Discussion post response

For the first medication to prescribe this patient newly diagnosed with type 2 diabetes mellitus, I would select metformin. This oral agent provides effective blood glucose reduction through various mechanisms including decreasing hepatic glucose production and improving insulin sensitivity (Stahl, 2021). Metformin is generally well-tolerated with gastrointestinal side effects like nausea and diarrhea being the most common but usually transient. It does not cause hypoglycemia which is important for safety. Metformin is also beneficial for promoting weight loss and cardiovascular protection. As an affordable generic medication, it provides good access for patients. Clinical guidelines consistently recommend metformin as the preferred initial monotherapy for most patients with type 2 diabetes like the one described here. Therefore, based on its favorable efficacy and safety profile, positioning as first-line therapy, and this patient's specific presentation, metformin is the appropriate choice for the first anti-hyperglycemic medication to prescribe. I will begin with low dose, once daily extended release metformin 500mg with food and titrate gradually while monitoring blood glucose and HbA1c response.

For education on medication management, I need to provide comprehensive instructions spanning proper administration, potential side effects and their management, lifestyle integration, adherence promotion, safety precautions, monitoring, and follow up recommendations. Clear verbal explanations supplemented with written materials will cover topics like taking metformin with food to reduce gastrointestinal side effects, typical dosing schedules, signs of hypoglycemia, the importance of adherence and regular refills, drug interactions to avoid, coordinating metformin with diet and exercise efforts, lab monitoring needs, and when to follow up regarding effectiveness and tolerability (Fukada, 2018). Ongoing education will reinforce optimal adherence and safety. Frequent contact is especially important when initiating pharmacotherapy in type 2 diabetes to ensure the patient understands how to properly take the medication, monitor effects, and collaborate on glycemic control. Effective education empowers patients to be active partners in diabetes management.

Fukada, M. (2018). Nursing Competency: Definition, Structure and Development. Yonago Acta Medica, 61(1), 1–7.

Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge university press.