Pharmacology Diabetes meds #3


Which finding in a newly diagnosed diabetes mellitus (DM) type 2 during a follow-up visit evaluating the client’s toleration and response to metformin treatment would be critical to report to the healthcare provider?


  1. History of 10 lb weight gain over the past year
    • Rationale:

      This answer is not correct because, although weight loss is expected while taking metformin, 10 lbs over a year is not critical. It could mean the person should have their diet and exercise evaluated, but it is not a critical finding compared to intake of alcohol with metformin.

  2. Daily intake of an angiotensin-converting (ACE) inhibitor
    • Rationale:

      This answer is not correct because a daily intake of an ACE-inhibitor is not concerning. Nevertheless, another anti-hypertensive, a beta blocker, can mask the clinical manifestations of hypoglycemia, which is a serious side effect.

  3. Report of drinking 1-2 glasses of wine each evening
    • Rationale:

      This answer is correct because alcohol intake with metformin can cause lactic acid build up in the body, causing lactic acidosis. This is a very critical condition and could cause death. Therefore, monitoring the client for alcohol intake and educating them about this serious interaction is of the utmost importance.

  4. Daily blood glucose levels of 140-180 mg/dL
    • Rationale:

      This answer is not correct because, although the blood glucose goal is probably lower than 140-180 mg/dL, it is not “critical” compared to the potential for lactic acidosis due to the alcohol and metformin interaction.


Lactic acidosis can occur with intake of alcohol while taking metformin. The nurse should inquire about alcohol intake, educate the client regarding this serious interaction, and report any non-adherence to the healthcare provider.


Learning Outcomes

Lactic acidosis occurs when lactic acid increases in the bloodstream. When oxygen becomes low in the body in areas where metabolism occurs, lactic acid is produced. Metformin intake causes an increase of lactic acid, in general. This is worsened with intake of alcohol since drinking too much alcohol can cause the body to not be able to rid itself naturally of lactic acid. The combination of this happening makes the ingestion of metformin and alcohol a dangerous interaction.

Test Taking Tip

Read the question and answers carefully for keywords. “Critical” is a keyword. This reflects detrimental outcomes if action is not taken.

Video Rationale