Sample Answer for DIABETES AND DRUG TREATMENTS NURS 6521 Included After Question
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/
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
A Sample Answer For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: 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).
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.
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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.
A Sample Answer 2 For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: DIABETES AND DRUG TREATMENTS NURS 6521
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).
References
Heinemann, L., & Parkin, C. G. (2018). Rethinking the Viability and Utility of Inhaled
Insulin in Clinical Practice. Journal of Diabetes Research, 2018, 4568903.
https://doi.org/10.1155/2018/4568903
A Sample Answer 3 For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: DIABETES AND DRUG TREATMENTS NURS 6521
Thank you for your response. I am glad you brought Afreeza to the discussion board. I have heard of inhaled insulin and seen it in recommendations but have not explored it as an option for therapy. On reading about Afreeza I realize the reason we do not actually see it being used very often is because of cost which is prohibitive for most patients. I also noted that concerns associated with Afreeza include acute bronchospasm, throat and lung irritation, and hypoglycemia. I will ask the physicians and APRNs I work with what their thoughts are on Afreeza prescribing as it does seem like an option patients would like to have for diabetes management. Thanks again!
References
Mohanty, R. R., & Das, S. (2017). Inhaled Insulin – Current Direction of Insulin Research. Journal of clinical and diagnostic research : JCDR, 11(4), OE01–OE02. https://doi.org/10.7860/JCDR/2017/23626.9732
A Sample Answer 4 For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: DIABETES AND DRUG TREATMENTS NURS 6521
Great job on your discussion! It was very thorough and informative. I liked that you included information about Humalog (insulin lispro) and the different ways it is available and the methods it can be administered as well. I was wondering if you can expand on the cost-effective way it can be available for people who have no insurance or are limited on funds?
I would personally like to learn more about how we as health care providers can help those less fortunate in affording certain medications or treatments so that their health does not decline due to financial difficulties. Upon my research I have learned that the insulin pens although convenient, are more expensive than the vials. There are pros and cons to each of them for example the pens are about 40% more expensive than the vials but are more convenient, easier to store and transport. The pens are also less painful. With the pens the dosage can be more accurate for the doses smaller than five units. However, if a patient is needing more than one type of insulin they cannot be mixed in the pen (Rosenthal et al, 2021).
What are your thoughts on Pramlintide an amylin analog? It has been approved by the Food and Drug Administration (FDA) for use with type 1 diabetes mellitus (T1DM) patients (American Diabetes Association (ADA), 2018). It can help with weight loss as well as requires lower insulin doses.
Nonetheless, there are different options for those with diabetes and we must encourage them to learn about their best fit to prevent any complications. We should also encourage our patients to speak up on how they are feeling and what helps them feel better controlled of their diabetes. Again, great discussion Tracey!
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
Rosenthal, L.D., & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
A Sample Answer 5 For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: DIABETES AND DRUG TREATMENTS NURS 6521
Type 1 diabetes occurs from an autoimmune reaction that attacks the insulin-producing cells in the pancreas; creating a shortage of insulin (Kalathil et al., 2018). In type 2 diabetes, the body fails to produce enough insulin or produces insulin but cannot use it. Type 1 diabetes is related to genetics while type 2 is related to lifestyle factors (Wexler, 2022). Gestational diabetes refers to high glucose levels that occur for the first time during pregnancy (Tsakiridis et al., 2021). Gestational diabetes usually disappears after pregnancy. Finally, juvenile diabetes is type 1 diabetes that starts in childhood. The condition is chronic and insulin-dependent because the pancreas cannot produce or produces too little insulin.
Treatment of type 2 diabetes first takes the lifestyle and diet change approach to manage blood sugar. In cases where lifestyle medication has failed to control blood sugar, metformin is the first-line medication recommended for the treatment of type 2 diabetes (Association, American Diabetes, 2020). Metformin is an oral drug that comes in two forms, tablet and solution. For preparation, the medication is taken with meals with a full glass of water. It should not be crushed, chewed, or broken, but swallowed whole. The starting dose is 500 mg x2 daily (Association, American Diabetes, 2020). A diabetic diet is recommended alongside the pharmacological treatment for type 2 diabetes to help maintain normal blood sugar levels (Wexler, 2022). A typical diabetic diet has high amounts of whole foods, little refined sugar and grains, nonstarchy vegetables, and fruits.
Diabetes affects every aspect of a person’s life including social, psychological, and physical. Some of the short-term effects include increased hunger and thirst, confusion, sweating, seizures and health conditions such as hyperglycemia. The psychosocial effects include stress and anxiety and a negative impact on social life. In the long-term, diabetes has serious financial implications and health complications, for example, hypertension, kidney failure, vision problems, and diabetic foot ulcer among others (Association, American Diabetes, 2020). Metformin therapy can have side effects such as diarrhoea and other stomach problems, nausea, and a metallic taste.
References
Association, American Diabetes. (2020). Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2020. Diabetes Care, 43(Supplement_1): S98–S110. https://doi.org/10.2337/dc20-S009.
Kalathil, D., James, S., & Zaidi, R. (2018). Diagnosis and management of type 1 diabetes mellitus. Pharmaceutical Journal, https://pharmaceutical-journal.com/article/ld/diagnosis-and-management-of-type-1-diabetes-mellitus.
Tsakiridis, I., Giouleka, S., Mamopoulos, A., Kourtis, A., Athanasiadis, A., Filopoulou, D., & Dagklis, T. (2021). Diagnosis and Management of Gestational Diabetes Mellitus: An Overview of National and International Guidelines. Obstetrical & Gynecological Survey, 76(6)- 367-381. https://doi.10.1097/OGX.0000000000000899.
Wexler, D. J. (2022). Patient education: Type 2 diabetes: Overview . UpToDate, https://www.uptodate.com/contents/type-2-diabetes-overview-beyond-the-basics.
A Sample Answer 6 For the Assignment: DIABETES AND DRUG TREATMENTS NURS 6521
Title: DIABETES AND DRUG TREATMENTS NURS 6521
Diabetes mellitus is a group of metabolic diseases that manifest with hyperglycemia caused by defects in insulin secretion, insulin action, or both. Type 1 diabetes results from autoimmune destruction of pancreatic B cells (ADA, 2020). Type 2 diabetes is a progressive disorder characterized by increasing insulin resistance and diminishing insulin secretory capacity. It is frequently associated with obesity (ADA, 2020). Gestational diabetes refers to any level of glucose intolerance with onset or first recognition during pregnancy (ADA, 2020). Juvenile diabetes occurs in children. It is characterized by the body’s inability to produce insulin secondary to autoimmune destruction of the beta cells in the pancreas.
Glipizide is an antidiabetic drug, under the class of sulfonylureas, used to treat Type 2 diabetes. Its main effect is to increase insulin secretion from pancreatic beta cells. It also reduces the rate of hepatic glucose production and increases insulin receptor sensitivity (Correa et al., 2020). The recommended starting dosage of Glipizide is 5 mg/d, with up to 15 mg/d given as a single dose. However, when higher daily dosages are required, they should be divided and given before meals. The maximum recommended total daily dose is 40 mg/d. For maximum effect in reducing postprandial hyperglycemia, it should be ingested 30 minutes before breakfast because absorption is delayed when the drug is taken with food. (Correa et al., 2020) It is contraindicated in patients with significant hepatic or renal impairment because of a high risk for hypoglycemia.
The short-term impact of type 2 diabetes includes hypoglycemia, which is associated with sulfonylurea medications and missing meals. A patient may develop hyperosmolar hyperglycemic nonketotic syndrome, characterized by very high blood glucose (Papatheodorou et al., 2018). The long-term impact includes complications such as nephropathy, diabetic retinopathy, diabetic neuropathy, and macrovascular disorders (Papatheodorou et al., 2018). The complications occur due to high glycemic levels, which damage small blood vessels causing microvascular complications and large vessels causing macrovascular complications.
Ruth and Colleagues:
Metformin, a biguanide antihyperglycemic medication, lowers blood glucose in patients with type 2 diabetes with minimal risk of hypoglycemia. The most common side effects include diarrhea, nausea, and vomiting. Extended-release metformin (Glucophage XR) *, a once-daily tablet using the patented Gel Shield Diffusion System release mechanism, may be better tolerated than immediate-release metformin (Glucophage). This retrospective chart review examined the overall gastrointestinal (GI) tolerability of both formulations. In this retrospective chart review, patients switching from immediate-release metformin to metformin-XR experienced fewer GI side effects on comparable doses of extended-release metformin. Blonde, Dailey & Mills (2004)
Metformin-induced diarrhea developing in individuals starting the medication has been attributed to changes in the gut microbiome, increased intestinal glucose and bile acid turnover, and increased GLP-1 concentration. Diarrhea usually reduces with time or after dose reduction, which may be followed by gradual up-titration. Metformin-induced weight loss has been hypothesized to result from appetite-modulating effects in the central nervous system, reduction in leptin production from adipose tissues, reduced carbohydrate absorption from the gut, and increased GLP-1 levels. Both side effects most commonly occur either immediately after the introduction of the drug or after a delay of a few weeks. However, the patients in all three cases presented here were on stable doses of metformin for several years before these effects developed. Manoj & Lakshmi (2021)
Reference:
Blonde, L., Dailey, G. E., Jabbour, S. A., Reasner, C. A., & Mills, D. J. (2004). Gastrointestinal tolerability of extended-release metformin tablets compared to immediate-release metformin tablets: results of a retrospective cohort study. Current medical research and opinion, 20(4), 565–572. https://doi.org/10.1185/030079904125003278
SUBRAMANIAM, K., MANOJ, JOSEPH P., & LAKSHMI. BABU A., (2021). A Common Drug Causing a Common Side Effect at an Uncommon Time: Metformin-Induced Chronic Diarrhea and Weight Loss After Years of Treatment Clin Diabetes 2021;39(2):237–240 https://doi.org/10.2337/cd20-0101
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