Patients with a history of pancreatic disease commonly have a history of:

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: Hyperglycemia typically increases appetite (polyphagia) due to cellular starvation, as glucose cannot enter cells effectively without insulin. Decreased appetite is not a hallmark of hyperglycemia and may indicate other issues, like gastrointestinal complications, making this statement incorrect for understanding hyperglycemia manifestations.

Choice B reason: Blurred vision can occur in hyperglycemia due to osmotic swelling of the lens from high glucose levels, but it is not constant ("all of the time"). This statement exaggerates the symptom, indicating a partial misunderstanding, as vision changes are typically temporary and resolve with glucose control.

Choice C reason: Increased thirst (polydipsia) is a classic hyperglycemia symptom. High blood glucose causes osmotic diuresis, leading to dehydration, which stimulates thirst to compensate for fluid loss. This statement reflects accurate understanding of hyperglycemia’s physiological effects on fluid balance and renal function.

Choice D reason: Fruity breath odor is a sign of diabetic ketoacidosis, a complication of severe hyperglycemia, due to ketone production from fat metabolism. This indicates understanding of a critical hyperglycemia manifestation, as it reflects metabolic acidosis requiring urgent intervention, making this statement correct.