Mechanism of Action
This is how metformin lowers blood glucose.
What is decreasing hepatic glucose production and increasing insulin sensitivity?
Rationale: Metformin works primarily in the liver and muscle tissues to reduce insulin resistance.
This is when NPH insulin is usually administered to control blood sugar.
What is twice daily (before breakfast and dinner)?
Rationale: NPH’s intermediate duration allows for morning and evening dosing to match mealtimes.
This potentially life-threatening condition is a rare but serious side effect of metformin.
What is lactic acidosis?
Rationale: Metformin may impair lactate clearance, especially in renal impairment or hypoxia.
This lab test is used to monitor long-term blood glucose control.
What is Hemoglobin A1C?
Rationale: HbA1C reflects average glucose over the past 2-3 months.
This food-based teaching should be included when prescribing metformin.
What is eat with meals to reduce GI upset?
Rationale: Metformin can cause nausea and diarrhea if taken on an empty stomach.
This is the primary action of NPH insulin.
What is lowering blood sugar by promoting glucose uptake into cells?
Rationale: Insulin helps transport glucose into muscle and fat cells for energy storage and use.
Metformin should be taken at this time of day
What is with meals?
Rationale: Taking metformin with food minimizes gastrointestinal side effects like nausea and diarrhea.
This electrolyte imbalance can occur from an insulin overdose.
What is hypokalemia?
Rationale: Insulin drives potassium into cells, lowering serum potassium levels.
This should be monitored when metformin is given with contrast dye.
What is renal function (creatinine/eGFR)?
Rationale: Metformin should be held before and after contrast studies to prevent renal injury and lactic acidosis.
This must be done if hypoglycemia is suspected in a patient using NPH insulin.
What is check blood sugar and give fast-acting carbs?
Rationale: Early recognition and treatment of low blood sugar prevent serious complications.
Metformin does not cause this common side effect of other diabetic medications
What is hypoglycemia?
Rationale: Metformin does not stimulate insulin secretion, reducing the risk of low blood sugar.
This action must be taken if a patient is NPO for a procedure and takes metformin.
What is hold the dose?
Rationale: To prevent lactic acidosis, metformin should be temporarily stopped during fasting or procedures using contrast dye.
Metformin is contraindicated in patients with this condition affecting filtration.
What is kidney dysfunction?
Rationale: Impaired renal function increases the risk of metformin-induced lactic acidosis.
This blood sugar pattern may be seen in patients taking NPH insulin.
What is a mid-day or nighttime hypoglycemia spike?
Rationale: NPH has a peak action around 4-12 hours post-dose, which can cause dips in blood sugar.
This self-care skill is critical for patients using NPH insulin at home.
What is rotating injection sites?
Rationale: Rotating prevents lipodystrophy, which impairs insulin absorption.
NPH insulin is classified as this type of insulin.
What is intermediate-acting insulin?
Rationale: NPH insulin has an onset of 1-2 hours, peaks at 4-12 hours, and lasts 12-18 hours.
NPH insulin should be given this long before a meal to avoid hypoglycemia.
What is 30-60 minutes before a meal?
Rationale: This allows the insulin to start working when the blood sugar begins to rise.
This common side effect of NPH insulin may indicate the dose is too high or not timed well.
What is hypoglycemia?
Rationale: Insulin promotes glucose uptake, and if meals are skipped or dose is too high, blood sugar drops.
This finding in blood glucose logs may indicate the need for NPH insulin adjustment.
What is a pre-dinner hyperglycemia?
Rationale: May indicate morning NPH dose is wearing off too early.
This symptom of lactic acidosis should prompt a patient to seek medical care while on metformin.
What is unusual muscle pain, trouble breathing, or weakness?
Rationale: These are signs of serious metabolic imbalance needing urgent evaluation.
This body organ plays a key role in how metformin reduces glucose production.
What is the liver?
Rationale: Metformin inhibits gluconeogenesis in the liver, decreasing overall glucose levels.
Metformin is typically started at this frequency.
What is once or twice daily?
Rationale: Dosing is often started low to reduce GI side effects and then titrated up.
Before starting metformin, this lab value should be assessed.
What is serum creatinine or eGFR?
Rationale: Kidney function must be adequate to avoid lactic acidosis.
This electrolyte is closely monitored in patients receiving insulin therapy.
What is potassium?
Rationale: Insulin can cause hypokalemia by shifting potassium into cells.
This item should always be worn or carried by insulin users.
What is medical alert identification?
Rationale: Ensures proper treatment in emergencies if the patient becomes unresponsive.