Diabetes and Drug Treatments sample discussion essay

response

congratulations for a great writeup and allow me the opportunity to comment on a point you make. You chose metformin as a great drug to treat type 2 diabetes and I agree with you that it is a great drug that is a first-line drug treatment for type 2 DM. Metformin is strongly suggested to be highly effective in blood sugar control and body weight reduction. Not only is it associated with less weight gain, and fewer episodes of hypoglycemia compared to other oral hypoglycemics, it is also associated with a lower mortality (Alzuhairi et al., 2020). However, as you mention, it is beset with the troublesome side effect of lactic acidosis. Lactic acidosis is particularly concerning for people with impaired drug excretion such as people with chronic kidney disease.

In the US, the incidence of metformin-associated Lactic acidosis is 3.3-3.9 per 100,000 annually (Alzuhairi et al., 2020). The FDA previously recommended CKD as a contraindication to treatment with metformin but they have since removed this. However immediate recognition and treatment of lactic acidosis are critical due to its poor clinical outcome.

Reference

Alzuhairi, S. M. A., Almatrafi, S. K. F., Alenezi, O. M. L., Aljohani, A. G. A., Alanazi, A. O. Z., Darwish, R. M. A., … & Ayesh, H. N. B. (2020). METFORMIN ASSOCIATED LACTIC ACIDOSIS, OVERVIEW AND MANAGEMENT: A LITERATURE REVIEW. Pharmacophore, 11(6).

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.

Types of Diabetes 

Type 2 diabetes affects over 34 million Americans (2019). DM 2 is caused by an insulin deficiency where the pancreas cannot keep up with the glucose levels in the body. DM2 is commonly an older person disease however we are seeing an increase in younger patients. Type 2 diabetes is commonly found with routine lab work such as HGB A1C by primary physicians.  DM2 can be controlled with diet and exercise and usually treated with oral anti-diabetic medications or with insulin Injections of short and or long-acting insulin.  

Gestational diabetes mellitus is a condition in which carbohydrate intolerance develops during pregnancy (Dr. Grobman is from the Department of Obstetrics and Gynecology at the Feinberg School of Medicine, 2017). Gestational diabetes is increasing due to obesity and lack of exercise.  Gestational diabetes can be treated with diet and/ or medications. Gestational diabetes affects 10% of all pregnancies. 

I chose to review juvenile diabetes/ type 1. Type 1 diabetes is a chronic autoimmune disease characterized by insulin deficiency where beta cells are destroyed through the autoimmune response. Type 1/ juvenile diabetes can affect people of all ages, but most commonly in the younger ages.  Juvenile/ Type 1 diabetes is managed with insulin for hyperglycemia and glucagon as needed for Hypoglycemia.  Glucagon is a Antihypoglycemic agent; a biosynthetic (recombinant DNA-derived) form of human glucagon hormone (2020).  Glucagon can be administered SQ, IM, or IV. Many patients have glucagon syringes in home as needed for hypoglycemic episodes as intramuscular injections.  Glucagon should be used to treat hypoglycemic patients only if they are not unable to swallow safely, passed out or having a seizure. Glucagon is injected under the skin, into a muscle, or into a vein(2020).  Patients are Instructed on use of glucagon and caregiver education is provided to ensure safe administration and disposal of device.  

Diet is key in keeping a diabetic in proper glucose ranges.  The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates. The diet should include foods with complex carbohydrates and cellulose, such as whole-grain bread and legumes (Thomas R Moore, 2020). The patient needs to avoid simple carbohydrates such as soda, refined sugars.  The patient should concentrate on complex carbohydrates such as whole grains, vegetables. The Diabetes Plate Method is the easiest way to create healthy meals that can help manage blood sugar (Intechnic, 2020).  It is important to be sure the patient has an evening snack to help maintain blood sugar levels overnight. 

Short term effects of type 1 diabetes would be hypoglycemia, which is low blood glucose levels, usually below 70. Common symptoms include sweating, shaking, seizures and eventually coma.  Hyperglycemia, which is elevated blood sugars above normal can also be very dangerous complication for type 1 patients, symptoms include nausea, Kussmaul breathing patterns, fruity breath. Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. It occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic (2021).  Longterm effects of diabetes on the body include quite serious ailments.  The narrowing of blood vessels can lead to cardiac issues and blockages.  Diabetic neuropathy is a type of nerve damage that can affect balance and sensations in feet. Diabetic retinopathy can cause blurred vision or blindness, patients require yearly appointments to check their retina. Kidney issues occur and can lead to kidney failure requiring transplants or Dialysis.   

Long-term usage of insulins can carry risks as well.   Insulin use can cause an increase in body fat, and weight gain, increase the risk of localized skin irritation or fat necrosis.   Insulin doses will have to be titrated due to a tolerance of the medication.  There is also an increased risk of certain cancers, such as pancreatic cancer. All types of diabetes require consistency with diet, medications, activity and constant 

 monitoring to avoid further complications.  

References  

Centers for Disease Control and Prevention. (2019, May 30). Type 2 Diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/type2.html. 

Dr. Grobman is from the Department of Obstetrics and Gynecology at the Feinberg School of Medicine. (2017, July). Prediction Is Very Difficult, Especially if It Is About the … : Obstetrics & Gynecology. LWW. https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2017. 

Glucagon Information from Drugs.com. Drugs.com. (2020, September 23). https://www.drugs.com/glucagon.html. 

Intechnic, http://www.intechnic.com. (2020, February 1). What is the Diabetes Plate Method? Diabetes Food Hub. https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html#:~:text=The%20Diabetes%20Plate%20Method%20is,you%20need%20is%20a%20plate 

Thomas R Moore, M. D. (2020, July 30). Diabetes Mellitus and Pregnancy: Practice Essentials, Gestational Diabetes, Maternal-Fetal Metabolism in Normal Pregnancy. https://emedicine.medscape.com/article/127547-overview. 

U.S. National Library of Medicine. (2021, February). Diabetic ketoacidosis: MedlinePlus Medical Encyclopedia. MedlinePlus. https://medlineplus.gov/ency/article/000320.htm#:~:text=Diabetic%20ketoacidosis%20(DKA)%20is%20a,the%20blood%20to%20become%20acidic. 

sample response

I am on the PMHNP track. I have had the opportunity to work with one provider that routinely checked A1C, testosterone levels in men, and other hormones in his patients. He was one of the few psychiatrists that followed these hormones and routinely studied them. Most of the psychiatrists I worked with showed very little interest in these hormones. And did not see them playing a part in a patient’s mental health and overall well-being, most would be ordered standard labs and drug tests which were pertinent as most of the patients we encountered were substance abusers. But especially with men, low testosterone was related to depression and anxiety ( Walther, Breidenstein, & Miller, 2019).

On the topic of diabetes, both insufficient and overproduction can cause psychiatric issues. Hyperinsulinemia can cause the patient to feel panicky, exhausted, and irritable. A study that was completed in 2008 found that 20% of those diagnosed with diabetes also had anxiety issues. Those diagnosed with diabetes are 2 to 3 times more likely to suffer from depression. Antipsychotic medications have also been shown to increase blood glucose levels; the increase of insulin resistance has also demonstrated a correlation with schizophrenia. Elevated blood sugars on the onset of diabetes are also responsible for brain atrophy leading to dementia and memory loss (Clinics, 2020).

References

Clinics, A. (Ed.). (2020, March 12). This one hormone is linked to 7 psychiatric issues. Retrieved April 04, 2021, from https://www.amenclinics.com/blog/this-one-hormone-is-linked-to-7-psychiatric-issues/

Walther, A., PhD, Breidenstein, J., & Miller, R. (2019, January 01). Testosterone treatment and alleviation of depression in men. Retrieved April 04, 2021, from https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976