Metformin
Trade names:
Glucophage
Class:
antidiabetics ,biguanides
Pregnancy:
(Category B) Action:
• Decreases hepatic production of glucose Decreases intestinal
absorption of glucose
Increases sensitivity to insulin.
Uses:
• Adjunctive management type 2 diabetes mellitus. May be used with
diet and/or sulfonylurea oral hypoglycemic agents.
Dose:
initially 500 mg with breakfast for at least 1
week
then 500 mg with breakfast and evening meal
for at least 1 week 
then 500 mg with breakfast, lunch and evening
meal;
max. 3 g daily in divided doses but most
physicians limit this to 2 g daily Contraindications:
Hypersensitivity
Metabolic acidosis of any cause Dehydration, sepsis, hypoxemia, impaired
hepatic function, excessive alcohol ingestion (acute or chronic)
Underlying renal dysfunction (serum creatinine
>1.5 mg/dl in men or >1.4 mg/dl in women)
Concurrent radiographic studies requiring IV
administration of iodinated contrast media (temporarily withhold metformin) 
CHF requiring pharmacologic treatment.
Side effects:
GI: abdominal bloating, diarrhea, nausea, vomiting,
unpleasant metallic taste.
Endo:
hypoglycemia.
F and E:
LACTIC ACIDOSIS.
Misc: decreased vitamin B12 levels.
Nursing
considerations:
Drugs may be taken with food to minimize GI
upset.
Stop the medication if signs of side-effects
or ketoacidosis appear. Check for early symptoms of hypoglycemia.
Assess diabetic more closely for infection or
emotional disturbances that may increase insulin requirements. Explain the necessity for close regular
medical supervision.
Explain to patient how to test the urine for
sugar & acetone.
Explain the use & care of equipment &
the storage of medication.
Explain the importance of exercise &
adhering to the prescribed diet. Explain the importance of carrying candy or
sugar at all times to counteract hypoglycemia should it occur.
Provide the client & family with a printed
chart explaining symptoms of hypoglycemia , hyperglycemia & instructions
concerning what to do for each.
