NURS 6521 Discussion: Diabetes and Drug Treatments Walden -

Sample Answer for NURS 6521 Discussion: Diabetes and Drug Treatments Walden 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!

Students will:

Differentiate types of diabetes
Evaluate the impact of diabetes drugs on patients
NURS 6521 Discussion Diabetes and Drug Treatments Walden
Evaluate alternative drug treatments and patient education strategies for diabetes management

A Sample Answer For the Assignment: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

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).

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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)

Conclusion

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

References

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

A Sample Answer 2 For the Assignment: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Type 1 diabetes, previously known as juvenile diabetes or insulin-dependent diabetes mellitus (IDDM) is a chronic condition in which the pancreas produce little or no insulin. The reason is the body’s own immune system mistakenly destroys the insulin- producing (islets of Langerhans) beta cells in the pancreas. These symptoms can go on for months or years before any symptoms appear. Type 1 diabetics will need to take insulin for the rest of their lives.

Type 2 diabetes previously known as adult/late onset diabetes or non-insulin dependent diabetes mellitus (NIDDM). In this disease process, the pancreas still makes insulin, but the cells cannot use insulin efficiently; therefore, glucose builds up in the blood. This is referred to as insulin resistance. The pancreas works increasingly hard to release enough insulin to overcome the body’s resistance and keep blood sugar levels down. Over time, the pancreas’ ability to release insulin begins to decrease, which leads to the development of type 2 diabetes.

Gestational diabetes is developed during pregnancy. It is typically seen in pregnant women who did not have diabetes before getting pregnant. Between 2% to 10% of pregnancies in the U.S. are affected by gestational diabetes every year. Testing is completed between 24 and 28 weeks pregnant.

Type 1 diabetes accounts for approximately 5% of all diabetes cases. The onset of age is usually childhood and adolescence, without family history. The etiology is an autoimmune process which then destroys the pancreatic beta cells (Copenhave, 2017). The symptoms are polyuria, polydipsia, polyphagia, and weight loss. Daily dosing of insulin is the cornerstone to the management of type 1 diabetes. Insulin can be delivered via syringes or pens, inhaled, pumps or new artificial pancreas systems. Though the administration method, frequency and type of insulin dosage vary on a case-by-case basis, injections may be needed multiple times per day. In addition to managing diabetes, there is also a strong recommendation to manage hypertension and dyslipidemia. In doing so, it can also manage the diabetes.

Recommendations from the American Diabetes Association (ADA) for youth with type 1 diabetes incorporate specific guidelines for glycemic control, and management of lipids, blood pressure and weight to support healthful growth and development and prevent chronic complications. The ADA recommendations for nutrition therapy for diabetes emphasize predominantly plant-based forms of carbohydrate (CHO) from fruits, vegetables, whole grains, and legumes along with low fat milk to minimize saturated fat (SFA) and added sugar (Summer, 2019). The short-term impact of diabetes is the signs and symptoms such as polyuria, polydipsia, ketonuria and weight loss. Over time, hyperglycemia can lead to heart disease, renal failure, blindness, neuropathy, amputations, impotence, and stroke. Some complications of insulin is that it can cause hypoglycemia; blood glucose less than 70 mg/dL. A major cause of insulin excess is overdose. Imbalance between insulin levels and insulin needs can also result from reduced intake of food, vomiting and diarrhea (which reduce absorption of nutrients), alcohol consumption (which promotes hypoglycemia), and childbirth (which reduces insulin requirements) ( Rosenthal, 2021, pg. 406).

Copenhaver, M., & Hoffman, R. P. (2017). Type 1 diabetes: where are we in 2017?. Translational pediatrics, 6(4), 359–364. https://doi.org/10.21037/tp.2017.09.09

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

nurses and physician assistants (2^nd ed.) St. Louis, MO: Elsevier.

Summer, S. S., Couch, S. C., Shah, A. S., McNeill, M. P., & Peairs, A. D. (2019). Evaluating a dietary pattern in adolescents with type 1 diabetes mellitus: The dash-d approach. Diabetes management (London, England), 9(1), 28–38.

A Sample Answer 3 For the Assignment: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Another factor of Type 1 diabetes (T1D) is faulty or impaired glucagon production. Glucagon is a peptide hormone secreted from the alpha cells of the pancreatic islets of Langerhans in response to lower blood glucose levels. It acts by increasing hepatic glucose production, and affects overall energy homeostasis in times of limited energy supply by stimulating lipid and protein catabolism (Rix et al., 2019). One theory suggest that because T1D does not excrete endogenous insulin, then glucagon is not stimulated to respond in times of hypoglycemia. Thus, there can be large variance in T1D blood sugar levels and hypoglycemic events can be severe with rapid onset. Traditionally, patients with T1D, especially children and adolescents, are prescribed an emergency kit of Glucagon. Glucagon is a powdered substance requiring reconstitution with sterile water and is an intramuscular injection.

However, there is currently an intranasal application under investigation for the emergency treatment of hypoglycemia. Of the 24 intramuscular participants and 58 of the 59 intranasal doses produced a ≥25 mg/dL rise in glucose within 20 min of dosing. Times to peak plasma glucose and glucagon levels were similar with both routes of administration. Transient nausea, the most common side effect of Glucagon, occurred in 67% of intramuscular sessions versus 42% of intranasal sessions (P = 0.05) (Sherr et al., 2016, p. 556). The benefit of intranasal dosing could be increased response time and decreased pain to the receiver, because the injection must be mixed prior to administration.

References

Rix, I., Nexøe-Larsen, C., Bergmann, N., Lund, A., & Knop, F. (2019, July 16). Glucagon physiology. Medtext.com. Retrieved October 2, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK279127/

Sherr, J. L., Ruedy, K. J., Foster, N. C., Piché, C. A., Dulude, H., Rickels, M. R., Tamborlane, W., Bethin, K., DiMeglio, L. A., Fox, L. A., Wadwa, P., Schatz, D., Nathan, B., Marcovina, S. M., Rampakakis, E., Meng, L., & Beck, R. (2016). Glucagon nasal powder: a promising alternative to intramuscular glucagon in youth with Type 1 diabetes. Diabetes Care, 39(4), 555–562. Retrieved October 2, 2020, from https://doi.org/10.2337/dc15-1606

A Sample Answer 4 For the Assignment: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Thank you Gregorie for a concise and informative post on classification and the management of diabetes mellitus. I concur with you that IDDM culminates from the partial or complete failure by the beta cells Islets of Langerhans to produce insulin (McCance & Huether, 2019). Similarly, NIDDM results from insulin resistance and later a combination of insulin resistance and inadequacies in insulin production (Rosenthal & Burchum, 2017). As described in your discussion, the gestational diabetes as diabetes which occurs during pregnancy and subsides significantly after delivery (Rosenthal & Burchum, 2017). However, during the search of evidence on juvenile diabetes I found out that even though IDDM accounts for about 90% of the juvenile diabetes cases (McCance & Huether, 2019). As such, I believe the term juvenile diabetes should be reserved for all types of diabetes mellitus amongst children and young adults below the legal age. I also concur with your exploration on the use of insulin in the management of type 1 diabetes mellitus including the recommendations by the America Diabetes Association, as well as, the short-term and long-term effects of IDDM to the patients. It is worth noting that the severity of the effects of diabetes are directly proportionate to exposure of the body tissues to hyperglycemia (McCance & Huether, 2019). As such sustaining the blood sugar levels within the normal range alleviates or reduce the burden of diabetes. NURS 6521 Discussion: Diabetes and Drug Treatments Walden

References

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

Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book. Elsevier Health Sciences.

A Sample Answer 5 For the Assignment: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

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: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

Title: NURS 6521 Discussion: Diabetes and Drug Treatments Walden

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.