responses

Respond with at least 2 references each peer apap format

Peer 1

Diabetes and Drug Treatment

Type of Diabetes

Diabetes mellitus is a metabolic disorder that occurs in the body because of a lack or decrease in insulin activity and a decline in insulin secretion. It may involve changes to the body, including cardiovascular complications, kidney disorders, delayed wound healing, and retinopathy. The two subtypes of diabetes are type one diabetes T1DM and type 2 diabetes (T2DM). Most patients with T1DM are treated with insulin, whereas most patients with T2DM are treated with oral hypoglycemics. Over the years, the research and treatment of diabetes have developed in leaps and bounds. There are many options available today for patients suffering from T2DM; however, with so many options, it can be difficult for a clinician to navigate what is best for their patients, what is most affordable, and what has the fewest side effects (Padhi et al., 2020).

 

One type of drug used to treat the type of diabetes type II 

Sulfonylureas have been used to treat 2D M since the 1950s. Their primary function is to stimulate the release of insulin from pancreatic islets and is only effective if the pancreas is capable of synthesis. They additionally promote insulin release by binding and blocking adenosine triphosphate-sensitive potassium channels in the cell membrane. This allows the membrane to depolarize and permits the influx of calcium, which causes insulin release (Rosenthal DNP ACNP, Laura et al., 2020). Sulfonylureas receptors are broken down into two subtypes, SUR1 and SUR 2. SUR1 is dominant in the brain and beta cells of the pancreas, while SUR2 is mostly present in cardiac muscle and smooth muscle. This is why the extent of the cardiac side effects can differ. They additionally decrease insulin metabolism in the liver and increase sensitivity in the peripheral tissue (Costello et al., 2023).  

They have been divided into first, second, and third-generation drugs. The significant difference between the two is the level of effects and potency. They come in two forms, some being long-acting and others having a much shorter duration.  The first generation includes Chlorpropamide, which is no longer available in the US, and Tolbutamide. The second generation is the most commonly used Glyburide and Glipizide. The third generation involves glimepiride. They all carry with them benefits and side effects. However, glimepiride or Amaryl carries with it the most up to date and research methodology and effects (Kalra et al., 2018).

Proper preparation and administration of this drug.  

In preparation, patients should have baseline laboratory data to evaluate kidney and liver function. Ideally, a patient would have a recent A1C level, echocardiogram, and Ultrasound of the kidneys. The kidney disease improving global outcomes 2020 guideline lists sulfonylureas as the least suitable anti-diabetic medication for patients with a GFR of less than 15. Therefore, it is extremely important to verify and assess the patient’s current kidney function (Costello et al., 2023).

Clinicians should begin with a low dose and titrate up due to glycemic control. They must also determine which generation is best for their patient. Glimepiride has the longest duration of action compared with other generations. Therefore, it can be the most beneficial to the patient. To administer in T2DM patients, the clinician should begin with a 1 to 2-milligram daily oral dose and may make incremental increases of  1 to 2 milligrams every 2 weeks if necessary. Maximum dose of 8 milligrams a day. in renal and hepatic impairment, the clinician should start with 1 milligram and titrate more slowly. clinicians should use caution in prescribing to patients with a history of diabetic ketoacidosis, hypersensitivity to sulfonamides, G6PD deficiency, hypoglycemia risk, autonomic neuropathy, and elderly and debilitated patients. Patients should be instructed to take it with the first meal of the day and to notify their practitioner immediately if they develop any severe reactions such as hemolytic anemia, pancytopenia, Stevens-Johnson syndrome, hepatotoxicity, or anaphylaxis. Common side effects of educating your patients would be hypoglycemia, dizziness, photosensitivity, nausea, and headache. The patient should have frequent monitoring of kidney function and liver enzymes (Epocrates, 2023).

  D ietary considerations related to treatment.

As with all T2 DM patients, they should be educated on a proper diabetic diet. Upon all new diagnoses of diabetes mellitus, patients should be immediately referred to a dietician to develop a dietary plan of care that is singular to the patient and their lifestyle. It should include a plan of macronutrient distribution and meal planning. Many dieticians propose the Mediterranean diet approach, which is a plant-based eating plan. Some suggest a low carbohydrate eating plan which may improve glycemia and have a potential reduction in antihyperglycemic dosage. In 2023 there are many options for diabetic patients, and therefore it is more essential to have an individualized plan than to give patients a diabetic diet protocol.

The short-term and long-term impact of diabetes you selected on patients, including the effects of drug treatments.

The short-term impact of T2 DM is a combination of multiple issues the patient is currently having; most type 2 diabetic patients are not in good health when they develop the disease. Most T2 DM patients have obesity, hypertension, physical inactivity, and family history. The short-term effects of T2 DM our reflection of these traits. The short-term effects would be polyurea, polydipsia, visual changes, fatigue, pruritus, recurrent infections, and symptoms of neuropathy. Proper medication and the restoration of normal blood glucose can correct the relative metabolic disorder. However, if not appropriately treated or patient is non-compliant with protocols for proper exercise, medication, and diet, this can lead to severe complications such as microvascular diseases such as diabetic retinopathy, diabetic kidney disease, diabetic neuropathies, and chronic macrovascular diseases such as cardiovascular disease, stroke, peripheral artery disease, and additional complications of infections and death (McCance & Huether, 2018).

The long-term effects of taking diabetic medications, or more specifically third, generation sulfonylureas, are an increased risk of weight gain, fluid retention, gastrointestinal problems, and increased cardiovascular risk (Azoulay & Suissa, 2017).

Peer 2

   Diabetes mellitus (DM) is a disease that can lead to serious health issues due to excess sugar in the blood. There are different types of DM. Following medication regimens as prescribed, maintaining a healthy diet and activity level, and having regular health checkups can decrease the risk of severe health problems for individuals with diabetes. The main goal for diabetes patients is to maintain and adequately manage blood sugar. There is no cure for type one or type two DM.

          Type 1 is a chronic condition in which your body does not produce insulin or makes such a small amount of insulin that sugar in the blood cannot get into cells and creates an overabundance of sugar in the blood (Mayo Clinic, 2023a). Type 1 DM is hypothesized to be an autoimmune reaction in which the body destroys beta cells. Beta cells are responsible for the production of insulin in the pancreas. Type 1 diabetes is not preventable like other types of diabetes and typically onsets during childhood or adolescents but can occur at any age. This disease, typically onset during childhood, is often called juvenile diabetes (CDC, 2022b).

          Type 2 diabetes is the most common DM and is when the body incorrectly regulates the use of sugar. Type 2 occurs for two main reasons. First, the pancreas produces insulin, but not enough for proper regulation, or second, the cell does not take in an adequate amount of sugar from the bloodstream (Mayo Clinic, 2023). Type 2 is considered insulin resistance. Type 2 DM occurs in roughly 1 out of 10 Americans and is most often developed in adults over 45 but can be diagnosed at any age (CDC, 2022).

         Gestational DM occurs during pregnancy. The body cannot utilize sugar properly, which can adversely affect the mother and child's health. Typically, the body returns to normal after birth and can regulate sugar properly again. During pregnancy, it is critical to control gestational DM, typically by eating healthy, exercising, and taking medication to manage gestational DM (Mayo Clinic, 2022).

         Semaglutide injection, commonly known as Ozempic, is a medication that has been in the spotlight for a while now for a new FDA-approved reason as a weight loss medication. Due to this new approval, the medication has been having supply issues (Office of the Commissioner et al., 2021). However, this medication was initially intended to assist patients with Type 2 diabetes in managing their condition. Ozempic goal is to lower A1C, lower blood sugar, and promote the patient's body to release its insulin. The medication assists in creating more insulin when the blood sugar increases, decreases the quantity of sugar released from the liver and slows down the rate at which food leaves the stomach (Novo Nordisk, 2022).

         The injectable medication is prescribed in a 0.5mg, 1mg, or 2mg pen once weekly. The pen will be kept in the refrigerator (Novo Nordisk, 2022). The patient can self-administer the medication by choosing an area of subcutaneous fat (typically stomach is the preferred location), cleaning it with an alcohol swab, and letting the area air dry. While drying, the patient should uncap the pen, twist a clean, unused needle onto the pen, and prep the pen if first used by twisting the dial to the dashed line and pushing the release button at the end of the pen. The patient should dial the correct dose if the pen is already prepped. The patient should then pinch the area around the cleaned site and inject the needle straight into the subcutaneous fat area. The patient should press the button to release the medication once the needle is in the skin and wait for the pen to administer the dose. The patient should hold the pen for an additional 6-10 seconds after the plunger in the pen stops moving to ensure all medication is administered and then pull the pen out straight and adequately dispose of the needle and recap the pen and return it to the refrigerator.

        Ozempic use long-term increases the risk of possible thyroid tumors and cancer. This medication is not recommended for patients with a family history of medullary thyroid carcinoma (MTC) or multiple endocrine neoplasia syndrome type 2 (MEN 2). Patients with kidney or pancreas problems are not encouraged to take this medication or have a history of diabetic retinopathy. The most common symptoms include n/v, constipation, diarrhea, and abdominal pain. Patients that take multiple medications to reduce blood sugar have an increased risk of hypoglycemia. The medication should be utilized with a proper diet, which includes decreasing sugar intake and proper exercise to manage diabetes. This medication has also been linked to decreased cardiovascular events in individuals with type 2 DM. It has recently been in the news due to it helping patients decrease weight (Office of the Commissioner et al., 2021). The medication is not recommended for children under 18 years old or pregnant women due to a lack of research on this patient population (Novo Nordisk, 2022).