Feb 23, 2024 Discussion: Diabetes and Drug Treatments NURS 6521
Discussion: Diabetes and Drug Treatments NURS 6521 Discussion: Diabetes and Drug Treatments NURS 6521 DIABETES AND DRUG TREATMENTS Millions of individuals all around the world suffer from diabetes. High blood sugar levels are a hallmark of the disease and, if left unchecked, can cause a host of health problems. Type 1, type 2, pregnancy-related, and juvenile diabetes are the four most common forms of the disease (Rosenthal & Burchum, 2021). The root of each condition and the available therapies are unique. An infection or illness that attacks the pancreas, for example, can set off a cascade of events that leads to type 1 diabetes (CDC, 2019). However, poor dietary habits and a lack of physical activity are major contributors to type 2 diabetes. Gestational diabetes is a form of diabetes diagnosed during pregnancy that often disappears after delivery. Finally, cases of diabetes that are diagnosed in children and young people are known as juvenile diabetes. Treatment options may vary amongst the various forms of diabetes; therefore, it’s crucial to have a firm grasp on the distinctions between them. People with a history of diabetes in their family, for instance, are more likely to develop type 1 diabetes themselves (Vijayaraghavan & Crabtree). As a result, they may require closer monitoring of their blood sugar levels and insulin therapy. Type 2 diabetics, on the other hand, may find relief from modifying their diet and increasing their physical activity levels. In conclusion, learning about the many forms of diabetes might aid in making sense of one’s own diagnosis or that of a loved one. It also emphasizes the significance of early diagnosis through checkups and the value of leading a healthy lifestyle to prevent or effectively manage this chronic disease. TYPES OF DIABETES According to Illinois Department of Public Health 2018, type 1 diabetes is distinct from other types of diabetes in that it results from an immune-mediated reduction of beta cells, which forces a lifetime reliance on exogenous insulin. Although both type 1 and type 2 diabetes lead to elevated blood glucose levels, the underlying mechanisms and causes of these diseases are different. Therefore, it is necessary to analyze each form of diabetes separately National Institute of Diabetes and Digestive and Kidney Diseases, 2018). This position statement aims to provide a concise overview of the existing evidence pertaining to the comprehensive management of persons diagnosed with type 1 diabetes (Flory & Lipska, 2019). The objective is to improve our capacity to identify and control type 1 diabetes to mitigate its related problems and ultimately find a cure and preventive measures for this condition (Chiang, Kirkman, Laffel, & Peters, 2014). It is imperative to consider that individuals who receive a diagnosis of type 2 diabetes exhibit impaired insulin use, leading to an inability to maintain blood glucose levels within the appropriate range. Based on the findings of the Centers for Disease Control and Prevention (CDC) in 2019, it is estimated that approximately 90–95% of individuals diagnosed with diabetes are afflicted with type 2 diabetes. The condition often manifests in adults; however, there is an increasing prevalence in children, adolescents, and young adults. Its progression occurs gradually over an extended period. This form of diabetes has been referred to by scholars as a lifestyle illness, suggesting that it can be prevented through modifications in one’s lifestyle, such as engaging in physical activity, adopting healthy eating habits, and achieving weight loss, among other potential strategies. Gestational diabetes exclusively impacts pregnant women, and it is crucial to note that it arises in individuals who have not previously experienced diabetes (CDC, 2019). One notable characteristic of gestational diabetes is that infants born to mothers with gestational diabetes may be vulnerable to certain health complications, including childhood or adolescent obesity and an increased risk of developing type 2 diabetes in adulthood. It is worth noting that gestational diabetes typically resolves after pregnancy. It is important to note that type 1 diabetes is commonly referred to as juvenile diabetes. TYPES OF DRUGS USE TO TREAT DIABETES Type 2 diabetes (T2D) encompasses a wide range of illnesses, ranging from instances of severe insulin resistance accompanied by minor insulin secretory defects to cases of deep insulin secretory defects with minimal insulin resistance (CDE, 2019). In accordance with Flory (year), In a study conducted by Lipska (2019), Metformin is widely recognized as the primary pharmacological intervention for the management of type 2 diabetes. It is the most often given medication for this condition globally, either as a standalone treatment or in conjunction with insulin or other therapies aimed at reducing blood glucose levels. Metformin, a pharmacological agent belonging to the biguanide medication class, has been extensively utilized for the management of diabetes since the 1950s (Flory & Lipska, 2019). The current guidelines established by the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) advocate for the early initiation of metformin as the primary medication for both monotherapy and combination therapy in patients diagnosed with type 2 diabetes mellitus (T2DM) (Rojas & Gomes, 2013). The primary basis for this advice is the glucose-lowering properties of metformin, its very affordable cost, and its generally low incidence of adverse effects, which notably do not include weight gain (ADA, 2011). The United Kingdom Prospective Diabetes Study (UKPDS) provided evidence that supports the use of metformin as a first-line treatment for diabetes. The study observed that individuals who were treated with metformin experienced a 32% reduction in the risk of any diabetes-related endpoint (p = 0.002), a 42% reduction in diabetes-related death (p = 0.017), and a 36% reduction in all-cause mortality (p = 0.011) compared to those in the control group. The study conducted by the Prospective Diabetes Study (UKPDS) Group in 1998 provided evidence that metformin and sulfonylurea are equally efficient in managing blood glucose levels in obese people diagnosed with type 2 diabetes mellitus. Metformin is administered in the form of tablets and is often ingested orally. It is commonly recommended to consume metformin alongside meals as a means of mitigating potential gastrointestinal side effects that may manifest during the initial weeks of treatment. It is recommended to ingest medication in its entirety, accompanied by enough water. DIETARY CONSIDERATIONS When it comes to the treatment of type 2 diabetes, dietary consideration has always been a source of disagreement. It is essential to bear in mind that even though there has been a great deal of pushback against Despite the fact that progress has been made on this front in terms of putting up evidence-based guidelines, there is still uncertainty in the minds of certain individuals. When it comes to the management of type 2 diabetes, the question that we ought to be asking ourselves at this juncture is which nutritional strategy would be most effective for us to use. It is generally accepted that certain dietary patterns, such as the Mediterranean diet, have proved particularly helpful in the management of type 2 diabetes. One example of such a pattern is the Atkins diet. Although there has been a general push for the intake of foods such as nuts, whole grains, vegetables, fruit, and other nutritional products like yogurt, there has also been a great deal of advice to approach this list of foods with caution. These foods include almonds, whole grains, vegetables, fruit, and other dietary products like yogurt. The efficacy of medical nutrition treatment, which was developed to lead a methodical and evidence-based approach to the management of diabetes through diet, has been shown to be effective. IMPACT Research shows that the early symptoms of diabetes, such as increased thirst and urination, fatigue, lethargy, blurred vision, extreme hunger, weakness or shaking, nervousness, or confusion, are the most common short-term effects of diabetes and should not be underestimated. However, type 2 diabetes has potentially disastrous long-term repercussions, including an increased risk of complications like retinopathy, blindness, nephropathy, cardiovascular disease, stroke, blood vessel damage, and neuropathy. The good news is that since diabetes is a lifestyle condition, diligent patients can avoid these consequences by keeping their blood sugar under control with medication, diet, and exercise. I read your interesting post and was happy to learn about short-term complications when metformin is used with insulin and other diabetic medication. Standard insulin therapy in type 1 diabetes has been associated with increased complications, including hypoglycemia, weight gain, and dyslipidemia. Insulin-stimulated skeletal muscle glucose uptake and insulin action reduce in type 1 diabetics (Beysel et al., 2018). This effect contributes to the development of insulin resistance. Insulin resistance leads to poor glycemic control and chronic complications in type 1 diabetics. Metabolic syndrome is a clinical proxy for insulin resistance. Type 1 diabetes associated with metabolic syndrome has been termed double diabetes. Obesity, lack of exercise, and puberty are primary causes of insulin resistance in type 1 diabetes. Management of insulin resistance usually requires an increase in insulin dose requirement. Increased insulin dose requirement might cause weight gain and hypoglycemia, leading to noncompliance with therapy and poor glycemic control. Metformin is an oral anti-hyperglycemic agent and is commonly used in the treatment of type 2 diabetes. It increases both hepatic and peripheral insulin sensitivity in the liver by inhibiting basal hepatic glucose production and in skeletal muscles and adipocytes by increasing glucose uptake. Thus, it enhances insulin action and improves glycemic control. Metformin leads to reduce insulin dose requirement as well as weight gain because it increases insulin sensitivity. In this respect, compared with insulin monotherapy, adding metformin to insulin therapy improves metabolic control and decreases complications in type 2 diabetes (“Glycemia Reduction in Type 2 Diabetes — Glycemic Outcomes,” 2022). References Beysel, S., Unsal, I. O., Kizilgul, M., Caliskan, M., Ucan, B., & Cakal, E. (2018). The effects of metformin in type 1 diabetes mellitus. BMC Endocrine Disorders, 18(1). https://doi.org/10.1186/S12902-017-0228-9 Diabetes is the most common endocrine disorder in the United States, and is caused by either an insulin deficiency or an insulin resistance. There are three types of diabetes: type 1, which was once referred to as juvenile diabetes, type 2, and gestational (Rosenthal & Burchum, 2021). This post will discuss the differences between these and touch on a medication option for type 2. Type 1 (Formerly Juvenile) Generally type 1 diabetes develops in childhood but can develop into adulthood as well. The body carries out an immune response that destroys pancreatic B cells, therefore the body does not synthesize insulin. Insulin levels eventually drop to zero and the body no longer produces the hormone (Rosenthal & Burchum, 2021). Type 2 Type 2 is more prevalent than type 1. It can occur at any age but typically develops in adulthood and keeps progressing. It is characterized by insulin resistance and impaired secretion of insulin. So unlike type 1, type 2 is still able to synthesize insulin but the release is delayed and it does not bind properly to receptors, so ultimately it is not used by the body how it should be (Rosenthal & Burchum, 2021). Gestational The gestational form is developing diabetes while pregnant, but then it resolves postpartum. The placenta Discussion Diabetes and Drug Treatments NURS 6521 produces certain hormones that affect the actions of insulin, cortisol production increases, and glucose passes between mother and fetus freely (Rosenthal & Burchum, 2021). Every year, almost 10 percent of pregnancies are affected by gestational diabetes in the United States (American Diabetes Association, n.d.). Type 2 Diabetes & Insulin Therapy The main goal of treating type 2 diabetes is preventing long-term complications. In order to do this, it is important to follow a healthy diet and lifestyle, as well as comply with any needed medication management. One form of insulin used to treat type 2 is insulin lispro, or Humalog. This is a rapid-acting insulin with a short duration time. It is known as an insulin analog because it has been modified for further benefits (Singh et al., 2009). Humalog is given by subcutaneous injection preferably right before meals but also can be given immediately after a meal because of its rapid onset of 15 – 30 minutes (Rosenthal & Burchum, 2021). Long-term Effects If left untreated or not properly maintained, diabetes can lead to several other comorbidities such as heart disease, stroke, renal failure, retinopathy, neuropathy, amputations, and others. Patients using insulin should be made aware of the signs, symptoms, and dangers of hypoglycemia (Rosenthal & Burchum, 2021). References American Diabetes Association. (n.d.). Diabetes overview. https://diabetes.org/diabetes 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. Singh, S., Ahmad, F., Lal, A., Yu, C., Bai, Z., & Bennett, H. (2009). Efficacy and safety of insulin analogues for the management of diabetes mellitus: A meta-analysis. Canadian Medical Association Journal, 180(4), 385-397. 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. Click here to ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Diabetes and Drug Treatments NURS 6521 For this Discussion Discussion: Diabetes and Drug Treatments NURS 6521, 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 group of metabolic diseases that results in hyperglycemia. It is caused by defects in insulin secretion, action, or both (McCance & Huether, 2019). DM is one of the leading causes of death. Diabetes is classified into four categories: type 1, type 2, gestational, and a genetic defect type of diabetes known as maturity-onset diabetes of youth. The focus of this post is on gestational diabetes and treatment with insulin. The two most common types of DM are type 1 and type 2. Type 1 diabetes, also called juvenile diabetes, is absolute insulin deficiency from the destruction of beta-cells via cellular-mediated autoimmune destruction in many cases but may also be idiopathic. Individuals with type 1 diabetes are prone to ketoacidosis, have little to no insulin secretion, and are insulin dependent with specific diagnoses under 30 years of age. Type 2 diabetes differs from type 1 because it is a progressive loss of b-cell function with insulin resistance. Type 2 diabetics are not typically insulin-dependent, but insulin-requiring is not ketosis-prone and is commonly diagnosed in individuals older than 40. It is associated with hypertension and dyslipidemia, and there is a strong genetic predisposition (McCance & Huether, 2019). A more uncommon form of diabetes is maturity-onset diabetes of youth (MODY). This commonly is presented in younger individuals that result from genetic abnormalities that decrease the function of b-cells (McCance & Huether, 2019). Six specific autosomal dominant mutations are associated with MODY, accounting for less than 5% of patients with DM (Hoffman & Anastasopoulou, 2022). The treatment depends on which gene mutation is present but is the same as type 1 and 2 diabetes. Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with an onset during pregnancy, with an incidence of approximately 7% (McCance & Huether, 2019). It is caused by insulin resistance and inadequate insulin secretion, leading to hyperglycemia. Commonly, these individuals are first discovering that they are type 1 or 2 diabetics (McCance & Huether, 2019). The treatment that this post will focus on is insulin, specifically short-acting. The goal of treatment is to maintain glucose levels no higher than the upper limit of the target range while avoiding hypoglycemic episodes. Tight metabolic control of blood glucose levels has no benefits in GDM and increases the risk for growth restriction (Durnwald, n.d.). Patient self-monitoring at least four times a day, fasting and postprandial, and as needed, is required with titration of insulin dosage. Administering insulin is a subcutaneous syringe titrating on a scale according to current blood sugar and patient weight. It is vital to verify insulin concentrations and units of measure on the syringe to ensure no under or overdosing. Insulin therapy is associated with better outcomes for fetal overgrowth but can also lead to hypoglycemia. Considerations with insulin pharmacotherapy about diet are more focused on blood glucose control. Initial treatment for GDM is dietary modifications followed by pharmacotherapy if glucose levels are not controlled. A diet with emphasis on elimination or reduction of sugar intake, restricting carbohydrate intake, and a meal plan of small to moderate frequent meals and snacks (Durnwald, n.d.). References American Diabetes Association. (2017). 8. pharmacologic approaches to glycemic treatment: standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement_1). https://doi.org/10.2337/dc18-s008 Durnwald, C. (n.d.). Gestational diabetes mellitus: Glucose management and maternal prognosis. UpToDate. Retrieved December 31, 2022, from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis Hoffman, L. S., & Anastasopoulou, C. (2022). Maturity onset diabetes in the young – statpearls – NCBI bookshelf. Retrieved December 31, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK532900/ McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier. Module 4 Week 5 In this week’s discussion, we are to reflect on differences between types of diabetes. Then, we are to select one type of diabetes to focus on and consider one type of drug used to treat the type of diabetes we selected including proper preparation and administration of this drug. Then we are to reflect on dietary considerations related to treatment. Finally, we are to think about the short-term and long-term impact of the diabetes selected, including effects of drug treatments. Type I diabetes (or juvenile diabetes) is the most common pediatric disease and is usually diagnosed from infancy to the late 30’s (McCance & Huether, 2019). There are two types: Autoimmune and Nonautoimmune. In this type of diabetes, a beta cells in the pancreas are destroyed. Symptoms for diagnosis are polydipsia, polyuria, polyphagia, weight loss, and hyperglycemia, and intermittent DKA. The patient is insulin dependent. Type II diabetes usually affects those people over 40. Insulin resistance and obesity is associated with type II diabetes. The pancreas cannot use the insulin produced properly, and there is a reduction in beta cell mass and function (McCance & Huether, 2019). The cells become resistant to insulin, making an excess of insulin than is necessary to keep blood glucose levels within a normal range. The symptoms are obesity, dyslipidemia, and hypertension. The patient experiences polyuria and polydipsia. There are also recurrent infections, genital pruritus, visual changes, paresthesia, fatigue, and acanthosis nigricans. The patient is not usually insulin dependent, but may require insulin. Gestational diabetes occurs during pregnancy. There is insulin resistance and inadequate insulin secretion. It is most likely to occur in women who are obese, 25-years-old, have a family history of diabetes, have a history of gestational diabetes, or are of Native American, Asian, or black (these ethnic groups have a higher incidence rate of gestational diabetes (McCance & Huether). For this discussion I am focusing on type II diabetes mellitus. Those with this type of diabetes have a mortality rate twice that of the general population. Complications from this type of diabetes are myocardial infarction, stroke, nephropathy, retinopathy, and peripheral arterial disease and neuropathy resulting in amputation (Laursen et. al., 2017). One of the drugs used to treat this type of diabetes is in a class of drugs called biguanide named Metformin. This drug decreases glucose production by the liver, reduces glucose absorption in the gut, and sensitizes insulin receptors in fat and skeletal muscle. Metformin is slowly absorbed from the small intestine, and is excreted unchanged by the kidneys. If there is renal impairment, it can produce toxic levels (Rosenthal & Burchum, 2021). It can be used alone, or with insulin. Importantly, it can be used for patients who skip meals because it does not lower blood glucose. It can be taken during pregnancy. Common side effects are decreased appetite, nausea, and diarrhea. Metformin decreases absorption of vitamin B12 and folic acid, thus causing vitamin B and folic acid deficiencies. It does not cause weight gain. It is important to eat healthy meals while taking Metformin, and not skip meals. Metformin can cause lactic acidosis. Initial dosing is immediate release 850-1000 mg daily or extended release 500 mg nightly. References Laursen, D., Christenssen, K., Christensen, U., & Frolich, A. (2017). Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnare (HeiQ). BMC Research Notes 10(213). https://doi10.1186/s13104-017-2536-6 McCance, L.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier. 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. 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! Discussion: Diabetes and Drug Treatments NURS 6521 The World Health Organization defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces (American Diabetes Association, 2022 ). Insulin is a hormone that regulates blood glucose. The number of people being diagnosed with diabetes continues to raise as the Centers for Disease Control report released in 2018 showed that 7.3 million Americans, or 11.3% of the population. There are several types of diabetes with the most common including type 1 diabetes, type 2 diabetes, juvenile, and gestational diabetes. These types differ from each other significantly hence this makes it easy for physicians to make correct diagnoses. Type 1 diabetes Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in your pancreas that produce insulin. The damage is permanent. According to the ICD-10, Type 1 diabetes diagnostic criteria include unexplained weight loss, excessive production of urine, experiencing excess thirst, increased appetite, tiredness, and blurry vision as well as mood changes. If the condition is left untreated, it can lead to heart damage, kidney damage, eye damage, foot damage, nerve damage, and oral infections. According to American Diabetes Association, the American diagnostic criteria for type 1 diabetes includes a 2-hour plasma glucose level ≥200 mg/dL (11.1 mmol/L) or during a 75 oral glucose tolerance test (OGTT). Type 2 diabetes Type 2 diabetes starts out as insulin resistance. This means your body cannot use insulin efficiently, which causes your pancreas to produce more insulin until it cannot keep up with demand. Insulin production then decreases, which causes high blood sugar. The body is impaired in how it regulates insulin and in the long term, there is a higher presence of sugar in the bloodstream. The symptoms of type 2 diabetes are increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, unexplained weight loss, numbness or tingling in the hands, and areas of darkened skin, usually in the armpits and neck. If not treated it can lead to kidney damage, eye damage, hearing impairment, sleep apnea, and dementia (DeFronzo et al., 2015). Type 1 diabetes is characterized by the inability of the body to produce enough insulin, the type 2 diabetes is characterized by the inability of the body to utilize insulin hence having high sugar in the blood. Gestational diabetes This type of diabetes occurs during pregnancy when insulin-blocking hormones are produced. Gestational diabetes occurs only in people who have preexisting diabetes or have family members who have been diagnosed with the condition. It affects how cells utilize insulin leading to high levels of blood sugar. Pregnancy influences the body significantly and these changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin. Gestational diabetes can go unnoticed as it has limited symptoms only frequent urination and increased th
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