adv pharmacology
Melinda
Diabetes
While there are differences in types of diabetes, the core dysfunction of the body’s inability to properly use or produce insulin in the body is the basis. In type I diabetes (previously called juvenile diabetes), the pancreatic beta cells are attacked by an auto-immune response which inhibits the actual production of insulin (McCance et al., 2019). Type I usually is diagnosed when the body is hyperglycemic and often causes diabetic ketoacidosis, which can be life-threatening. Type II diabetes used to effect only adults but is occurring much more frequently in obese children. In Type II diabetes there is a dysfunction of the bodies ability to effectively use the insulin it produces. Type II diabetics usually produce some amount of insulin, however there is insulin resistance and hyperglycemia that results from this. While Type I is more likely related to genetics and has some environmental triggers and relation, Type II is thought to be have some genetic factor and then more linked to the environmental influences such as hypertension, diet, obesity, and physical inactivity. Gestational diabetes occurs in pregnancy when the body has the inability to properly utilize insulin after pregnancy occurs. Gestational diabetes has both a decreased production of insulin from the pancreas, as well as increased insulin resistance.
Drug Description, Preparation and Administration
In this discussion post, we will take a closer look at Type II diabetes and the use of metformin in controlling glucose levels. Metformin has three main effects on the body. Rosenthal et al. explains these three effects as inhibiting glucose production in the liver, reducing glucose absorption in the GI tract, and third, it increases glucose uptake in fat and skeletal muscle tissue (2021). All three of these mechanisms drive lowering glucose levels in the blood and reducing instances of hyperglycemia for the patient, which ultimately lead to worse long-term outcomes. Metformin is used in conjunction with lifestyle changes in patients with Type II diabetes and can only provide partial glycemic control in many of these patients.
Metformin is usually prepared in doses starting at 500mg and going up to 850 mg and 1000 mg tablets. There can be some gastrointestinal side effects so it is often started at 500 mg and if needed, the dose can be incrementally increased until the desired effect is reached. The medication should be taken with a meal in order to reduce the possible GI discomfort (Sanche-Rangel et al., 2017). It is also recommended that metformin is stored at room temperature and expiration dates on bottles should always be followed.
Dietary considerations
Diet is incredibly important in the control of Type II diabetes and it important for these diabetic patients to work closely with their providers to make the proper lifestyle changes. In the use of metformin, it is important to make sure that patients are eating a normal diet when they take the medication. Nasari et al., discusses that metformin does not usually cause hypoglycemia but it can occur if a patient stops eating while on the medication (2014). If a patient continues there diet as discussed with their providers and are eating regularly, this should not be a problem.
Short-term and long-term impact
The most common short-term impacts of metformin use on the diabetic patient have to do with GI discomfort. Some patients have instances of nausea and vomiting and in some cases, it can be enough to discomfort to discontinue the medication. Metformin can also cause malabsorption of some vitamins. Lastly, metformin can cause hypoglycemia in rare cases such as discussed in the dietary consideration.
The long-term effects and impact of metformin are the most important and are the actual desired effect of the drug. Metformin’s aim is to reduce instances of hypoglycemia in the diabetic patient. Instances of hypoglycemia lead to worse outcomes including atherosclerotic cardiovascular disease, hypertension, dyslipidemia, and kidney disease, among many others (Davies et al., 2018). There are not many known negative effects on the long-term use of metformin, however with so many patients effected with Type II diabetes there is constant research and it is necessary to continually research the drugs our patients are using.
References
Davies, M. J., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing,
P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018). Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). DIABETOLOGIA, 61(12), 2461–2498. https://doi.org/10.1007/s00125-018-4729-5
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in
adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Nasri, H., & Rafieian-Kopaei, M. (2014). Metformin: Current knowledge. Journal of research in
medical sciences : the official journal of Isfahan University of Medical Sciences, 19(7), 658–664.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Sanchez-Rangel, E., & Inzucchi, S. E. (2017). Metformin: clinical use in type 2
diabetes. Diabetologia, 60(9), 1586–1593. https://doi.org/10.1007/s00125-017-4336-x
cordelia
Diabetes Mellitus and its Treatment
Diabetes mellitus is a chronic medical condition affecting the metabolic function of the body characterized by altered glucose conversion into energy for cellular utilization, insulin resistance by the cells, and anomalies in insulin secretion (Chaudhary &Tyagi, 2018). The disorder can be diagnosed at any age and is usually diagnosed by testing the random blood sugars and fasting blood glucose. However, a more accurate way of diagnosing DM is by measuring glycosylated hemoglobin levels (HbA1C).
It is divided into four main types: Type 1/juvenile DM, Type 2 DM, and gestational DM. Type 1/juvenile DM mainly occurs in the under-ten population resulting from autoimmune dysfunction which activates CD4, CD8 T cells, and macrophages which infiltrate the pancreas leading to chronic inflammation, consequently causing destruction and death of the B-cells (Chaudhary &Tyagi, 2018). Type 2 DM is primarily hereditary and occurs due to the risk of old age, obesity, and lack of exercise, which results in high sugar due to the body's inability to produce and utilize insulin. Individuals mainly present with symptoms such as fatigue, frequent infections, and prolonged wound healing, among others. Gestational DM usually occurs due to pregnancy, and its onset is during the gestation period due to high blood sugar.
Use of Metformin in Managing Type 2 DM
I will choose to describe Type 2 DM. Metformin is a drug that is classified under biguanides in antidiabetic drugs. Biguanides are usually the first-choice drugs for Type 2 DM and are contraindicated in cases where it inhibits the liver's glucose production and increases muscle tissue insulin sensitivity (Rosenthal &Burchum, 2021). Metformin is usually available in two oral preparations. The first is an initial adult dose as an immediate-release tablet, which is 500mg, taken orally once or twice daily, or 850mg can be taken daily. The first oral preparation is administered when a meal is taken to reduce gastrointestinal disturbance, and the dose is gradually increased every seven and; the purpose is to minimize the adverse GIT effects. The second preparation is the initial adult dose for extended release; the dosage taken is 500mg-1g once a day and is advisable to be administered during the evening meal. The dose is gradually reduced to minimize GIT upset (Rosenthal &Burchum, 2021). Metformin is contraindicated in cases whereby the individual has renal impairment with creatinine levels (>136mmol/l in males and >124mmol/l in females). Another contraindication in congestive heart failure requires pharmacological treatment, and individuals hypersensitive to metformin are also contraindicated from using it.
Short-term and Long-term Complications of Type 2 DM and the Effects of Treatment
Short-term Complications of Type 2 DM
One of the short-term effects of Type 2 DM is Hyperosmolar Hyperglycemic Nonketotic Syndrome, a condition whereby blood glucose rises drastically. If not treated, it might lead to death. Another complication is hypoglycemia, a drop in blood glucose levels below the normal range of 11g/dl. It occurs due to the effect of insulin medications and might also be due to other medications such as salicylic acid(aspirin) and excessive alcohol consumption. The most obvious signs of hypoglycemia include increased heart rate, numbness and tingling sensation in the extremities, and confusion.
Long-term Complications of Type 2 DM
Long-term complications usually develop after years of having the disease. Most of the long-term complications usually affect the blood vessels and cause damage to the organs of the body. Examples include microvascular complications, which are retinopathy, nephropathy, and diabetic neuropathy, and macrovascular complications, which affect the heart, brain, and blood vessels. Retinopathy is a condition that causes cataracts in the eyes, which can lead to vision loss. Diabetic neuropathy causes nerve damage due to damage to the small blood vessels that supply the nerve cells. Nephropathy is a condition that causes kidney damage when diabetes is not well controlled. This leads to impaired kidney function and may lead to heart failure.
Effects of Treatment
Despite the positive effects of metformin in treating Type 2 DM, side effects may also occur. The most common side effects involve the gastrointestinal system, including abdominal discomfort, decreased appetite, and nausea. Other less common effects are anxiety, blurred vision, dizziness, nervousness, and difficulty breathing. Individuals under the prescription of metformin must monitor vitamin B12 levels because it can lead to vitamin B12 deficiency (ADA,2018). They are recommended to monitor hematologic and renal system function. Finally, they should continually do fasting blood sugar tests and hemoglobin A1C in patients with stable blood glucose.
References
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes 2018. Diabetes care, 10.2337/dc18-S008
Chaudhary, N., & Tyagi, N. (2018). Diabetes mellitus: An Overview. International Journal of Research and Development in Pharmacy & Life Sciences, 7(4), 3030-3033.http://dx.doi.org/10.47583/ijpsrr.2021.v69i01.011
Rosenthal, L. D., & Burchum, J. R (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed .) St. Louis, MO: Elsevier. https://evolve.elsevier.com/cs/product/9780323554954?role=student