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Talking with the patient

How to explain metformin

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

Metformin is the first medicine for most people with type 2 diabetes. Good teaching helps patients get past early stomach side effects.

Step by step

  1. Explain how it works

    It lowers the sugar the liver makes and helps the body use insulin. On its own it rarely causes low sugar. [1]

  2. Explain how to take it

    Take it with meals. The dose starts low and goes up slowly. [1]

  3. Talk about stomach side effects

    Nausea, loose stools or gas are common at first and often fade. The extended-release form may be easier on the stomach. [1]

  4. Explain kidney checks

    Kidney tests guide the dose. It is not started when eGFR is below 45 and is stopped below 30. [2]

  5. Say when to pause it

    Hold it during severe vomiting or dehydration, and as instructed around contrast scans or surgery. [1]

  6. Mention vitamin B12

    Long-term use can lower vitamin B12, so it is checked from time to time. [2]

  7. Use teach-back

    Ask the patient when they would stop the pill and call the clinic. [3]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

21 Making Synapses cases train this skill: open the case library

Sources

  1. Open RN, Nursing Pharmacology 2e (CC BY 4.0)
  2. NCCPA PANCE Content Blueprint
  3. AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back)
  4. AAMC Core Entrustable Professional Activities (Core EPAs)

Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back). Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.