METFORMIN | What NURSE PRACTITIONERS Need To Know
OVERVIEW
In this blog, we are going to tackle metformin and the things that you need to know about medication. Metformin is apart of the Biguanide drug class and is the only drug in the class that is used in the US.
MECHANISM OF ACTION
It has a primary and secondary action. The primary action: decreases the hepatic glucose production (gluconeogenesis)-- so all the new glucose molecules that are made by the liver, it decreases that and puts the kibosh on that. The secondary action: improves the peripheral insulin sensitivity in the skeletal muscles. This allows the insulin to be registered by the tissues and to be utilized.
The ideal candidate for metformin is the person that is obese, dyslipidemia, elevated fasting glucose and then also somebody who is possibly insulin resistant. Something else to keep in mind when it comes to metformin is that the person still needs to be producing insulin & is also indicated in people who are pre-diabetic.
SIDE EFFECTS
There's two big ones: GI upset & the metallic taste in their mouth. You will see this at the higher doses & it is always recommended that you start low and you go slow okay. I remember hearing that when I was an undergrad nursing but that's really true for any medicine. You want to titrate them up to the desired dosage. After about a week or two, it’s likely they won't experience the side effects. Educate them on taking this medicine with food because that will minimize any common side effects they may experience.
PRECAUTIONS & CONTRAINDICATIONS
Let's dive into some precautions and contraindications! Metformin is eliminated mainly through the urine so our kidneys need to be functioning well and filtering that medication out otherwise we're going to get an accumulation of drug. It is also not recommended that you initiate metformin with anybody who has a GFR between 30 and 45. Proceed with caution in this case. Do not prescribe to a person who has a GFR less than 30. Also, something else to consider is if you're dealing with a patient that is 80 years of age or older, obtain a 24 hour creatinine clearance on them to test their kidney function.
Here's another thing that we need to keep in mind - lactic acidosis. The metabolism of lactate is in the liver so if you have hepatic dysfunction, metformin could possibly accumulate.
Now anything that could predispose your patient to any acute renal dysfunction or hypoperfusion, you need to temporarily stop that metformin. So here are some cases of when you would need to do that:
-having a test that will involve IV contrast
-myocardial infarction
-exacerbations with congestive heart failure & COPD
These are things that would predispose a patient with decreased renal dysfunction or hypoperfusion. In these cases, you will need to stop the metformin for a couple of days & then restart it when the kidney function returns.
Ok guys, I hope this was helpful & a refresher for you! Thank you and if you want a bit more detail, I’ll link the YouTube video below that I filmed over metformin and don’t forget to download the FREE METFORMIN CHEAT SHEET in the NP Diabetes Starter Pack!
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