Diabetes And Drug Treatments Discussion

Diabetes And Drug Treatments Discussion

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Alternative drug management for diabetes

Oral and injectable treatment modalities are available for treating diabetes, the former aiming at stimulating the existing insulin and the later aim at introducing exogenous insulin in the body. Blaslov at el. (2018) describes the effective treatment of diabetes as complex and requiring a multitude of interventions for successful disease management, all people with type 1 diabetes have to inject insulin, while those with type 2 diabetes usually only need insulin if treatment with tablets doesn’t reduce their blood sugar levels enough. Two different types of insulin are available: human insulin and insulin analogues; combination of insulin with oral hypoglycemic can also be used if blood sugar can’t be lowered enough by using a single treatment modality.

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Insulin, according to Thota & Akbar (2021), is stored refrigerated to maintain its potency and injected using special insulin needles. Depending on the duration of action, insulin categorizes as rapid acting start their action in 5 to 15 minutes and peak in 30 minutes and duration of action is 3 to 5 hours, short-acting (regular insulin) starts the action in 30 to 40 minutes and peaks in 90 to 120 minutes and duration of action is 6 to 8 hours, intermediate-acting (NPH) start the action in 1 to 4 hours and peak in 4 to 8 hours given twice a day, and long-acting such as glargine and detemir, start action in 1 to 2 hours, given usually during the night time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day. Insulin acts by directly binding to its receptors on the plasma membranes of the cells that are abundant in hepatocyte and adipocytes, by binding it activates second messenger system that eventually causes the translocation of glucose transporters from the cytoplasm to the cell’s surface, allowing the influx of glucose from the blood into the cell, thus reducing the blood glucose levels. Insulin can cause side effect like profound hypoglycemia and patient need to be well educated on sites to inject and technique which if not well adhered to may result in decreased compliance.

Health Education Strategies

Lifelong treatment success is based on active involvement of patients in managing their own health. Zhang & Chu (2018) describe systematic health education as individual education not only during hospitalization but also extended care outside hospital, with an aim of supporting informed decision-making, problem-solving, active collaboration with the health education team, and self-care behaviors as well as to improve clinical outcomes, quality of life, and health status, the health education can be delivered as group session, telemedicine or one on one session. Diabetes And Drug Treatments Discussion

References

Thota S., & Akbar A. (2021). Insulin. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560688/

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. doi: 10.4239/wjd.v9.i12.209.

Zhang, Y., & Chu, L. (2018). Effectiveness of systematic health education model for type 2 diabetes patients. International journal of endocrinology, 2018.

Diabetes and Drug Treatments.

Alternative drug management for diabetes

Oral and injectable, treatment modalities are available for treating diabetes, the former aiming at stimulating the existing insulin and the later aim at introducing exogenous insulin in the body. Blaslov at el. (2018) describes the effective treatment of diabetes as complex and requiring a multitude of interventions for successful disease management, all people with type 1 diabetes have to inject insulin, while those with type 2 diabetes usually only need insulin if treatment with tablets doesn’t reduce their blood sugar levels enough. Two different types of insulin are available: human insulin and insulin analogues; combination of insulin with oral hypoglycaemic can also be used if blood sugar can’t be lowered enough by using a single treatment modality.

Insulin according to Thota at el. (2022). is stored refrigerated to maintain its potency and injected using special insulin needles. Depending on the duration of action, insulin categorizes as rapid acting start their action in 5 to 15 minutes and peak in 30 minutes and duration of action is 3 to 5 hours, Short-acting (regular insulin) starts the action in 30 to 40 minutes and peaks in 90 to 120 minutes and duration of action is 6 to 8 hours, intermediate-acting (NPH) start the action in 1 to 4 hours and peak in 4 to 8 hours given twice a day, and long-acting such as glargine and detemir, start action in 1 to 2 hours, given usually during the night time after meals. Their long duration of action helps in reducing the frequency of dosing throughout the day. Insulin acts by directly binding to its receptors on the plasma membranes of the cells that are abundant in hepatocyte and adipocytes, by binding it activates second messenger system that eventually causes the translocation of glucose transporters from the cytoplasm to the cell’s surface, allowing the influx of glucose from the blood into the cell, thus reducing the blood glucose levels. Insulin can cause side effect like profound hypoglycaemia and patient need to be well educated on sites to inject and technique which if not well adhered to may result in decreased compliance. Diabetes And Drug Treatments Discussion

Health education strategies

Lifelong treatment success is based on active involvement of patient in managing their own health; Yongwen at el. (2018)Diabetes And Drug Treatments Discussion. Describes systematic health education as individual education not only during hospitalization but also extended care outside hospital, with an aim of supporting informed decision-making, problem-solving, active collaboration with the health education team, and self-care behaviors as well as to improve clinical outcomes, quality of life, and health status, the health education can be delivered as group session, telemedicine or one on one session.

References

Thota S, Akbar A. Insulin. [Updated 2021 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560688/

Blaslov K, Naranđa FS, Kruljac I, Renar IP. Treatment approach to type 2 diabetes: Past, present and future. World J Diabetes. 2018 Dec 15;9(12):209-219. doi: 10.4239/wjd.v9.i12.209. PMID: 30588282; PMCID: PMC6304295

Yongwen , Zhang and Lanfang Chu. Effectiveness of Systematic Health Education Model for Type 2 Diabetes Patients nt J Endocrinol. 2018; 2018: 6530607.Published online 2018 Jul 25. doi: 10.1155/2018/6530607 PMCID: PMC6083492 PMID: 30147724

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Type of diabetes

Diabetes mellitus (DM) is a disease of inadequate control of blood glucose levels. Sapra at el. (2018). Describe it being either due to inadequate insulin production, ineffective insulin or both, with many sub-classifications, based on onset; type 1 presenting at childhood or adolescences, type 2 adulthood or maturity-onset, gestational diabetes, neonatal diabetes, and steroid-induced diabetes. Type 1 and 2 DM are the main subtypes, each with different pathophysiology, presentation, and management, but both have a potential for hyperglycaemia. Type 2 is the most common form of diabetes occurring due to pancreases’ inability to produce or use enough insulin. The body is still able to produce insulin but it does not use it properly, while gestation diabetes occurs due to increased glucose counter- regulatory hormones like cortisone, which is the same scenario with drug- induced diabetes where counter regulatory hormones are in excess and suppress the function of insulin resulting into hyperglycaemia. Diabetes And Drug Treatments Discussion

Alternative drug management for diabetes

Blaslov at el. (2018) describes the effective treatment of diabetes as complex and requiring a multitude of interventions for successful disease management. Oral and injectable, treatment modalities are available for treating diabetes, the former aiming at stimulating the existing insulin and the later aim at introducing exogenous insulin in the body, all people with type 1 diabetes have to inject insulin, while those with type 2 diabetes usually only need insulin if treatment with tablets doesn’t reduce their blood sugar levels enough. Two different types of insulin are available: human insulin and insulin analogues. Human insulin and insulin analogues work equally well in the treatment of type 2 diabetes; combination of insulin with oral hypogycaemic can also be used if blood sugar can’t be lowered enough by using a single treatment modality. Insulin needs to be refrigerated to maintain its potency and injected using special insulin needles, patient need to be well educated on sites to inject and technique.

Health education strategies

References

Sapra A, Bhandari P. Diabetes Mellitus. [Updated 2021 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551501/

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.

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Diabetes and Drug Treatments

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Types of Diabetes

Diabetes mellitus is a category of metabolic diseases characterized by hyperglycemia due to defects in insulin secretion, insulin action, or both (McCance & Huether, 2019). There are different types of diabetes. The main types are type 1, type 2, gestational and juvenile diabetes. Type 1 typically presents in childhood or adolescents. This occurs when the body produces little or no insulin (cdc.gov, 2022)Diabetes And Drug Treatments Discussion. Patients with type 1 require insulin injections. Type 2 diabetes generally develops with increased age, sedentary lifestyle, and obesity. This is the most common form of diabetes and typically occurs in adulthood. Elevated blood sugar levels result from the pancreases’ inability to produce or use enough insulin. The body is still able to produce insulin but it does not use it properly. The first line of treatment is generally diet and exercise with the majority of patients eventually needing oral medication for blood glucose control. Gestational diabetes refers to elevated blood sugar readings during pregnancy. This type will likely disappear after childbirth, but some patients may have had undiagnosed diabetes and found out during pregnancy. Monitoring after pregnancy is needed to determine is the patient is truly diabetic. Patients with gestational diabetes are at risk of developing type 2 diabetes. Juvenile diabetes is type 1 diabetes discovered in children.

Medication Treatment

Metformin is a common medication administered in type 2 diabetics. This is a biguanide medication that decreases glucose production by the liver and increases tissue response to insulin (Rosenthal & Burchum, 2021). It should be stored in the container it came in, at room temperature and away from light. This is the first line treatment immediately following the diagnosis of type 2 diabetes. The generic form comes in extended release and immediate release dosing. The initial dosing for immediate release is 850-1000 mg oral daily. The extended-release form is 500 mg oral every night. The most common side effect when beginning this medication is GI upset. It should be taken with meals to help reduce any nausea or vomiting. It should be swallowed with a full glass of water and should not be crushed, broken, or chewed to ensure proper absorption. It is often titrated in increments of 500mg or 850mg to decrease the risk of GI upset (nih.gov, 2022)Diabetes And Drug Treatments Discussion.

Dietary Considerations

There is no specific dietary restriction while taking the medication. Metformin delays and decreases the extent of the absorption of food (nih.gov, 2022). It can cause GI upset so it should be taken with food and water. There is an association with decreased Vitamin B12 levels so supplemental replacement may be necessary. Diet and exercise contribute to improved results. It can cause appetite suppression in response to GI side effects such as nausea and vomiting that can lead to weight loss (Rosenthal & Burchum, 2021).

Short-term and Long-term Impact

The short-term effects of type 2 diabetes include hypoglycemia and hyperosmolar hyperglycemic nonketotic syndrome (HHNKS). Hypoglycemia can occur when medications are taken to control blood sugar levels such as sulfonylureas. Exercise can be associated with decreasing the response of counter-regulatory hormones to hypoglycemia (McCance & Huether, 2019). HHNKS occurs due to insulin deficiency, an elevation of glucose levels, and fluid deficiency (McCance & Huether, 2019). Glycosuria and polyuria occur resulting in volume depletion, increased serum osmolarity, intracellular dehydration and electrolyte imbalance. Long-term effects include diabetic retinopathy, peripheral neuropathy, and cardiovascular disease. Long-term use of metformin may be associated with vitamin B12 deficiency so periodic B12 levels should be monitored (ADA, 2018). Metformin can cause lactic acidosis. In patients with renal failure, metformin can quickly accumulate to toxic levels (Rosenthal & Burchum, 2021)Diabetes And Drug Treatments Discussion. Patients with renal insufficiency should not use Metformin. Peripheral neuropathy can occur from long-term use of Metformin. For example, Metformin decreases the absorption of Vitamin B12 and folic acid. This deficiency thus contributes to peripheral neuropathy in patients taking the medication for long-term use.

References

American Diabetes Association; 8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018. Diabetes Care 1 January 2018; 41 (Supplement_1): S73–S85. https://doi.org/10.2337/dc18-S008

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Centers for Disease Control and Prevention. (2022, March 11). What is type 1 diabetes? Centers for Disease Control and Prevention. Retrieved June 27, 2022, from https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html

McCance, K. 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.

TF;, C. C. J. (n.d.). Metformin. National Center for Biotechnology Information. Retrieved June 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/30085525/ Diabetes And Drug Treatments Discussion

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