A nurse is preparing to administer insulin lispro to a patient with type 1 diabetes mellitus. Which action should the nurse plan to take?

Choice A reason: Metformin reduces blood sugar primarily by inhibiting hepatic gluconeogenesis, decreasing liver glucose production. It also enhances insulin sensitivity in peripheral tissues, reducing hyperglycemia in type 2 diabetes without causing hypoglycemia, as it does not stimulate insulin secretion, making this the accurate mechanism.

Choice B reason: Metformin does not block carbohydrate absorption in the intestine. Drugs like alpha-glucosidase inhibitors (e.g., acarbose) slow carbohydrate breakdown, but metformin primarily acts on the liver to reduce gluconeogenesis and improve insulin sensitivity, not directly affecting intestinal absorption.

Choice C reason: Metformin does not stimulate insulin release from the pancreas. This is the mechanism of sulfonylureas, which enhance beta-cell insulin secretion. Metformin works by reducing hepatic glucose output and increasing insulin sensitivity, making this statement incorrect for its mechanism of action.

Choice D reason: Metformin decreases, not increases, insulin resistance. It enhances insulin sensitivity in muscle and liver cells, improving glucose uptake and utilization. Increasing insulin resistance would worsen type 2 diabetes, making this statement incorrect, as metformin’s goal is to counteract insulin resistance.

Choice A reason: Contacting the provider is important but not the priority. The insulin overdose risks hypoglycemia, and immediate assessment of current glucose levels is critical to determine the patient’s status and guide interventions, as delays could worsen hypoglycemia, causing neurological or cardiovascular complications.

Choice B reason: Administering a carbohydrate snack assumes hypoglycemia without confirmation. Regular insulin peaks in 2-4 hours, and 45 minutes post-administration, glucose may not yet be critically low. Giving carbohydrates prematurely could cause hyperglycemia, making this less urgent than assessing actual glucose levels first.

Choice C reason: Completing an incident report is necessary for documentation and quality improvement but is not the priority in an acute situation. The immediate risk of hypoglycemia from excess insulin requires clinical action to assess and stabilize the patient before addressing administrative tasks.

Choice D reason: Checking blood glucose is the priority, as excess regular insulin risks hypoglycemia, especially in type 1 diabetes with no endogenous insulin reserve. Knowing the current glucose level guides interventions, preventing seizures or unconsciousness, and ensures timely correction of potential hypoglycemia or other metabolic imbalances.