The nurse is assessing a client with peptic ulcer disease (PUD). Which finding, if observed by the nurse, would require immediate follow-up?

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

Administering 1 mg of glucagon intramuscularly stimulates glycogenolysis in the liver, increasing blood glucose levels. However, it is slower in onset compared to IV dextrose, which is critical in a non-arousable patient with a dangerously low blood glucose level of 50 mg/dL. Time efficiency is vital in this emergency.

Choice B rationale

Administering 25 g of dextrose IV pushes glucose directly into the bloodstream, providing an immediate increase in blood glucose. This is the most appropriate action for a non-arousable, hypoglycemic patient. Normal blood glucose ranges between 70-100 mg/dL fasting, making this an emergency requiring prompt correction.

Choice C rationale

Encouraging the patient to eat may be effective in mild hypoglycemia, but not for a critically low level like 50 mg/dL in a non-arousable patient. This delay can result in prolonged neuroglycopenic effects, worsening the patient’s condition.

Choice D rationale

Administering 7 units of Humalog insulin would worsen the hypoglycemia by facilitating glucose uptake into cells, which is contraindicated in this situation. Instead, glucose administration is required to correct the hypoglycemia immediately.