NURS6521 Week 5 Discussion: Diabetes and Drug Treatments

Discussion: Diabetes and Drug Treatments

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!

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

Endocrine system Disorder, Diabetes Mellitus Example Approach

Diabetes mellitus (DM) is a disorder of the endocrine system that affects how the body uses glucose. The various diseases and the treatments. DM is a group of metabolic disorders where hyperglycemia is a distinctive factor. Patients with DM are often undiagnosed or under-diagnosed; they have an increased risk for evolving life-threatening diseases, incurring substantial medical costs, and a decreased quality of life. According to Brutsaert (2019), there are different types of DM such as type 1 DM, type 2 DM, and gestational diabetes. Endocrine disorders are common, and the advanced practitioner must be able to distinguish between the glucose levels in DM are abnormally high and the body is unable to make enough insulin to bring down the glucose levels. The purpose of this discussion is to compare DM type 1, type 2, and gestational diabetes while exploring the drug treatments and dietary considerations of gestational diabetes.

Comparison of Diabetes Mellitus Type 1, Type 2, and Gestational Diabetes:

DM type 1 is an autoimmune disease where the pancreas does not produce insulin (Saberzadeh-Ardestani et al., 2018). According to Brutsaert (2019), DM type 1 is usually diagnosed in childhood but can occur at any age. DM type 2 is the most common endocrine a disorder where the body is insulin resistance and is unable to produce enough insulin (Mihai, Lacatusu, Grigorescu, & Botnariu, 2015). According to Brutsaert (2019), DM type 2 is usually referred to as adult-onset diabetes and the body does not produce enough insulin to meet the body’s need resulting in elevated glucose levels. Gestational diabetes is a complication of pregnancy and results in hyperglycemia due to insulin sensitivity (Plows, Stanley, Baker, Reynolds, & Vickers, 2018). According to Friel (2019), during pregnancy, more insulin is needed due to the placenta releasing a hormone that causes the body to not respond to insulin resulting in gestational diabetes.

Gestational Diabetes Treatment:

The goal of treatment for gestational diabetes is to monitor blood glucose levels and keep the levels normal throughout pregnancy to ensure the health of the mother and fetus. According to Friel (2019), the initial treatment plan is monitoring diet and incorporating low impact exercise. If diet and exercise do not help bring down glucose levels, drug therapy should be started either with insulin or oral agents. Insulin was always the gold standard of treatment for gestational diabetes, but it has been found to cause increased weight in pregnant women or cause hypoglycemia which has led to the use of metformin (Sindu et al., 2018). According to Rosenthal & Burchum (2018), metformin is an acceptable alternative to insulin due to the treatment outcomes being the same.

Metformin:

Metformin mechanism of action is to reduce glucose levels by activating adenosine monophosphate-activated protein (AMP) a kinase (Sindu et al., 2018). According to Rosenthal and Burchum, 2018), metformin is absorbed slowly from the small intestine and not metabolized but rather excreted by kidneys. Metformin is available in immediate-release and extended-release forms and taken by mouth (Rosenthal & Burchum, 2018). The immediate-release is initially dosed as 500mg twice daily with breakfast and dinner whereas the extended-release is dosed 500mg daily with dinner (Rosenthal & Burchum, 2018).

Dietary Considerations:

The goal of treating gestational diabetes is to maintain normal blood glucose by initiating good nutrition (Sindu et al., 2018). The patient with gestational diabetes will be asked to measure their blood glucose several times a day an hour after eating so proper nutrition ensures better outcomes (Friel, 2019). The patient should start by decreasing carbohydrate intake is the first while eating small meals and snacks spread out throughout to maintain normal glucose levels.

Short-Term and Long-term Effects of Gestational Diabetes:

The short-term effect of gestational diabetes for the woman is the risk of developing pre-eclampsia and potential for a c- section (Sindu et al., 2018). The short-term effect on the fetus is macrosomia, shoulder dystocia, and hypoglycemia at birth (Sindu et al., 2018). The long-term effects on the mother are the potential of developing type 2 DM after delivery as well as gestational diabetes in future pregnancies (Friel, 2019). The fetus may be affected long term by gestational diabetes and be at risk for weight problems and diabetes later in life (Friel, 2019). According to the study conducted by Sindu et al. (2018), metformin has proven to decrease weight gain in pregnant women as well as a lower rate of preeclampsia.

Conclusion

The advanced practitioner must understand all the diabetic diseases and the treatment plans that will ensure the patient’s health is maintained. Each diabetic treatment is different; the approach to treatment remains to avoid medications when lifestyle changes can maintain healthy blood glucose levels. The long-term goal is to keep diabetes from affecting the rest of the body, improving the quality of life. Each medical treatment must be individualized to maintain the patient’s blood glucose levels, optimizing the medical regime, and reducing any potential side effects. Holistic treatment must factor in the psychological needs of the patient, monitoring for depression related to newly diagnosed diabetes.

References

Brutsaert, E. F. (2019). Diabetes mellitus (DM). Merck Manual. Retrieved from https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/diabetes-mellitus-dm

Friel, L. A. (2019). Diabetes during pregnancy. Merck Manual. Retrieved from https://www.merckmanuals.com/home/women-s-health-issues/pregnancy-complicated-by-disease/diabetes-during-pregnancy#v812497

Mihai, B., Lacatusu, C. M., Grigorescu, E., & Botnariu, G. E. (2015). Pathophysiology of type 2 diabetes: the long journey into present. Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 20(3), 294-301. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.1515/rjdnmd-2015-0027.

Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The pathophysiology of gestational diabetes mellitus. International Journal of Molecular Sciences, 19(11), 1-21. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.3390/ijms19113342.

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Saberzadeh-Ardestani, B., Karamzadeh, R., Basiri, M., Hajizadeh-Saffar, E., Farhadi, A., Shapiro, J., … Baharvand, H. (2018). Type 1 diabetes mellitus: cellular and molecular pathophysiology at a glance. Cell Journal, 20(3), 294-301. Retrieved from https://doi-org.ezp.waldenulibrary.org/10.22074/cellj.2018.5513.

Sindu J. Christian, Vincent Boama, Hiba Satti, Joohi Ramawat, Tarik A. Elhadd, Khaled Ashawesh, … Stephen Beer. (2018). Metformin or insulin: logical treatment in women with gestational diabetes in the Middle East, our experience. BMC Research Notes, (1), 1. https://doi-org.ezp.waldenulibrary.org/10.1186/s13104-018-3540-1.