Today we were talking about metformin. I like to use visuals when I'm working
with my students and my patients to help them understand what's happening inside
the body. And when we can understand what's happening inside the body we're
better able to predict the side effects and the intended consequences. So we're
going to start with metformin. It's one of my favorites as all of my students
know - comment below if you've been one of my students - and we're gonna get started
right after this. Welcome back my name is Tammy and this is NurseMinder and on
this channel we do everything nursing so if you're new here consider subscribing
below so that you get the next video when it's released. Welcome back. We're
talking about metformin today and how to use visual tools or stories to help you
remember the way a drug works and then subsequently what side effects and
intended effects might you see. Now before I get started with metformin I
just want to let you know in the description box below in this video
you'll find that there is a list of equipment that's used to make this video.
So if you're an aspiring YouTuber you can see what I'm using to make my video
and there's also links there and if you want to do a little shopping on Amazon.
And the second is - please comment below. For sure I'm, I'm certain some of you
have been my students in the past that have heard my metformin story so share
your experiences and how this has helped you; and other stories that may be able
to help elevate the practice of those watching. Let's get on to metformin. So
I'm not going to get into how diabetes occurs and what's happening in the body
I'm simply just gonna tell you a story about metformin. So when I look at
metformin and it has three functions. The first is a decreases hepatic glucose
production. Number two: decreases intestinal absorption, and number three
increases insulin sensitivity. So this tells me there's a lot going on in the
body. So let's look at number one first - hepatic glucose production. That occurs
in the liver. And because metformin - I use former, it reminds me of a factory we
got somebody in charge. He's got these orders today to
decrease production, so the factory is going on a shutdown. And what that means
is all the workers who are responsible for breaking down glycogen into glucose,
have to be reassigned today. So we're going to reassign them to do a few
different tasks. The first one is to decrease intestinal absorption. So some
of these workers are going to travel down here to the intestine and they got
their shields and they're saying nope, we are closing off all these ports. There's
no sugar needed today. So what happens with that glucose is it ends up
transiting through the intestine instead of being absorbed.
Now glucose is a bit of an osmotic diuretic so it's going to pull out the
water and so if I have a high concentration of glucose in my stool, I'm
likely to have diarrhea as a side effect of metformin. Now a few of these other
workers are going to work on increasing insulin sensitivity. So what's happening
at the cell, is this glucose is transporting over it towards the cells
is they are kind of resistant - there really " nah, I don't really want that today" but they
need it. They really do need it. So it's kind of like a used salesman coming to
your door and he's trying to sell you a vacuum - you know the old days. So these
workers are coming over here and they see that insulin is trying to get that
door to open that they are having none of it.
So my factory worker comes on over, kind of greases the wheel, greases the lock,
and is able to create an opening- these are glucose transporters - so that the
sugar will come into the cell. So he's really made a good sale that day. So with
that I'm going to have glucose leaving the blood vessel and I'm not going to
have it being replenished this is just being excreted out. So the
combining effect of that is I've lowered my glucose so my chem strip should come
back to normal and it also decreases new sugars being formed by breaking down
proteins and fatty acids. Okay so now we need to look at side effects. So I have
an intended target of reducing glucose. Side effects are often related to over
dosing or under treatments. If I have too much I've been over treated- I'm losing even
more glucose - I'm so low in sugar in my bloodstream. What do we call that?
Hypoglycemia. So all of the signs and symptoms that go with hypoglycemia
potentially will be a side effect of metformin. When we think of the nervous
system, like our brain and our nervous system love sugar, it is their primary
source of energy. The brain doesn't store sugar. It doesn't create its own source
of energy, so it needs that continuous supply and if it's not getting that I
may end up with a headache; I may feel weak and tired along with your other
hypoglycemic, so shaky, irritable. If I come down now to the GI system - anything
I put into my stomach - nausea, vomiting, constipation, diarrhea, those are common
side effects. But I also talked about that sugar. So it's more likely to be on
that diarrhea side if I'm excreting all of that sugar. I can also have some bloating
and gas - flatulence. Now when you're teaching your patient about these side
effects it's also important to look at the other medications are taking
whether that's over-the-counter, herbals, or prescription medications. So anything
that would work with metformin to reduce sugar levels should be investigated to
make sure that it's not going to decrease the sugars too quickly.
There's also medication that will work to increase your sugar levels. If they're
taking a steroid for example. So we need to be looking to make sure those are
balancing out in the big scheme of their care. Another thing to consider is the
functioning of their liver and their kidneys. So metabolized in the liver,
excreted in the kidneys. So any pathology with the liver or the kidneys that
affects its ability to do its job will affect the concentration of metformin in
the body. For example if my kidneys are not able to excrete urine; maybe I'm a
dialysis patient, and I'm maintaining, so I'm gonna have a buildup of metformin in
my body - and knowing it's half life will let you know how long that will be
sitting in the body - because it will just stack on top of each other and you may
end up having a very hypoglycemic patient when you go to check them
after multiple doses. So today we talked about metformin, the foreman of the
factory and how it needs to reassign is his staff members because he has in order to
decrease hepatic glucose production. That's his marching order for today.
He's reassigned his staff members - I keep wanting to say patients.
He's reassigned his staff member. Some are working on that intestinal
absorption, ah! not happening. The others are working on increasing insulin
sensitivity like that salesman at your door. Together that's going to work to
decrease serum glucose levels so that we can reduce the risk of hyperglycemia in
our patients. We need to watch for hypoglycemia because that's one of the
common side effects of treating high blood sugars. I hope the story helps you
remember how metformin works and you can share that with your patients. If you
have another story that works for you please, share in the comments below and
let's elevate the practice of those around us. Until next time, make it a
great day :)