prato, 2014).
• Nursing considerations on Metformin administration.
• According to the American Diabetes Association. (2016), Metformin is
considered the drug of choice for patients who are overweight, those
whom dieting has been unable to control diabetes, to patients who are not
overweight and to those whom diabetes cannot be controlled with the
treatment by sulphonylurea. The advantage of metformin medication is
that it has a lower incidence of weight gain. The gastrointestinal tend to be
more common with higher doses and to avoid them metformin can be
taken with meals (Karch, 2015). It should not be used with patients who
have renal impairment this is in order to avoid lactic acidosis. Metformin
stored in a cool dry place. Advising the patient to take the drug with food
can help since the side effects are common. Alternatively, slow-release
tablets can also help.
References.
American Diabetes Association. (2017). Standards of medical care in diabetes—2017
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 35(1), 5.
Kahn, S. E., Cooper, M. E., & Del Prato, S. (2014). Pathophysiology and treatment of type 2
diabetes: perspectives on the past, present, and future. The Lancet, 383(9922), 1068-1083
Karch, A. (2015). Lippincott nursing drug guide. Lippincott Williams & Wilkins
Rena, G., Hardie, D. G., & Pearson, E. R. (2017). The mechanisms of action of
metformin. Diabetologia, 60(9), 1577-1585
Caution.
Creatinine should be measured before the onset of metformin medication and maintained
twice a year during the treatment. Metformin is contraindicated to a breastfeeding patient,
pregnant patient, renal impairment and the one with ketoacidosis (American Diabetes
Association, 2017). Some of the common side effects observed with administration of metformin
include headache, tinnitus, vertigo, fatigue, feeling of drowsiness, weakness, metallic taste,
rashes, anorexia, nausea, vomiting, abdominal pain and thrombocytopenia (American Diabetes
Association, 2017). The rare side effects may include erythema, hypoglycemia, lactic acidosis and
a decrease in vitamin B12 absorption. Metformin is administered orally and it has an increased risk
of lactic acidosis with alcohol. Monoamine oxidase inhibitors enhance the hypoglycemic effect of
metformin.