Feb 23, 2024 NURS 6521 Discussion Diabetes And Drug Treatment
NURS 6521 Discussion Diabetes And Drug Treatment
NURS 6521 Discussion Diabetes And Drug Treatment
The four categories of diabetes mellitus are type 1, type 2, gestational, and other specified types. Type 1 diabetes results from the destruction of pancreatic beta cells and requires daily dosing with insulin. This is caused by an autoimmune or idiopathic response. Type 2 is the most common form of diabetes and accounts for 90-95% of all diagnosed cases (Rosenthal & Burchum, 2021). Type 2 usually results from insulin resistance and inappropriate insulin secretion. At one point type 1 diabetes was termed juvenile- onset as it was thought to occur solely in young children.
Type 1 is now known to develop in adulthood as well and type 2 is becoming more common in children. Although both type 1 and type 2 carry signs and symptoms, they differ in etiology, prevalence, treatments, and outcomes (Rosenthal & Burchum, 2021). In gestational diabetes, insulin requirements physiologically increase during pregnancy. The increase in insulin demand is due to increased maternal caloric intake, maternal weight gain, presence of the placental hormones such as placental growth hormone, and placental lactogen, as well as increased prolactin and growth hormone production (Lende & Rijhsinghani, 2020). As pregnancy advances, the pancreatic beta cell mass increases to keep up with the demand for increased insulin. Failure of the beta cell expansion with a relative inadequate rise in insulin secretion leads to gestational diabetes ( McMcance & Heuther, 2019).
Insulin is the preferred treatment for control of hyperglycemia in patients with gestational diabetes. Insulin is a large molecule and does not cross the placenta. In patients unable to take insulin, oral hypoglycemic agents can be considered. Metformin is preferred over glyburide due to the risk of possible fetal hypoglycemia associated with maternal administration of glyburide. Typically, the dose of oral medications is once or twice a day. Metformin and glyburide have been shown to cross the placenta and into the fetus. Oral medications have not been adequately studied for possible long-term effects on neonatal outcomes, and therefore they are not recommended as the first choice in treatment for persistent hyperglycemia in gestational diabetic patients (Lende & Rijhsinghani, 2020).
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One complication of insulin treatment is hypoglycemia unawareness. Hypoglycemia occurs when insulin levels exceed insulin needs. The more a patient experiences hypoglycemia, they begin to have diminished symptoms over time (Rosenthal & Burchum, 2021). Frequent blood glucose monitoring minimizes the risk for this complication. When therapy is successful, both hyperglycemia and hyperglycemia are minimized and the patient is actively involved in their own therapy. To reach optimal glucose control, dosage must be closely matched with insulin needs (Rosenthal & Burchum, 2021).
References
Lende, M., & Rijhsinghani, A. (2020). Gestational Diabetes: Overview with Emphasis on Medical Management. International Journal of Environmental Research and Public Health, 17(24). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17249573
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Health Sciences.
Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences.
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Discussion: Diabetes and Drug Treatments
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Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.
For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/
To Prepare
Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.
By Day 3 of Week 5
Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.
Diabetes Mellitus
There are four types of diabetes mellitus: type 1, type 2, gestational, and juvenile. Type 1 diabetes mellitus is characterized by destroying pancreas beta cells resulting in extremely low or absent insulin production (Sapra, 2022). Typically, type 1 diabetes is secondary to autoimmune disease and genetic correlation (Skyler et al., 2017). Similarly, type 2 diabetes mellitus can occur from autoimmune diseases and genetic correlation (Skyler et al., 2017); however, type 2 diabetes has a more insidious onset occurring from imbalances of insulin levels, causing functional insulin deficits (Sapra, 2022).
Gestational diabetes occurs during pregnancy, and the development of this type of diabetes is still not entirely known. It is, however, thought that gestational diabetes occurs from high concentrations of hormones such as progesterone, cortisol, prolactin, and estrogen affecting beta-cell function (Sapra, 2022). Juvenile diabetes occurs in children when their pancreas produces little or no insulin (Sapra, 2022). Juvenile diabetes is later classified as type 2 diabetes when the child transitions into adulthood.
Type 2 Diabetes Mellitus
More than 30 million Americans are diagnosed with diabetes mellitus, and type 2 diabetes mellitus makes up more than 90% of those diagnosed (“Type,” 2022). Individuals diagnosed with type 2 diabetes mellitus may initially require minimal medication management; however, diabetes is a condition managed mainly by the patient (“Type,” 2022). Without careful monitoring of blood sugar levels, meticulous medication regimen, and diet control, the patient may risk worsening their disease altogether.
Medication Management
One of the most common medications for type 2 diabetes mellitus treatment is Metformin. Metformin is an oral prescription medication under the biguanide class. Metformin lowers blood glucose and improves glucose tolerance by inhibiting glucose production in the liver, reducing glucose absorption in the gut, and it sensitizes insulin receptors in fat and skeletal muscle tissues to increase glucose reuptake (Rosenthal & Burchum, 2021). Metformin is not metabolized but excreted by the kidneys; therefore, those with any renal impairment must be monitored closely or given alternative treatment altogether for the risk of drug toxicity and lactic acidosis (Rosenthal & Burchum, 2021).
When Metformin is indicated for diabetes treatment, the medication is recommended to be taken with meals to reduce gastrointestinal side effects, including nausea, diarrhea, and decreased appetite (Rosenthal & Burchum, 2021). Metformin is most commonly prescribed with a dosage of 500mg twice daily or 850mg daily, although some individuals may only require 500mg daily (Rosenthal & Burchum, 2021).
Dietary Considerations
Those with type 2 diabetes mellitus should manage their blood sugar levels with healthy foods and an active lifestyle. Healthy carbohydrates, fiber-rich foods, heart-healthy fish, and good fats such as nuts and avocados are encouraged for those with type 2 diabetes (“Diabetes,” 2021). However, patients should avoid foods high in saturated fats, trans fats, cholesterol, and sodium to assist in blood sugar control (“Diabetes,” 2021).
Short-Term and Long-Term Impacts of Type 2 Diabetes
Short-term impacts of type 2 diabetes mellitus may include medication side effects such as nausea, vomiting, or diarrhea and signs of hyper- or hypoglycemia (Rosenthal & Burchum, 2021). Patients with long-term diagnoses of type 2 diabetes risk more complex long-term impacts. Some long-term implications of type 2 diabetes mellitus include: macro- and microvascular damage, often leading to heart disease, kidney disease, nerve damage, vision or hearing loss, and many other issues (Skyler et al., 2017). When holistic approaches are made for diabetes control, including diet, exercise, and meticulous medication management, patients can avoid some long-term consequences; however, upon diagnosis, patients should always be aware of the risks.
References
Diabetes diet: Create your healthy-eating plan. (2021, March 25). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295Links to an external site.
Rosenthal, L. D., & Burchum, J. R. (2021) Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Sapra, A. (2022, June 26). Diabetes Mellitus. StatPearls. https://www.statpearls.com/ArticleLibrary/viewarticle/20429Links to an external site.
Skyler, J. S., Bakris, G. L., Bonifacio, E., Darsow, T., Eckel, R. H., Groop, L., Groop, P., Handelsman, Y., Insel, R. A., Mathieu, C., McElvaine, A. T., Palmer, J. P., Pugliese, A., Schatz, D. A., Sosenko, J. M., Wilding, J. P., & Ratner, R. E. (2017). Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes, 66(2), 241-255. https://doi.org/10.2337/db16-0806Links to an external site.
Type 2 diabetes. (2022, March 2). Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.htmlLinks to an external site.
By Day 6 of Week 5
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 5 Discussion Rubric
Post by Day 3 of Week 5 and Respond by Day 6 of Week 5
To Participate in this Discussion:
Week 5 Discussion
What’s Coming Up in Module 5?
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In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.
Looking Ahead: Midterm Exam
Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.
Next Week
To go to the next week:
Module 5
Week 5: Endocrine System Disorders and the Treatment of Diabetes
The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions.
As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include
This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.
Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from https://www.niddk.nih.gov/health-information/endocrine-diseases
Learning Objectives
Students will:
Differentiate types of diabetes
Evaluate the impact of diabetes drugs on patients
Evaluate alternative drug treatments and patient education strategies for diabetes management
Learning Resources
Required Readings (click to expand/reduce)
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf
This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.
Document: Mid-Term Summary & Study Guide (PDF)
Required Media (click to expand/reduce)
Speed Pharmacology. (2017). Drugs for Diabetes (Made Easy) [Video]. https://www.youtube.com/watch?v=LWDQyaKVols&t=79sNote: This media program is approximately 17 minutes.
appetite by slowing the motility of food (Otto-Buczkowska & Jainta, 2018).
Classes of Drugs used in Type II diabetes Management
Type II diabetes has several treatment options as well based on a non-insulin approach. The first-line treatment for type II is an oral hypoglycaemic agent (OHL) class of biguanide metformin. The second class of OHL are the sulfonylureas (SUs). Thiazolidineiones (TZDs) were introduced in the 1990’s but many were pulled from the market due to the potential to cause liver failure. Pioglitazone is the TZD most commonly prescribed today. A class of drugs whose main emphasis is on the gut belongs to a group of anti-hyperglycemic agents called incretin. The development of dipeptidyl-peptidase inhibitors led to the use of glucagon-like peptide-1 receptor antagonists or GLP-1 (Blaslov et al., 2018).
Treating Type II Diabetes with Biguanides
In treating type II diabetes, antidiabetic biguanides are the first-line drug of choice and are the first medications most often prescribed for type II diabetics. One such medication metformin belongs to this class of drugs. This medication is available as a tablet as well as a solution and is taken orally. The liquid is taken with meals one to two times daily, the regular tablet is taken two to three times daily with meals, and the extended release is taken with a meal once daily and has been noted to cause less gastrointestinal upset such as diarrhea. Dosing is usually initiated at 500 mg twice daily or 850 mg once daily. Metformin can build up in the kidneys if there they are not functioning properly therefore careful monitoring is needed in patients with reduced kidney function (Ibrahim et al., 2021).
Biguanides such as metformin, are not metabolized and are excreted in the urine through tubular secretion (kidneys). Cation transporters distribute the medication to tissues. The OCT2 gene is responsible for the uptake of metformin from the body’s circulation and then into renal cells. Metformin suppresses glucose production in the liver through gluconeogenesis while signaling the body to make more insulin and increasing the uptake of glucose into the cells. It does not cause hypoglycemia as it there is no endogenous insulin secretion stimulation (Zake et al., 2021).
Dietary Considerations & Short-term and Long-term Impacts of Type II Diabetes
Diet is definitely very important in the management of type II diabetes. Monitoring sugar intake and keeping body fat at a healthy level is vital for controlling this disease. Excess sugar not only overworks beta cells it also causes narrowing of blood vessels by decreasing the elasticity resulting in reduced blood flow and decreased oxygen levels. This can lead to neuropathy, heart attacks, stroke, and premature death. Medications can also cause complications in that many are damaging to the liver and kidneys as the medication is excreted along with sugar. Managing diet along with routine visits and labs are all crucial in both preventing and controlling diabetes. Eating foods high in fiber along with unprocessed foods, and exercise are great ways to fight back (Forouhi et al., 2018).
References
Blaslov, K., Naranđa, F. S., Kruljac, I., & Renar, I. P. (2018). Treatment approach to type 2 diabetes: Past, present and future. World Journal of Diabetes, 9(12), 209–219. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304295/
Butler, A., & Misselbrook, D. (2020). Distinguishing between type 1 and type 2 diabetes. British Medical Journal, 370. Retrieved from https://www.researchgate.net/publication/343583965_Distinguishing_between_type_1_and_type_2_diabetes
Forouhi, N. G., Misra, A., Mohan, V., Taylor, R., & Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type2 diabetes. British Medical Journal, 361. Retrieved from https://www.bmj.com/content/361/bmj.k2234
Ibrahim, M., Morley, M. D., Ding, H., & Triggle, C. R. (2021). A critical review of the evidence that metformin is a putative anti-aging drug that enhances healthspan and extends lifespan. Frontiers in Endocrinology, 12, n. p. Retrieved from https://www.frontiersin.org/articles/10.3389/fendo.2021.718942/full
Otto-Buczkowska, E, & Jainta, N. (2018). Pharmacological treatment in diabetes mellitus type 1- Insulin and what else? International Journal of Endocrinology and Metabolism, 16(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903388/
Zake, D. M., Kurlovics, J., Zaharenko, L., Komasilovs, V., Klovins, J., & Dtalidzans, E. (2021). Physiologically based metformin pharmacokinetics of mice and scale-up to humans for the estimation of concentrations in various tissues. Plos One, 16(4), n. p. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249594
People with diabetes have elevated blood glucose levels. Type I, Type II, gestational, and juvenile diabetes are the four types of diabetes. The etiology and timing of onset are the main differences between the two types of diabetes. For instance, diabetes type one is primarily an autoimmune condition brought on by the body’s immune system attacking the pancreas, impairing its ability to produce enough insulin and causing an elevated level of glucose in the blood (Redondo et al., 2020).
It usually starts during childhood and has a higher hereditary component than the others.Contrarily, type 2 diabetes can be brought on by either a decline in the body’s sensitivity to insulin or a decline in its capacity to produce insulin. T2DM typically appears later in life and is primarily triggered by food. Juvenile diabetes, like type 1 DM, advances in adolescents and young adults, whereas gestational diabetes is frequently characterized by uncontrollable sugar levels during the 2nd or 3rd trimester of pregnancy.
Type 1 Diabetes Treatment
The majority of clinical practice guidelines recommend starting Type 1 diabetes treatment with insulin (TID). Patients with type 1 diabetes should start their treatment with aggressive insulin therapy. Once or twice a day, 100 units of short-acting standard insulin are diluted in 1 ml of the liquid solution and administered intravenously (Tornese et al., 2020). Subcutaneous or insulin pump administration is an option for other insulin formulations. The dose is typically adjusted following the patient’s blood sugar levels.
Dietary Considerations
To attain and retain acceptable blood sugar levels, T1D patients are frequently advised to eat foods with a lower glycemic index. Proteins and complex carbohydrates like brown rice are also appropriate for T1D patients. The timing of meals must be ideal to prevent hypoglycemia (Yuan et al., 2022).
The Short-Term and Long-Term Impacts
Patients with T1D frequently experience numerous side effects linked to higher risks of hypoglycemia during the first few months after diagnosis, including palpitations, anxiety, headaches, and disorientation (DiMeglio et al., 2018). Long-term, however, this condition can lead to significant organ failure, with kidney damage, nerve damage, heart disease, and ocular impairment being the most common. On the contrary, insulin administration for a brief period may result in weakened metabolic control. In addition to other issues, long-term insulin use can increase the likelihood of cardiovascular and psychiatric issues.
References
DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449–2462. https://doi.org/10.1016/s0140-6736(18)31320-5
Redondo, M. J., Hagopian, W. A., Oram, R., Steck, A. K., Vehik, K., Weedon, M., Balasubramanyam, A., & Dabelea, D. (2020). The clinical consequences of heterogeneity within and between different diabetes types. Diabetologia, 63(10), 2040–2048. https://doi.org/10.1007/s00125-020-05211-7
Tornese, G., Ceconi, V., Monasta, L., Carletti, C., Faleschini, E., & Barbi, E. (2020). Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity. Dia
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