Diabetes and Drug Treatments NURS 6521

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Discussion: Diabetes and Drug Treatments NURS 6521

Diabetes and Drug Treatments NURS 6521

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.

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?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.

Looking Ahead: Midterm Exam

Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.

Next Week

To go to the next week:

Module 5

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Diabetes and Drug Treatments NURS 6521
Diabetes and Drug Treatments NURS 6521

Week 5: Endocrine System Disorders and the Treatment of Diabetes

The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include

This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from https://www.niddk.nih.gov/health-information/endocrine-diseases

Learning Objectives

Students will:

  • Differentiate types of diabetes
  • Evaluate the impact of diabetes drugs on patients
  • Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources

Required Readings (click to expand/reduce)

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

  • Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
  • Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

 

This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.

Document: Mid-Term Summary & Study Guide (PDF)

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Diabetes and Drug Treatments NURS 6521
Diabetes and Drug Treatments NURS 6521

Week 5 DiscussionCollapse

Week Five Forum Initial Post

The four distinct types of diabetes are Type I diabetes, which is associated with B-cell destruction; individuals are born with this form of diabetes. It is characterized by the absence of insulin being created by the pancreas to respond to an individual’s blood glucose.  People with this form of diabetes are insulin-dependent and require artificial insulin as a form of treatment (Sapra & Bhandari, 2020). Second, Type II diabetes is linked to obesity, aging,  comorbidities. This form of diabetes stems from an imbalance between insulin levels and insulin sensitivity (Sapra & Bhandari, 2020). During pregnancy, some women develop a temporary form of diabetes called gestational diabetes. The third is Gestational diabetes, which results from glucose intolerance; the outcome for pregnant women is hyperglycemia during pregnancy (Baz et al., 2016). The causative factor for this form of diabetes is an obstruction of hormones near the placenta. This blockage prevents insulin from doing its job in reducing blood glucose (Baz et al., 2016). The last of the four forms of diabetes is juvenile diabetes. With similar characteristics to Type I diabetes, there is an exception. Although it manifests in childhood, it can also occur randomly due to the absence of insulin stemming from the pancreas’ failure to produce insulin. When a child’s pancreas malfunctions in this manner, a child now has type 1 diabetes (Sapra & Bhandari, 2020).

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. https://www.diabetes.     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 DiscussionCollapse

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 Medicine36,

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 5COLLAPSE

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Diabetes and Drug Treatments NURS 6521
Diabetes and Drug Treatments NURS 6521

  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

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