A patient with type 2 diabetes is prescribed glipizide (Glucotrol) 10 mg orally before meals.
The patient inquires, “What is the mechanism of action of this medication in managing my diabetes?” How should the nurse respond?

Choice A rationale:

Respiratory distress is not a direct side effect of metformin. While metformin can cause a rare condition called lactic acidosis, which can lead to rapid breathing, respiratory distress is not a primary concern with metformin use.

Respiratory distress typically involves difficulty breathing due to other causes such as asthma, pneumonia, heart failure, or chronic obstructive pulmonary disease (COPD).

Choice B rationale:

Seizures are not a known side effect of metformin.

Seizures are typically associated with neurological conditions, such as epilepsy, or metabolic disturbances such as hypoglycemia or electrolyte imbalances.

Metformin does not directly affect the central nervous system in a way that would increase the risk of seizures.

Choice C rationale:

Lactic acidosis:

This is a rare but serious condition that can occur with metformin use.

It happens when lactic acid builds up in the bloodstream, causing the blood to become too acidic. Symptoms of lactic acidosis include:

Rapid breathing Nausea and vomiting Abdominal pain Muscle weakness Unusual sleepiness Feeling cold

Risk factors for lactic acidosis in patients taking metformin include:

Kidney disease Congestive heart failure Liver disease Dehydration

Excessive alcohol intake Recent surgery or heart attack

It's important to note that lactic acidosis is rare, occurring in about 3 to 10 cases per 100,000 people taking metformin per year.

Renal failure:

Metformin is primarily eliminated by the kidneys.

If kidney function is impaired, metformin can build up in the body, increasing the risk of lactic acidosis. Additionally, metformin can potentially cause kidney damage in rare cases, further worsening kidney function. It's crucial to monitor kidney function regularly in patients taking metformin.

Choice D rationale:

Hyperglycemia (high blood sugar) is not a side effect of metformin.

In fact, metformin is a medication used to lower blood sugar levels in people with type 2 diabetes. It works by:

Decreasing the amount of glucose produced by the liver Improving the body's sensitivity to insulin

Slowing the absorption of glucose from the intestines

Choice A rationale:

Regular insulin peaks within 2-4 hours after administration. Therefore, to prevent hypoglycemia due to the insulin administered at 0700, the client should eat breakfast within 1-2 hours of insulin administration. This will ensure that there is glucose available in the bloodstream to match the insulin's action and prevent blood sugar levels from dropping too low.

Breakfast is the most important meal of the day, especially for individuals with diabetes. It helps to regulate blood sugar levels throughout the morning and can even help with weight management and overall health.

Skipping breakfast can lead to fluctuations in blood sugar levels and increase the risk of hypoglycemia, especially after insulin administration.

Choice B rationale:

Supper, typically consumed in the evening, would not be timely enough to prevent hypoglycemia due to the 0700 insulin administration. The insulin's peak action would have already subsided by that time, and the client would be at risk for hyperglycemia (high blood sugar) instead.

Choice C rationale:

Lunch, typically consumed around noon, would also be too late to prevent hypoglycemia from the 0700 insulin administration. The insulin's peak action would have already passed, and the client would be more likely to experience hyperglycemia.

Choice D rationale:

A snack, while it can provide some glucose, is not a substitute for a balanced meal like breakfast. Snacks often contain less protein and fiber, which are essential for slowing down glucose absorption and maintaining blood sugar stability. Relying solely on snacks to prevent hypoglycemia is not a reliable strategy for long-term blood sugar management.