Feb 23, 2024 DIABETES AND DRUG TREATMENTS NURS 6521
DIABETES AND DRUG TREATMENTS NURS 6521
DIABETES AND DRUG TREATMENTS NURS 6521
According to the Center for Disease Control (CDC) 11.3% or 37.1 million people in the United States have diabetes mellitus. Major complications of diabetes are neuropathy, heart disease, and hypertension. Diabetes management should be aimed at preventing short and long-term complications.
Different Types of Diabetes
Type I diabetes, also known as juvenile diabetes, because the onset commonly occurs during childhood or adolescence and is abrupt. Type I diabetes occurs when pancreatic beta cells are damaged or destroyed. Pancreatic beta cells produce insulin and when they are damaged or destroyed by autoimmune disease, genetic or environmental factors or viral infections insulin production becomes insufficient. Type II diabetes commonly occurs in middle age and progresses gradually. In Type II diabetes a combination of increased tissue resistance to insulin and impaired pancreatic insulin secretion lead to hyperglycemia. A third type of diabetes is gestational diabetes which occurs during pregnancy and subsides rapidly following delivery. Gestational diabetes causes high birth weights, and hyperinsulinemia in infants (Rosenthal & Burchum, 2021).
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Treatment of Type I Diabetes
The mainstay of treatment for Type I diabetes is insulin. Insulin dosing is weight-based and recommended ranges are 0.4 to 1.0 units per kilogram per day (u/kg/day) of total insulin. Higher ends of the dosing range are needed during puberty and if the patient presents with ketoacidosis. American Diabetes Association (ADA) recommendations for initiation of therapy in a patient who is metabolically stable is 0.5 (u/kg/day) (American Diabetes Association [ADA], 2018).
Insulin should be administered with a meal and based on blood glucose levels, carbohydrate consumption, and activity level. While administration of rapid onset insulin should be at meal- time, timing and administration should be individualized (ADA, 2018).
Insulin comes in many forms and prandial dosing insulin should be fast acting to reduce the risk of hypoglycemic episodes. Humalog (insulin lispro) is a fast-acting insulin that can be administered IV, by subcutaneous injection or by a continuous subcutaneous infusion pump. Most short acting insulin is available in a pen that is easy for patients to use correctly and conveniently by dialing the dose into the pen and then attaching a small needle and pressing it into subcutaneous tissue on the stomach, back of the arm, or fatty portion of the thigh. Humalog has a more rapid onset and a shorter duration of action than regular human insulin so when taken with a meal the risk of hypoglycemia is reduced. Onset is within 5 minutes and peak is usually 30 – 60 minutes after administration (Food and Drug Administration [FDA] & Eli Lilly and Company, 2012).
Short and Long-Term Impacts
Individuals who are diagnosed with Type I diabetes face short-term risks of ketoacidosis if glucose levels are not controlled, and hypoglycemic episodes related to insulin therapy (Rosenthal & Burchum, 2021, Chapter 68). They face long-term risks of renal failure, peripheral neuropathy, hypertension, and heart disease. Treatment with ACE inhibitors, angiotensin II receptor blockers, and statin drugs should be considered for long-term disease prevention in adult patients (Gray & Threlkeld, 2019). Treatment with prandial insulin dosing, and balancing carbohydrate intake with activity are key to maintaining safe blood glucose levels.
Conclusion
Type I diabetes is caused by decreased or lack of insulin production and requires close management that includes insulin dosing to prevent long-term disease complications. Humalog is a form of insulin that can be used as part of a comprehensive treatment plan to successfully treat Type I diabetes.
References
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes – 2018. Diabetes Care, 41(1), 573–585. Retrieved March 30, 2022, from https://doi.org/10.2337/dc18-S008
Food and Drug Administration & Eli Lilly and Company. (2012). Humalog (insulin lispro). FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020563s115lbl.pdf
Gray, A., & Threlkeld, R. K. (2019). Endotext [Internet]. MD Text, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279012/
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
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 (DM) is a metabolic disorder that occurs due to a decreased production or no production of insulin which is produced by beta cells in the pancreas to lower blood glucose (Rosenthal et al., 2021). There are different types of diabetes including type 1, type 2, juvenile, and gestational diabetes. In DM type 1, insulin production is nonexistent, damage to the beta cells in the pancreas causes the organ to not produce insulin which is used to decrease blood glucose levels by pulling the glucose out of the bloodstream and into the cells (Rosenthal et al. 2021). As a result of the absence of insulin production, individuals with DM type 1 are fully insulin dependent. Juvenile DM is type 1 insulin dependent diabetes in adolescents. DM type 1 use to be known as juvenile diabetes, however type 1 although most often is diagnosed in children and adolescents, it can be diagnosed at any age (CDC, 2022a).
On the other hand, DM type 2 results from an impaired lack of insulin production or an insulin sensitivity often related to obesity or liver issues (Li et al., 2022). DM type 2 can often be controlled with diet, exercise, and oral anti diabetic medication that helps to decrease blood glucose levels in patient’s whose pancreas produces some insulin (Li et al., 2022). Occasionally, individuals with Type 2 DM who have multiple co morbidities or are poorly controlled with diet, exercise, and oral medication may have insulin incorporated into their drug therapy plan for better control.
Lastly, gestational diabetes is a metabolic condition that occurs during pregnancy. During pregnancy, women can experience insulin resistance as a result of rapid body changes and hormones which can cause inability of the pancreas to produce enough insulin to meet the body’s current needs (CDC, 2022b). Women are tested for gestational diabetes between 24 and 28 weeks of pregnancy. If a woman is diagnosed with gestational diabetes, they will be considered high risk requiring close monitoring of the baby’s growth. In addition, the woman will be required to monitor her blood glucose levels, make changes to her diet, incorporate light physical activity, and may require insulin to help manage blood glucose levels (Rosenthal et al., 2021).
Proper management and treatment for DM type 2 is vital to maintain glucose control and prevent complications associated with uncontrolled DM. The first line management for Type 2 is diet, exercise and glucose monitoring (Li et al., 2022). However, the majority of patients diagnosed with Type 2 also require oral anti diabetic medications.
There are several drug classes of anti-diabetics but for the purpose of this discussion, I will focus on Metformin which is a biguanide. A biguanide is a class of oral anti diabetics that inhibits the production of glucose in the liver, decreases some absorption of glucose in the abdomen, and triggers insulin receptors to increase consumption of glucose regarding the minimal insulin that has been produced (Rosenthal et al., 2021). The pharmacokinetics of metformin include absorption into the small intestine and then is excreted by the kidneys. A contraindication for prescribing Metformin is if a patient has decrease kidney or liver dysfunction because it can cause toxicity (Rosenthal et al., 2021). Metformin is recommended as a first line treatment of DM type 2 because of its effects on decreasing A1C, weight loss, and preventing cardiac issues (American Diabetes Association, 2018). The recommended dose is 850 mg BID in combination with a low carbohydrate, low fat, high protein diet and daily exercise for patients with Type 2 DM (Rosenthal et al., 2021 & Ernawati et al., 2021).
The short-term impact of Metformin is that it is a very effective drug to help manage and stabilize blood glucose control because it does not directly decrease blood glucose therefore patient’s do not experience hypoglycemic events related to taking this medication (Rosenthal et al., 2021). Long term impact of Metformin can cause deficiencies of vitamin B12 and folic acid as well as cause weight loss (American Diabetes Associations, 2018). In addition, patients who have or develop kidney or liver disease should stop taking Metformin because the long-term effects can result in toxicity leading to lactic acidosis (Rosenthal et al., 2021). Overall, DM type 2 can be managed effectively if the individual is compliant with the treatment plan and does not have a lot of other existing co morbidities. As a provider, education is key in helping patients to properly manage their disorder to have the best possible outcome long term.
References
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment:Standards of medical care in diabetes Links to an external
Links to an external site.
site.
Links to an external site.—2018.
Ernawati, U., Wihastuti, T. A., & Utami, Y. W. (2021). Effectiveness of diabetes self-management education (DSME) in type 2 diabetes mellitus (T2DM)
patients: Systematic literature review. Journal of public health research, 10(2), 2240. https://doi.org/10.4081/jphr.2021.2240
Links to an external site.
Li, A. P. Z., & Kariyawasam, D. (2022). Type 2 Diabetes Mellitus. Comprehensive Pharmacology, 225–243. https://doi.org/10.1016/b978-0-12-820472-
Links to an external site.
6.00098-0
Links 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.
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.
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. Diabetes Technology & Therapeutics, 22(6), 462–467. https://doi.org/10.1089/dia.2020.0169
Yuan, X., Wang, J., Chen, X., Yan, W., Niu, Q., Tang, N., Zhang, M. Z., Gu, W., & Wang, X. (2022). Effects of the timing of the initiation of dietary intake on pediatric type 1 diabetes for diabetic ketoacidosis. BMC Pediatrics, 22(1). https://doi.org/10.1186/s12887-022-03243-z
Type 1 diabetes is an autoimmune condition characterized by a lack of insulin production, type 2 diabetes involves insulin resistance and inadequate insulin secretion, gestational diabetes occurs during pregnancy, and juvenile diabetes refers to type 1 diabetes in children and young adults. Each type of diabetes has unique underlying causes, age of onset, and management strategies. Type 1 diabetes mellitus is an autoimmune disease and it is caused by a person’s immune system’s attack on pancreatic cells responsible for insulin production. This condition results in insufficient insulin production and elevated blood glucose levels.
Type 1 diabetes.often diagnosed in childhood or adolescence. Insulin therapy serves as the primary treatment for type 1 diabetes. The administration of insulin involves subcutaneous injections or the use of insulin pumps. Dosage and timing of insulin are tailored based on factors such as blood sugar levels, dietary intake, and physical activity. Diligent monitoring of blood glucose levels and adherence to prescribed insulin regimens are vital to maintaining stable glycemic control.
Regarding dietary considerations, individuals with type 1 diabetes must carefully manage their carbohydrate intake in tandem with insulin doses. Carbohydrate counting, a commonly employed method, entails estimating the carbohydrate content of meals and matching it with the appropriate insulin dose. Opting for complex carbohydrates and high-fiber foods while limiting sugar consumption is advisable. Regular meal patterns and scheduled snacks aid in maintaining consistent blood glucose levels throughout the day.
(FDA, 2021) Type 1 diabetes manifests through symptoms such as excessive thirst, frequent urination, fatigue, and unintended weight loss. If left untreated, it can culminate in a critical condition known as diabetic ketoacidosis (DKA), necessitating immediate medical intervention. Over the long term, type 1 diabetes carries the risk of complications affecting various organs, including diabetic retinopathy (eyes), diabetic nephropathy (kidneys), diabetic neuropathy (nerves), and cardiovascular disease. Nevertheless, diligent management and adherence to treatment regimens can help mitigate these risks.
One pharmaceutical intervention for type 1 diabetes is insulin lispro, commercially known as Humalog. Insulin lispro, a rapid-acting insulin analog, is frequently employed to manage postprandial blood glucose surges. It is typically administered shortly before or after meals to regulate blood sugar levels effectively. The preparation process involves withdrawing the prescribed insulin dose using a syringe or insulin pen, carefully handling and storing the insulin vial or cartridge. Subsequently, the insulin is subcutaneously injected into adipose tissue, commonly in the abdominal or thigh region.
The utilization of insulin lispro empowers individuals with type 1 diabetes to regulate their blood glucose levels and prevent hyperglycemia. (Sakurai et al., 2023) However, potential side effects, such as hypoglycemia, may arise if dosage adjustment or administration is not meticulous. Furthermore, insulin therapy necessitates diligent monitoring, dose modifications, and adherence to a structured treatment plan, which can be demanding for some individuals.
If type 1 diabetes is not effectively managed over the long t
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