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Unformatted text preview: Management of Type II
Diabetes with Metformin
NSG6005 Week 2
Sarah Toler What is Type II Diabetes Diabetes effects one’s body by causing hyperglycemia (the rise of blood glucose).
There are four classes of diabetes, types 1, 2, gestational, and diabetes related to
other factors (Woo & Robinson, 2015). According to the CDC, type 2 diabetes is the
most common type of diabetes affecting more than 29 million people in the United
States (CDC, 2017).
The result of type 2 diabetes is insulin resistance. Insulin resistance is the body
inability to properly use insulin. Initially, the pancreas makes extra insulin but
eventually it is unable to keep up with the body’s need for insulin causing
hyperglycemia. Without proper treatment, diabetes can have negative effects on
multiple organs (Facts About Type 2, 2015). Clinical manifestations Type 2 diabetes typically has a gradual onset and typically occurs after 40. Genetics
can play a role in the development of type 2 diabetes in addition to lifestyle factors
(Woo & Robinson, 2015). Common symptoms of type 2 diabetes include: frequent urination, excessive thirst and
hunger, fatigue, vision changes, and/or numbness and tingling in hands and feet
(Diabetes Symptoms, 2018). Diagnosing Type II Diabetes There are 4 tests that utilized in diagnosis diabetes. These tests are (Diagnosing,
1. Hemoglobin A1C is a simple blood draw that measures one’s average blood glucose
over a two to three month period. A Hgb A1C of greater than 6.5 indicates diabetes.
2. Fasting Plasma Glucose is a blood tests that checks one’s blood glucose when nothing
to eat or drink as been consumed 8 hours prior to blood draw. A fasting blood glucose
of 126 indicates a diagnosis of diabetes.
3. Oral Glucose Tolerance Test checks one’s blood sugar prior and two hours post oral
administration of a sugar rich drink. Indication of diabetes is conclusive if blood sugar
is greater than 200 when checked after drinking the sweet drink.
4. Random Plasma Glucose is a random blood glucose check during any time of the day.
Results greater than 200 can indicate diabetes. Pharmacodynamic/Management Not all patients are treated with the same therapy. Common management of diabetes
can include a single therapy or a combination of the following (Woo & Robinson, 2015):
1. Insulin- a hormone that is produced by the pancreas that is released when
hyperglycemia is detected
2. Oral drug therapies- mono or combination therapy will result in the decrease of Hgb
3. Other injectables- hormones that are stimulated by the presence of a meal that slows
down gastric emptying that in return allows a gradual release of glucose
4. Lifestyle management- following dietary restrictions based on providers judgement,
regular physical activity, and weight loss Metformin( Glucophage) Medication class- Biguanides, anti-hyperglycemic drug, the only biguanide used clinically to date Mechanism of action- increases peripheral glucose uptake, decreases hepatic glucose production,
and decreases intestinal absorption of glucose Route- by mouth, available forms include immediate or extended release tablets and oral solution. Pharmacokinetics- food can delay absorption in immediate release tablet, plasma half-life of
metformin is approximately 6 hours and blood half life is 17.6 hours Metabolism/Elimination- excreted unchanged in urine, renal tubular secretion is major route of
elimination, no hepatic metabolism noted Contraindications- patients with severe renal impairment (GFR below 30 mL/min) or acute or
chronic metabolic acidosis should not take medication. Use caution in patients over 80 due to
decrease in renal function Black box warnings- Lactic acidosis is a rare but can be fatal . Metformin should be held for at
least 48 hours after IV contrast administration or until renal labs are WNL to reduce risk for lactic
acidosis. (Woo & Robinson, 2015). Adverse reactions and Drug
Interactions Patients taking metformin can often experience GI related issues including abdominal
bloating, diarrhea, nausea, vomiting, and metallic taste. Symptoms typically resolve
within the first two weeks of treatment. The following can cause possible drug interactions when taking metformin
1. Beta-adrenergic blockers- risk for masking signs of hypoglycemia
2. Furosemide- increases plasma levels of metformin
3. Iodine-based contrast (IV contrast)- possible renal impairment and increase risk for
4. Nifedipine- enhances absorption of metformin and can increase effects of drug
(Woo & Robinson, 2015) Conclusion One of the most common drug therapies used to treat type 2 diabetes is Metformin. Metformin can be used in monotherapy or as a combination therapy Patients should use caution when taking metformin with other drugs and should make
their PCP aware of all medication and herbal supplements GI symptoms are a common side effect of metformin but usually resolve in 2 weeks References CDC Newsroom. (2017, February 27). Retrieved from
Diabetes Symptoms. (2018, August 29). Retrieved from
Diagnosing Diabetes and Learning About Prediabetes. (2016, November 21). Retrieved
from Facts About Type 2. (2015, October 27). Retrieved from
Woo, T. & Robinson, M. (2015). Pharmacotherapeutics for Advanced Practice Nurse Prescribers with Davis Plus
eResourses, 4th ed. F.A. Davis Company. ISBN: 9780803638273 ...
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- Fall '16
- Diabetes, Blood sugar, Medication class