Type 2 Diabetes: Glucose Targets, Metformin Safety, and Daily Foot Care
Teach the usual glucose targets: 80 to 130 mg/dL before meals, under 180 mg/dL 1 to 2 hours after the start of a meal, and an A1C under 7% for many adults, or the targets the provider sets. Teach the plate method, at least 150 minutes of moderate activity weekly, metformin with meals, and daily foot inspection. Call 911 for confusion, or for very high glucose with vomiting or rapid breathing.
Who needs this teaching
Clients with type 2 diabetes and the family member who shops, cooks, or helps with monitoring. Insulin resistance and progressive beta-cell dysfunction cause chronic hyperglycemia. Glycemic control and daily self-care reduce retinopathy, nephropathy, neuropathy, and cardiovascular disease.
The priority teaching points
- Blood glucose monitoring. Check capillary blood glucose on the schedule the provider sets. Record each result. The usual targets are 80 to 130 mg/dL before meals and under 180 mg/dL 1 to 2 hours after the start of a meal. Normal fasting glucose is under 100 mg/dL.
- A1C. The A1C reflects average glucose over about 3 months. The goal for many nonpregnant adults is under 7%; normal A1C is under 5.7%. Follow the individualized goal.
- Healthy eating. Teach the plate method: half the plate nonstarchy vegetables, one quarter lean protein, and one quarter carbohydrate foods such as whole grains. Keep carbohydrate portions consistent at each meal. Replace regular soda, juice, and sweetened drinks with water. Refer to a registered dietitian.
- Physical activity. Aim for at least 150 minutes of moderate activity weekly, over at least 3 days, with no more than 2 days in a row without activity. Activity increases insulin sensitivity. Clients taking insulin or a sulfonylurea check glucose before exercise and carry a fast-acting carbohydrate.
- Metformin. Take metformin with meals to reduce nausea, diarrhea, and abdominal discomfort. Metformin alone does not cause hypoglycemia. Avoid excess alcohol, which increases the risk of lactic acidosis. Hold metformin before iodinated contrast as instructed, and restart it only after the provider confirms stable renal function, usually 48 hours after the procedure.
- Daily foot care. Peripheral neuropathy causes loss of protective sensation, so injuries go unnoticed. Inspect both feet daily, including the soles and between the toes, with a mirror or a family member. Wash in warm water, test the temperature with the elbow or a thermometer, and dry between the toes. Cut nails straight across and file sharp edges. Wear well-fitting shoes with socks, and check inside shoes first. Never walk barefoot, even at home.
- Yearly screening. Keep a dilated eye examination, kidney tests (urine albumin-to-creatinine ratio and estimated glomerular filtration rate), and a comprehensive foot examination at least yearly, or on the schedule the provider sets. Keep blood pressure below 130/80 mm Hg and stop smoking.
- Hyperglycemic emergencies. Hyperosmolar hyperglycemic state develops over days with polyuria, polydipsia, dehydration, and confusion. Call 911 for confusion, or for very high glucose with vomiting, Kussmaul respirations, or a fruity breath odor.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Glucose over 300 mg/dL on 2 readings in a row | Confusion, extreme drowsiness, or difficulty waking |
| A foot sore, blister, cut, or color change | Very high glucose with vomiting, deep rapid respirations, or fruity breath odor |
| Polyuria, polydipsia, or blurred vision with readings above target | Unconsciousness or seizure |
Teach-back questions
- "What are your glucose targets before and after meals?"
- "Show me how you will fill your plate at dinner."
- "When will you take your metformin?"
- "Show me how you will check your feet each day."
- "What reading means you call your provider today?"
Teaching tips
- Write the client's glucose and A1C targets on the handout.
- Observe a return demonstration of meter use and foot inspection.
- Build sample plates from the client's usual foods.
- Schedule the eye, kidney, and foot examinations with the client.
Read more on NCLEXPace
- Chronic Disease Management: Hypertension, Diabetes, Hyperlipidaemia
- Diabetes Emergencies: DKA vs HHS, Step by Step
- Endocrine Map: DKA vs. HHS, Addison’s vs. Cushing’s, Thyroid Emergencies
Sources
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Diabetes.
- American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(Suppl 1).
- Metformin Hydrochloride Tablets: FDA prescribing information (DailyMed).
Why this matters for the NCLEX
Teaching is effective when the client states, "I check both feet every day, including the bottoms, with a mirror," and "I take my metformin with breakfast and dinner." Statements requiring further teaching include, "I soak my feet in hot water every night," "I walk barefoot inside my house," and "I will stop my metformin once my A1C is under 7%."
Frequently asked questions
Does a client who takes only metformin need a hypoglycemia plan?
Metformin alone does not cause hypoglycemia. Clients who also take insulin or a sulfonylurea need a hypoglycemia plan and a fast-acting carbohydrate source.
Why does the client test bath water with the elbow and not the foot?
Peripheral neuropathy reduces temperature sensation in the feet. Hot water causes burns the client does not feel.
More patient teaching on Endocrine (Diabetes, Thyroid)
Hypoglycemia and Sick-Day Rules: The Rule of 15, Glucagon, and Ketone ChecksTeach recognition and treatment of hypoglycemia with the rule of 15, glucagon use by family members, prevention, and sick-day management of insulin, glucose checks, fluids, and ketones.Insulin at Home: Pen Technique, Site Rotation, Storage, and HypoglycemiaTeach insulin types and timing, insulin pen technique, site rotation, safe storage, sick-day insulin use, hypoglycemia treatment, and sharps disposal.Hyperthyroidism: Antithyroid Medication Safety, Radioactive Iodine Precautions, and Thyroid StormTeach antithyroid medication safety, beta blocker use, radioactive iodine precautions, Graves eye care, nutrition, and recognition of thyroid storm.3,200+ NCLEX questions with think-like-a-nurse rationales, unfolding case studies and adaptive readiness exams. Start with free practice questions, then choose a plan when you are ready.
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