Discussion: Diabetes and Drug Treatments NURS 6521

Discussion: Diabetes and Drug Treatments NURS 6521

The case study features a 43-year-old white male who complains of pain. When ambulating, he employs a set of clutches. The patient reports that his family doctor referred him for psychiatric evaluation after noticing that he was in psychological distress (Laureate Education, 2016). The pain started seven years ago when I fell and landed on my right hip. Four years ago, it was discovered that the cartilage surrounding the right hip joint was 75% torn. However, no surgeon was willing to perform a total hip replacement because they believed that tissue repair would occur over time (Laureate Education, 2016). He complains of severe cramping in his right limb. He was diagnosed with complex regional pain syndrome by a neurologist (CRPS). He admits to having bad moods but denies being depressed. He had been prescribed Hydrocone, but he used it in low doses due to drowsiness and constipation, and the drug does not effectively manage pain (Laureate Education, 2016). The mental health examination is unremarkable.

Decision Point One: Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.

Reason: Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al., 2015). I prescribed Savella to help in pain management and improve the overall mood.

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/

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).

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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.

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.

Diabetes mellitus is divided into four categories: type 1, type 2, gestational, and other specific kinds. Diabetes type 1 is caused by the loss of pancreatic beta cells and requires daily insulin administration. This is the result of an autoimmune or idiopathic reaction. Type 2 diabetes is the most prevalent kind, accounting for 90-95 percent of all diagnosed cases (Rosenthal & Burchum, 2021). Type 2 diabetes is typically caused by insulin resistance and improper insulin production. At one time, type 1 diabetes was referred to as juvenile-onset since it was believed to only affect young children. It is now recognized that type 1 can develop in adults, and type 2 is becoming increasingly prevalent in youngsters. Type 1 and type 2 diabetes share symptoms, but differ in their etiology, prevalence, treatments, and results (Rosenthal & Burchum, 2021). In gestational diabetes, the need for insulin increases physically throughout pregnancy. Increased maternal caloric intake, maternal weight gain, the presence of placental hormones such as placental growth hormone and placental lactogen, and increased prolactin and growth hormone synthesis all contribute to the rise in insulin requirement (Lende & Rijhsinghani, 2020). As the pregnancy progresses, the pancreatic beta cell mass rises to meet the increased demand for insulin. Failure of beta cell growth accompanied with a relatively insufficient increase in insulin secretion causes gestational diabetes ( McMcance & Heuther, 2019).

Insulin is the treatment of choice for gestational diabetes patients with hyperglycemia. Insulin is a big molecule that cannot pass through the placenta. Consider oral hypoglycemic medications for those who are unable to take insulin. Metformin is chosen over glyburide due to the potential for fetal hypoglycemia when glyburide is administered to the mother.
Typically, oral drugs are administered once or twice daily. Metformin and glyburide have been demonstrated to pass the placenta and enter the fetal circulation. Oral drugs have not been extensively evaluated.

They have not been evaluated for potential long-term implications on neonatal outcomes; consequently, they are not advised as the initial treatment for persistent hyperglycemia in individuals with gestational diabetes (Lende & Rijhsinghani, 2020).

Unawareness of hypoglycemia is a side effect of insulin therapy. When insulin levels exceed insulin requirements, hypoglycemia ensues. The more frequently a patient experiences hypoglycemia, the more gradually their symptoms diminish (Rosenthal & Burchum, 2021). Frequent glucose monitoring reduces the likelihood of this problem. When therapy is effective, both hyperglycemia and hyperinsulinemia are reduced, and the patient actively participates in his or her own therapy. To achieve optimal glucose control, insulin dosage must be closely matched to patient requirements (Rosenthal & Burchum, 2021).

References

Lende, M., & Rijhsinghani, A. (2020). Overview of Gestational Diabetes with an Emphasis on Medical Management. Volume 17 of the International Journal of Environmental Research and Public Health (24). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17249573

McCance, K. L., and S. E. Huether (2019). Pathophysiology: The biological underpinning of adult and child disease (8th ed.). The Elsevier Health Sciences journal.

Rosenthal, L., & Burchum, J. (2021). Advanced practice nurses and physician assistants use Lehne’s Pharmacotherapeutics (2nd ed.). The Elsevier Health Sciences journal.

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

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.

Next Week

To go to the next week:

Module 5

Module 5: Neurologic and Musculoskeletal Systems
What’s Happening This Module?
Module 5: Neurologic and Musculoskeletal Systems is a 2-week module, Weeks 6 and 7 of the course. In this module, you will analyze drugs prescribed to treat neurological and musculoskeletal disorders and explore patient education strategies for treatment and management of these disorders. You will also evaluate the impact of patient factors on the effects of prescribed drugs and drug therapy plans for neurologic and musculoskeletal disorders. You will also complete your Midterm Exam.

What do I have to do?
When do I have to do it?
Review your Learning Resources
Days 1-7, Weeks 6 and 7
Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders
You are encouraged to begin your Assignment in Week 6 and continue working on it in Week 7. However, this Assignment is not due until Day 7 of Week 8 in Module 6.
Midterm Exam
Complete by Day 7 of Week 7.
Go to the Week’s Content

Week 6

Week 7

Week 6: Neurologic and Musculoskeletal Disorders

Sabrina is a 26 year old female who has just been diagnosed with multiple sclerosis. She has scheduled an appointment for a follow up with her physician but has several questions about her diagnosis and is calling the Nurse Helpline for her hospital network. As she talks with the advanced practice nurse, she learns that her diagnosis also impacts her neurologic and musculoskeletal systems. Although multiple sclerosis is an autoimmune disorder, both the neurologic and musculoskeletal systems will be affected by adverse symptoms that Sabrina needs to be aware of and for which specific drug therapy plans and other treatment options need to be decided on.

As an advanced practice nurse, what types of drugs will best address potential neurologic and musculoskeletal symptoms Sabrina might experience?

This week, you will evaluate patients for the treatment of neurologic and musculoskeletal disorders by focusing on specific patient case studies through a decision tree exercise. You will analyze the decisions you will make in the decision tree exercise and reflect on your experiences in proposing the recommended actions to address the health needs in the patient case study.

Learning Objectives

Students will:

Evaluate patients for treatment of neurologic and musculoskeletal disorders
Analyze decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders
Justify decisions made throughout the diagnosis and treatment of patients with neurologic and musculoskeletal disorders

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Chapter 11, “Basic Principles of Neuropharmacology” (pp. 67–71)
Chapter 12, “Physiology of the Peripheral Nervous System” (pp. 72–81)
Chapter 12, “Muscarinic Agonists and Cholinesterase Inhibitors” (pp. 82–89)
Chapter 14, “Muscarinic Antagonists” (pp. 90-98)
Chapter 15, “Adrenergic Agonists” (pp. 99–107)
Chapter 16, “Adrenergic Antagonists” (pp. 108–119)
Chapter 17, “Indirect-Acting Antiadrenergic Agents” (pp. 120–124)
Chapter 18, “Introduction to Central Nervous System Pharmacology” (pp. 125–126)
Chapter 19, “Drugs for Parkinson Disease” (pp. 127–142)
Chapter 20, “Drugs for Alzheimer Disease” (pp. 159–166)
Chapter 21, “Drugs for Seizure Disorders” (pp. 150–170)
Chapter 22, “Drugs for Muscle Spasm and Spasticity” (pp. 171–178)
Chapter 59, “Drug Therapy of Rheumatoid Arthritis” (pp. 513–527)
Chapter 60, “Drug Therapy of Gout” (pp. 528–536)
Chapter 61, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 537–556)

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

This website provides information relating to the diagnosis, treatment, and patient education of dementia. It also presents information on complications and special cases of dementia.

Document: Mid-Term Summary & Study Guide (PDF)

Required Media (click to expand/reduce)

Laureate Education (Producer). (2019b). Alzheimer’s disease [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat Alzheimer’s disease.

Laureate Education (Producer). (2019e). Complex regional pain disorder [Interactive media file]. Baltimore, MD: Author.

In this interactive media piece, you will engage in a set of decisions for prescribing and recommending pharmacotherapeutics to treat complex regional pain disorders.

Disorders of The Nervous System

Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)