NURS 6521 Discussion: Diabetes and Drug Treatments Walden
Diabetes is a disorder of carbohydrate metabolism (Rosenthal & Burchum, 2021). There are different types of diabetes and they are managed in different ways. Some require the use of insulin while others can be prevented with change in diet and exercise, while others may only require an oral agent. Type 1 Diabetes is an autoimmune-mediated disease where your pancreas doesn’t make insulin or makes very little (Rosenthal & Burchum, 2021). There is a destruction of pancreatic beta cells which are responsible for insulin synthesis and the release of insulin into the blood stream (Rosenthal & Burchum, 2021). Insulin is a hormone that helps sugar enter he body so it can be used for energy. Without insulin the blood sugar can’t get into the cells and builds up in the bloodstream Type 1 diabetes is typically diagnosed in children, teens, and young adults but can develop and any age (Type 1 diabetes, 2021). Type 1 diabetes is also called juvenile diabetes (Type 1 diabetes, 2021).
In type 2 diabetes is the most prevalent of the different forms of diabetes. This is where the cells in your body do not respond correctly to insulin which causes insulin resistance (Type 2 diabetes, 2019). This causes your pancreas to make more insulin to get the cells to respond (Type 2 diabetes, 2019). Eventually it gets to a point where your pancreas can not produce enough to do its job and the blood sugar rises causing type 2 diabetes (Type 2 diabetes, 2019). There are three causes for insulin resistance: reduced binding of insulin to its receptors, reduced receptor numbers, and reduced receptor responsiveness (Rosenthal & Burchum, 2021). Hyperglycemia causes diminished pancreatic beta cell function and insulin production and secretion decline due to the beta cells working to hard (Rosenthal & Burchum, 2021).
Gestational Diabetes is found in women that did not have diabetes before pregnancy but develops it while pregnant (Gestational diabetes, 2020). One reason is that the placenta produces hormones that antagonize insulin’s actions (Rosenthal & Burchum, 2021). Another is the production of cortisol that promotes hyperglycemia (Rosenthal & Burchum, 2021). Lastly, hyperglycemia in the mother will stimulate excessive secretion of insulin in the fetus (Rosenthal & Burchum, 2021). Gestational diabetes subsides rapidly after delivery (Rosenthal & Burchum, 2021).
In the inpatient setting type 2 diabetes is found in the majority of patients seen on a medical surgical floor. This is where I want to focus when discussing medications. The medication that I would like to discuss is the long acting insulins. There are 2 specifically, Lantus and Levemir. I have worked at two different hospitals and one only gave Lantus and the other only Levemir. So it is important for myself to better understand the difference between the two.
Lantus is a modified human insulin that has a prolonged duration of action (Rosenthal & Burchum, 2021). The authors discuss it can be used to treat both type 1 and type 2 diabetes. They also mention that dosing can be given at any time of the day but should be given at the same time every day. When injected, if forms microprecipitates that slowly dissolve which releases insulin glargine in small amounts over an extended time (Rosenthal & Burchum, 2021). The authors mention that Lantus does not have a peak time and achieves blood levels that are relatively steady.
Levemir is a human insulin with a slow onset and dose-dependent duration of action (Rosenthal & Burchum, 2021). When given low doses the effects can last up to 12 hours, when given higher doses the effects can last up to 24 hours (Rosenthal & Burchum, 2021). Levemir peaks at 12-24 hours (Rosenthal & Burchum, 2021).
Both of these long acting insulins come in vial or pen format. They are both given subcutaneously. Most people take these medications at night time around/after dinner time.
When taking insulin it is important to monitor your blood glucose levels. Since you are not eating while you sleep, some people can wake up and be hypoglycemic which is when your blood sugar is less than 70mg/dL (Rosenthal & Burchum, 2021). It is important that if your glucose levels are low that you drink a cup of juice, take glucose tablets, eat sugar cubes, etc. If levels are too low Intravenous glucose might be given.
(2019). Type 2 diabetes. Centers for Disease Control and Prevention. CDC. Retrieved 20
June 2021, from https://www.cdc.gov/diabetes/basics/type2.html
(2020). Gestational diabetes and pregnancy. Centers for Disease Control and Prevention. CDC.
Retrieved 20 June 2021, from https://www.cdc.gov/pregnancy/diabetes-gestational.html
(2021). What is type 1 diabetes? Centers for Disease Control and Prevention. CDC. Retrieved 20
June 2021, from https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
The endocrine system is composed of eight major glands that regulate growth and development, metabolism, sexual function, and mood (National Institutes of Health). Hypothyroidism, diabetes, and Hashimoto’s disease are just a few of the most frequently diagnosed endocrine disorders. Not surprisingly, treating one endocrine disorder may have an effect on the functioning of other body systems. As an advanced practice nurse, treating patients who may have endocrine disorders requires a thorough understanding of the endocrine system’s structure and function. Additionally, a thorough understanding of patient factors and behaviors will aid in the development of the most effective drug therapy plans for your patients. Several of the most frequently diagnosed endocrine disorders include the following:
This week, you’ll learn about the different types of diabetes and the effects of diabetes medications on patients. Additionally, you evaluate alternative diabetes management strategies such as alternative drug treatments and patient education.
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
- Differentiate types of diabetes
- Evaluate the impact of diabetes drugs on patients
- Evaluate alternative drug treatments and patient education strategies for diabetes management
Discussion: Diabetes and Drug Treatments
Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images
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/
- 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!
Submission and Grading Information
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.
To go to the next week:
Gestational Diabetes Doud.S Main post
Main Post Doud.S
Types of Diabetes
Diabetes is commonly thought to be related to eating too many sweets and to be managed by avoiding sweets, but since the condition
is an issue of carbohydrate metabolism it is much more involved than managing sugary food intake. Each type of diabetes has the sign of sustained hyperglycemia without treatment, but the process and treatment of Type 1, Type 2, gestational and other causes of diabetes has some variance and particular considerations for treatment (Burchum, 2017). According to the American Diabetes Association (ADA) (2019), a basic breakdown of differences are as follows
- Type 1 diabetes is characterized by beta cell destruction in an autoimmune response resulting in the body’s ability to produce little to no insulin. (Known previously as juvenile diabetes.)
- Type 2 diabetes is characterized by a decrease in the beta cell secretion of insulin and increased resistance to insulin.
- Gestational diabetes is characterized by second and third trimester diagnosis of diabetes that was not apparent prior to pregnancy and resolves with birth.
- Other types of diabetes are due to a destructive process interfering with insulin production or processing and causing sustained hyperglycemia dependent on factors of the specific disease.
One Drug Used specific to one type of Diabetes
Gestational diabetes mellites (GDM) develops and resolves with pregnancy. According to McIntyre et al. (2019) GDM is the most common medical complication of pregnancy and increases risk factors for both mother and child for multiple long-term health conditions. While diet modification and increased physical activity are the ideal treatment for GDM, one drug used to manage the immediate pregnancy outcomes usually includes insulin (McIntyre et al., 2019).
Insulin does not cross the placenta, which makes it safe for the fetus while providing the glycemic control necessary for the mother, but can be concerning to the mother due to the increased burden of pregnancy related to the discomfort from needles, costs of treatment and episodes of hypoglycemia (McIntyre et al., 2019). Human insulin is given in multiple daily doses, according to blood glucose monitoring results, drawn up in a syringe and administered subcutaneously (ADA, 2019). NURS 6521 Discussion: Diabetes and Drug Treatments Walden
Dietary considerations related to treatment
Pharmacological treatment is initiated to manage GDM if hyperglycemia persists for more than one to two weeks after lifestyle interventions are initiated (McIntyre et al., 2019). Many patients are able to manage GDM with diet and exercise to avoid the necessity of pharmacological interventions and the related complications of poorly managed GDM (McIntyre et al., 2019). According to the ADA (2019) Glucose self-monitoring throughout day timed around meal with consideration to carbohydrate intake and activity is an aspect of pharmacological or diet-controlled management of GDM. Avoiding excessive weight gain is one aspect of lifestyle focused interventions.
Short term affects
The intensity of pharmacological treatment is determined by monitoring and measurement of the rate of fetal growth and is intended to prevent the short-term complications of GDM of fetal overgrowth and pregnancy complications (McIntyre et al., 2019). Complications of pregnancy reported by Johns et al. (2018) can include gestational hypertension, pre-eclampsia, polyhydramnios, Caesarean section, and shoulder dystocia creating an urgent need for diabetic management.
Long term affects
Johns et. Al (2018) reports a rate seven times higher for women that experienced GDM to develop Type 2 diabetes. Both maternal and offspring long term complications include development of Type 2 diabetes, obesity and cardiovascular disease (McIntyre et al., 2019)
Glycemic control is a cornerstone goal of diabetes management, but one type of diabetes may respond to a combination of treatment differently than another type of diabetes. Diabetes is a complex condition that is essential for the nurse practitioner to understand thoroughly and gain expertise in managing treatment and patient education. NURS 6521 Discussion: Diabetes and Drug Treatments Walden
American Diabetes Association. (2019). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes care, 42(Supplement 1), S13-S28. https://doi.org/10.2337/dc19-S002
Burchum, L.R. J. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Providers – E-Book. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9780323447799/
Johns, E. C., Denison, F. C., Norman, J. E., & Reynolds, R. M. (2018). Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends in Endocrinology & Metabolism, 29(11), 743-754. https://doi.org/10.1016/j.tem.2018.09.004
McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus (primer). Nature Reviews: Disease Primers,https://doi.org/10.1038/s41572-019-0098-8