Discussion: Diabetes and Drug Treatments NURS 6521

Discussion: Diabetes and Drug Treatments NURS 6521

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Another treatment option for type 1 diabetes is insulin human inhalation powder (Afrezza).   It is a dry powder form of human insulin which is mixed with fumaryl diketopiprazine crystalizing the mixture into microparticles which are easily deliver into the alveolar fluid in the lungs (Heinemann & Parkin, 2018). The mixture is very water soluble making it easy for it to be absorbed into the systemic circulation via the alveolar barrier (Heinemann & Parkin, 2018). This delivery allows for faster onset of action and are short acting (Heinemann & Parkin, 2018). Given the mechanism of action use of inhaled insulin would be contraindicated in patient to with asthma or chronic lung disease (Heinemann & Parkin, 2018). 

Type I diabetes, which is a congenital condition linked to B-cell apoptosis, is one of the four types of diabetes. It is distinguished by the absence of insulin production by the pancreas in response to a person’s blood glucose levels. Because they are insulin-dependent, people with this type of diabetes must use artificial insulin as a form of treatment (Sapra & Bhandari, 2020). Second, there is a link between obesity, aging, and Type II diabetes. This type of diabetes is caused by an imbalance in insulin sensitivity and insulin levels (Sapra & Bhandari, 2020). Gestational diabetes is a type of diabetes that occurs in some pregnant women. The third condition is gestational diabetes, which is caused by glucose intolerance and results in hyperglycemia in pregnant women.

Each year, 1.5 million Americans are (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

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 , 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.

Read Also:

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.

destruction of the β-cells (Baynest, 2015).

Diabetes Type 2

According to Baynest (2015) this type of diabetes composes 80% to 90% of all cases of diabetes. It comprises of the individuals who have insulin resistance and relative deficiency of insulin (Isley & Molitch, 2005). According to a publication by CDC, the major risk factors for this type of diabetes which is also referred to as adult-onset diabetes mellitus include obesity, old age, impaired tolerance of glucose, family history of diabetes and physical inactivity.

Gestational diabetes

This type of diabetes is characterized by the accumulation of glucose levels in the bloodstream during pregnancy. According to the American Diabetes Association (2015), patients with gestational diabetes may not be diabetic and may have no prior history.  This type of diabetes occurs in about 4% of the pregnancies (Baynest, 2015). Women at risk of getting this type of diabetes include those with a prior history of gestational diabetes in the family, those with history of big babies and with history of miscarriages or stillbirths (CDC, 2017).

Drug Medication for Gestational Diabetes

The gestational diabetes can be treated using the glucose regulatory measures such as dietary therapy as well as physical exercise therapy. However, if these measures are not able to bring down the glucose levels in the woman, other medications are put in place for instance the use of insulin therapy. The insulin therapy is recommended for pregnant women who have intolerable glucose concentration (Donovan & McIntyre, 2010). While using this form of medication, there is need to provide education to patients concerning the dosage and how to inject themselves. According to Donovan & McIntyre (2010), the treatment is individualized depending on the concentrations of the glucose in the person’s blood.

For patients with higher body mass index, higher doses are prescribed. The dose starts at 4-6 units and can be increased 2-4 units until the glucose concentration targets are met (Donovan & McIntyre, 2010). As the pregnant woman takes the insulin therapy, it is accompanied by diet therapy depending on their concentration of glucose in the bloodstream (Donovan & McIntyre, 2010). The patients are required to perform regular check-ups with the physician to ensure that their progress is monitored.

Impact of Gestation Diabetes and Insulin therapy on patients

It is important to note that insulin therapy cannot be used for pregnant women who are insulin resistant and therefore other treatment such as use of metformin drug can be recommended to balance their glucose concentration (Donovan & McIntyre, 2010).As an Advanced Nurse Practitioner, I will use Metformin also known as Glucophage to treat my patient with Gestational Diabetes except that this drug of choice is contraindicated for the patient. The reason I will chose this drug is because, Metformin helps to reduce blood sugar with little or no hypoglycemic reaction( Arcangelo & Peterson, 2017).Metformin also has been effective in stabilizing and reducing body weight especially patient’s with Gestational diabetes( American Diabetes Association, 2015).Before prescribing this medication to my patient, it is imperative to make sure the patient is not alcoholic, has no renal, kidney or liver impairment, has no cardiovascular abnormalities and since the patient is pregnant, make sure it is not contraindicated (Arcangelo & Peterson, 2017).It is recommended to begin therapy with a small dose which is usually 500 mg twice daily, then increase the dose weekly based on the patient’s condition to the maximum effect of 2,550 mg a day.(Arcangelo & Peterson, 2017).It is very important to educate the patient that Metformin should be taken whole  with food or meal to avoid gastrointestinal effects.

The gestational diabetes is responsible for 4-6% of all birth complexes experienced which is equivalent to 200,000 birth complexities (American Diabetes Association, 2009; Bortolon et al., 2016). If left untreated, the gestation diabetes is capable of advancing to the child and affects their glucose or sugar concentration. There is also a higher chance of developing Type 2 diabetes from gestation diabetes if the sugar levels are not contained (Bortolon et al., 2016; Donovan & McIntyre, 2010). During medication using insulin therapy, there is likelihood of developing insulin resistance during the 32-38week of treatment (Donovan & McIntyre, 2010). Bortolon et al. (2016), indicates that two thirds of patient with gestational diabetes will develop the condition again, and 20% will have impaired glucose tolerance. Patients should be encouraged to eat healthily, be compliant with their prescribed medications to keep blood glucose under control and prevent more complications (Bortolon et al., 2016; Donovan & McIntyre, 2010). During medication using insulin therapy, there is likelihood of developing insulin resistance during the 32-38week of treatment (Donovan & McIntyre, 2010). Bortolon et al. (2016), indicates that two thirds of patient with gestational diabetes will develop the condition again, and 20% will have impaired glucose tolerance. Patients should be encouraged to eat healthily, be compliant with their prescribed medications to keep blood glucose under control and prevent more complications

References

Arcangelo, V.P., & Peter A.M.(Eds.) (2013). Pharmacotherapeutics for advanced practice: practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins

American Diabetes Association. (2009). Diagnosis and Classification of Diabetes

Mellitus. Diabetes Care, 33(Supplement_1), S62-S69. http://dx.doi.org/10.2337/dc10s062

Baynest, H. (2015). Classification, Pathophysiology, Diagnosis and Management of Diabetes

Mellitus. Journal Of Diabetes & Metabolism, 06(05). http://dx.doi.org/10.4172/2155-

6156.1000541

Bortolon, L., de Paula Leão Triz, L., de Souza Faustino, B., de Sá, L., Rocha, D., & Arbex, A. (2016). Gestational Diabetes Mellitus: New Diagnostic Criteria. Open Journal Of

Endocrine And Metabolic Diseases, 06(01), 13-19. http://dx.doi.org/10.4236/ojemd.2016.61003

CDC. (2017). Diabetes: What Is It? (pp. 1-2). Center for Disease Control and Prevention.

Retrieved from https://www.cdc.gov/diabetes/diabetesatwork/pdfs/diabeteswhatisit.pdf

Donovan, P., & McIntyre, H. (2010). Drugs for gestational diabetes. Australian

Prescriber, 33(5), 141-144. http://dx.doi.org/10.18773/austprescr.2010.066

Isley, W., & Molitch, M. (2005). Type 1 Diabetes. The Journal of Clinical Endocrinology &

Metabolism, 90(1), 0-0. http://dx.doi.org/10.1210/jcem.90.1.9996

Jaacks, L., Siegel, K., Gujral, U., & Narayan, K. (2016). Type 2 diabetes: A 21st century epidemic. Best Practice & Research Clinical Endocrinology & Metabolism, 30(3), 331-

343. http://dx.doi.org/10.1016/j.beem.2016.05.003

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

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?

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

The endocrine system consists of eight major glands located throughout the body that influence growth and development, metabolism, sexual function, and mood (National Institutes of Health). Hypothyroidism, diabetes, and Hashimoto’s disease are some of the most common endocrine disorders. Not surprisingly, treating one endocrine disorder may have an impact on other body systems or functions. Treating patients with endocrine disorders as an advanced practice nurse necessitates a thorough understanding of the endocrine system’s structure and function. Furthermore, a thorough understanding of patient factors and behaviors will aid in developing the best drug therapy plans for your patients. Some of the most common endocrine disorders are as follows:

This week, you distinguish between types of diabetes and investigate the effects of diabetes medications on patients. You also assess alternative diabetes treatment options and patient education strategies.

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from

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)
Week 5 Discussion

Week Five Forum Initial Post

Treatment involves testing blood glucose regularly and administering insulin. According to the American Diabetes Association,  the different forms of insulin are Rapid-acting insulin,  which has an onset of 15 minutes after injection and reaches its peak within 1 hour with a duration of up to 4 hours. Regular or short-acting insulin works within 30 minutes after injection and peaks within 2 to 3 hours. Its duration is within 3 to 6 hours. Intermediate-acting insulin starts lowering blood glucose are 2 to 4 hours after injection, and peaks within 4 to 12 hours. It stays in the system for up to 12 to 18 hours. Long-acting insulin takes a longer time to saturate the blood with insulin after its injected. This insulin allows for blood glucose to work in the body for an extended period of up to 24 hours (American Associaiton, 2020). People with Type 1 diabetes can no longer produce insulin on their own. They need to maintain their blood glucose as close to near normal as possible; this is insulin therapy’s goal.

Reference:

American Associaiton, D. (Ed.). (2020). Medication Management. American Diabetes Association. .     org/diabetes/medication-management.

Baz, B., Riveline, J.-P., & Gautier, J.-F. (2016). ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects. European Journal of Endocrinology, 174(2), R-43-R-51. https://doi.org/10.1530/eje-15-0378

Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017, March). Type 1 Diabetes – A Clinical Perspective. Point of care. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5606981/.

Sapra, A. (2020, June 7). Diabetes Mellitus. https://www.ncbi.nlm.nih.gov/books/NBK551501/.

RE: Week 5 Discussion

Christien, thank you for highlighting diabetes type 1 in your discussion post. As you mentioned the treatment of short acting, intermediate-acting, and long acting insulin along with close blood glucose monitoring is imperative to maintaining the patient’s health and avoiding long term organ damage. One-way glycemic control is safely reached in young patients with newly diagnosed diabetes type 1 is via an insulin pump that provides continuous subcutaneous insulin infusion, which in some cases is more effective than traditional injections multiple times a day (Pickup, 2018). Katsarous et al., 2017, explain prior to the creation of insulin in 1922 the outcome of diabetes type 1 was death. Today, patients with diabetes have a shorter life expectancy due to increased risk of cardiovascular diseases. Short term consequences of diabetes include diabetic ketoacidosis, which can lead to cerebral edema and pituitary insufficiency (Katsarous et al., 2017).

As nurse practitioners it will be important to know not only what medications to prescribe for the treatment of diabetes type 1, but also the barriers our patients face when attempting to obtain lifesaving medications. Rosenthal and Burchum, 2021, explain the cost of treatment for diabetes type one can cost anywhere from $1700 to $5800 a year (Rosenthal and Burchum, 2021). Staying up to date on the latest treatment options and services is imperative to getting patients lifesaving insulin.

Resources

Katsarou, A., Gudbjornsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson B.,

Jacobsen, L., Schatz, D., Lernmark, A. (2017) Type 1 diabetes mellitus. Nature reviews disease primers, 3(17016), 1-17. https://www.researchgate.net/profile/Ake_Lernmark/publication/315903949_Type_1_diabetes_mellitus/links/5eaecf4645851592d6b53257/Type-1-diabetes-mellitus.pdf

Pickup, J.C. (2018). Is insulin pump therapy effective in type 1 diabetes. Diabetic Medicine, 36,

269-278. https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.13793

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice

nurses and physician assistants (2nd ed.)

Main Discussion – Week 5

  Main Discussion Post

Diabetes is a term used for an endocrine disorder leading to abnormal blood glucose levels. Oftentimes patients report having diabetes without specifying which type. As providers, the patients recount of the onset and medication taken can reveal the type of diabetes the patient presents with if no other information is provided. Type 1 diabetes occurs when there is a deficiency in the bodies insulin production while in type 2 diabetes the disfunction is the bodies target tissue resistance to insulin. Type 1 diabetes can have an onset in childhood and is then referred to as juvenile diabetes. Gestational diabetes manifests when the hormones produced by the placenta antagonize the action of insulin along with the bodies enhanced production of cortisol and hormones that promote hyperglycemia. Type 2 diabetes is commonly treated with oral medications such as Glucophage (metformin) (McCance & Huether, 2019).

Glucophage (metformin) is a drug classed as biguanides and although the mechanism of action is not clear in all texts, it mainly works by lowering hepatic glucose production and increases tissue response to insulin. This drug is commonly prescribed as a first line therapy with for Type 2 diabetes upon diagnosis (Rosenthal & Burchum, 2021). Glucophage (metformin) is available in oral tablets and dosages are often initiated as 500 mg twice daily. Dosage based on glucose control can increase by 500 mg at weekly intervals until 2000 mg a day is reached, in which case dosages should be divided into 3 administration times (Vallerand & Sanoski, 2017). Prescribed dosages may increase thereafter depending on patient presentation and other contributing comorbidities or lifestyle factors.

Common side effects include nausea, vomiting, diarrhea, and loss of appetite which may lead to weight loss. A less common side effect include Lactic acidosis, usually in patients with organ failure. Decreased absorption of Vitamin B12 and folate has been seen in long term therapy (Ramachandran, 2007). Furthermore, patient that are on Glucophage (metformin) drug therapy need to be  informed to stop the medication 48 hours prior to any surgeries or testing involving contrast dye. Renal impairment is a risk with any contrast administation and since Glucophage (metformin) is excreted mainly by the kidneys the risk of accumulation and toxicity may occur (King, 2004).

References

King, J. E. (2004). Why hold the metformin? Nursing34(7), 20. https://doi-org.ezp.waldenulibrary.org/10.1097/00152193-200407000-00018

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.).St. Louis, MO: Mosby/Elsevier

Ramachandran, A. (2007). Pharmacology recall. (2nd ed.). Philadelphia, PA: Lippincott

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Vallerand, A. H., & Sanoski, C. A. (2017). Davis’s drug guide for nurses. (15th ed.). Philadelphia, PA: F.A.

Davis

Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

(0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3
(0%) – 0 (0%)
(0%) – 0 (0%)
(0%) – 0 (0%)
Does not post by day 3
First Response
17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

15 (15%) – 16 (16%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

(0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues. .

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed. .

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

(0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Participation
(5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
(0%) – 0 (0%)
(0%) – 0 (0%)
(0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100

 

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