A 60-year-old client with type 2 diabetes is newly prescribe… | MyMerci
Medical EmergenciesPA
Question
A 60-year-old client with type 2 diabetes is newly prescribed sitagliptin 100 mg orally daily. Which statement by the client demonstrates correct understanding?
1I will skip the dose if my blood sugar is normal that morning.
2I will report severe abdominal pain that radiates to my back, persistent nausea, or new joint pain — these may indicate pancreatitis or other adverse effects of this DPP-4 inhibitor.✓ Correct answer
3I will check my blood glucose every hour because sitagliptin causes severe hypoglycemia.
4I should chew sitagliptin tablets for faster absorption.
Explanation
DPP-4 inhibitors — patient teaching DPP-4 inhibitors (the gliptins): sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin. Mechanism: inhibit dipeptidyl peptidase-4 → prolonged endogenous incretin (GLP-1, GIP) → glucose-dependent insulin secretion + decreased glucagon. Generally well tolerated; typically once daily oral.
Key teaching: • Hypoglycemia risk is LOW as monotherapy (glucose-dependent action). Routine hourly checks not needed; standard SMBG and A1c follow. • Pancreatitis (rare but reportable): severe abdominal pain radiating to the back, persistent nausea/vomiting — stop the drug and notify the provider. • Severe joint pain — class warning; can occur weeks to years after initiation; usually resolves on discontinuation. • Heart failure: saxagliptin and alogliptin associated with HF hospitalization — caution in HF patients. • Renal dose adjustment: sitagliptin reduce dose in CrCl
In-depth explanation
Clinical reasoning summary DPP-4 inhibitors — patient teaching DPP-4 inhibitors (the gliptins): sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin. Mechanism: inhibit dipeptidyl peptidase-4 → prolonged endogenous incretin (GLP-1, GIP) → glucose-dependent insulin secretion + decreased glucagon. Generally well tolerated; typically once daily oral.
Key teaching: • Hypoglycemia risk is LOW as monotherapy (glucose-dependent action). Routine hourly checks not needed; standard SMBG and A1c follow. • Pancreatitis (rare but reportable): severe abdominal pain radiating to the back, persistent nausea/vomiting — stop the drug and notify the provider. • Severe joint pain — class warning; can occur weeks to years after initiation; usually resolves on discontinuation. • Heart failure: saxagliptin and alogliptin associated with HF hospitalization — caution in HF patients. • Renal dose adjustment: sitagliptin reduce dose in CrCl