A patient with diabetes is starting on insulin therapy.
Which type of insulin will the nurse discuss using for mealtime coverage?

Choice A rationale

Metformin primarily increases peripheral insulin sensitivity, particularly in muscle and adipose tissues, facilitating glucose uptake and utilization. It inhibits hepatic glucose production through AMPK activation, reducing gluconeogenesis. Metformin also improves lipid profiles and insulin resistance without promoting insulin secretion, which minimizes the risk of hypoglycemia. Its actions target metabolic pathways, enhancing cellular glucose management for type 2 diabetes control.

Choice B rationale

Metformin does not stimulate pancreatic insulin release. It acts independently of insulin production mechanisms, focusing on improving peripheral sensitivity and reducing hepatic glucose output. Drugs like sulfonylureas target beta cells for insulin release, unlike metformin, which avoids direct engagement with the pancreas, minimizing hypoglycemia risks associated with excessive insulin secretion.

Choice C rationale

Stimulating glucose uptake in skeletal muscles is a partial outcome of improved insulin sensitivity induced by metformin. However, metformin’s mechanism extends beyond this, involving significant hepatic effects. It does not directly stimulate glucose uptake as a sole action; rather, it enhances overall metabolic efficiency and glucose management through multiple pathways.

Choice D rationale

Metformin decreases hepatic glucose production rather than increasing it. It inhibits gluconeogenesis by activating AMPK, suppressing the production of glucose from non-carbohydrate sources. This inhibition aids in reducing fasting glucose levels, which are often elevated in type 2 diabetes. The opposite action described contradicts its therapeutic role in managing hyperglycemia effectively.

Choice A rationale

Applying a warm pack is inappropriate for controlling active bleeding, as it can exacerbate blood flow to the site, worsening the hemorrhage rather than controlling it effectively.

Choice B rationale

Using a tourniquet above the bleeding site is a last-resort method typically reserved for life-threatening bleeding. It may cause complications such as nerve damage or ischemia, so other measures are prioritized first.

Choice C rationale

Direct pressure or sterile pressure dressing with elevation minimizes blood loss effectively by compressing the damaged vessels, promoting clot formation, and utilizing gravity to reduce the pressure at the wound site. It is the recommended first-line method.

Choice D rationale

Placing an ice pack on the bleeding site may reduce localized blood flow by inducing vasoconstriction but is less effective than direct pressure for stopping active hemorrhage. It is secondary to other control measures.