Diabetes and Drug Treatment Discussion, Responses

Diabetes and Drug Treatment Discussion, Responses Diabetes and Drug Treatment Discussion, Responses Main Post, M. K 2020 COLLAPSE Diabetes is a disease that affects millions of people around the world. Some people go years without being diagnosed, others know from a very young age. In general, diabetes is a disease wherein the pancreas chooses not to function properly, meaning it does not produce and/or use insulin correctly. Diabetes comes in many forms including Type 1, Type 2, Gestational, and Juvenile. (IDF, 2020). Diabetes and Drug Treatment Discussion, Responses ORDER NOW FOR CUSTOMIZED AND ORIGINAL NURSING PAPERS Type 1 and Juvenile Diabetes Type 1 diabetes (T1DM) is one of the lesser common types of diabetes, usually first found in children and adolescents—where the name Juvenile Diabetes originated but is now an antiquated term. With T1DM, the patient’s pancreas either does not produce insulin at all, or it produces very little. Type 1 diabetics will have to take insulin daily for the rest of their lives. Many type 1 diabetics use different types of insulin: insulin lispro-rapid-acting, human regular-short acting, glargine-long acting, degludec-ultralong acting. (Diabetes.org) Type 2 Type 2 diabetes (T2DM) is the most common type of diabetes in adults (NIDDK, 2016). Most patients with T2DM start with resistance to insulin, many will require insulin to control their blood sugar levels. T2DM has many different types of medications meant to assist the body with processing insulin including the most common, metformin. Gestational Some women develop diabetes during pregnancy, which is where gestational diabetes (GD) comes from. Most gestational diabetics have the issue resolved after the baby is born, but some women become type 2 diabetics, and all women that have GD are at increased risk for developing T2DM later in life. (NIDDK, 2016) Insulin There are many different types of insulins, rapid-acting, short-acting, intermediate-acting, long-acting and most recently created ultra-long-acting (Diabetes.org). Most patients that are taking insulin have used or do use rapid-acting insulin, sometimes referred to as mealtime insulin. Insulin lispro is the most commonly administered insulin in my hospital setting as it has a rapid onset of 15 minutes after administration, peaking in 1 hour, and usually lasting no more than 4 hours (Drugs.com). Insulin lispro can come in primarily two different forms, an insulin pen or a vial/syringe. An insulin pen physically resembles an ink pen, containing a cap and a well of insulin. To administer from an insulin pen, the patient would take the cap off, clean the end, attach a single-use microneedle, dial the unit knob on the back to 2 units and press down to prime the needle. After priming the needle, the patient would dial in however many units are required based on the scale their endocrinologist has established for them, then clean the skin and inject it into the site. It is recommended that the patient leave the pen in the skin for 10 seconds to ensure adequate absorption of the insulin into the subcutaneous tissue. If the patient uses the vial and syringe combo, the premise is the same but instead of priming the pen, the patient cleans the vial, draws up the insulin, cleans the skin, and then administer to themselves. For patients that are using insulin, a consistent carbohydrate (CC) diet is now the gold standard, especially in the healthcare setting. Carbohydrates typically raise your blood sugar levels and maintaining a consistent intake of carbohydrates daily allows the body to avoid sharp spikes and dives in glucose levels. Each patient is different and based on the patient’s specific needs: Hemoglobin A1C, diet, and exercise. The average CC diet is 60 grams of carbohydrates for breakfast, lunch, and dinner, with small optional snacks in between if needed. (Renee, n.d.) Effects on the patient Type 1 Diabetes can be very manageable for patients. Many patients with T1DM chose to use an insulin pump that continually administers insulin, and if the patient is diagnosed as a child, by adolescent years can manage their diabetes very well. Diet and correct usage of insulin are key, however, if the patient chooses to be noncompliant with treatment, they can become sick very quickly and even die from blood sugars being too high or too low. References Diabetes.org. (n.d.). Insulin Basics. Retrieved July 02, 2020, from https://www.diabetes.org/diabetes/medication-management/insulin-other-injectables/insulin-basics Drugs.com. (2020, April 6). Insulin lispro Uses, Side Effects & Warnings. Retrieved July 02, 2020, from https://www.drugs.com/mtm/insulin-lispro.html International Diabetes Foundation (IDF). (2020, March 26). What is diabetes? Retrieved July 02, 2020, from https://www.idf.org/aboutdiabetes/what-is-diabetes.html National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2016, December 01). What is Diabetes? Retrieved July 02, 2020, from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes Renee, J., MS, RD. (n.d.). The Consistent Carbohydrate Diet for Diabetics. Retrieved July 02, 2020, from https://www.livestrong.com/article/436101-the-consistent-carbohydrate-diet-for-diabetics/ REPLY QUOTE EMAIL AUTHOR RE: Main Post, M. K 2020 COLLAPSE Module 4 Week 5 Discussion Reply #1 M Great job on your post. I thought it was well written and informative. Rapid-acting insulins are fairly common for those with type 2 diabetes mellitus. Rapid-acting insulins include lispro, aspart, glulisine, and inhaled insulin. The most common rapid-acting insulin used at my facility is also lispro (American Diabetes Association [ADA], 2018). Working within a prison has its challenges when thinking about diabetic management through diet. There are no special diets that exist in the prison, so rapid-acting insulin is heavily relied on to help manage diabetes. Lispro has an onset of 15-30 minutes, peaking at 0.5-2.5 hours and last 3-6 hours (Rosenthal & Burchum, 2018). Our patients receive their blood glucose checks at 630 am (breakfast at 7 am), 1030 am (lunch at 11 am), and 330 pm (dinner at 4 pm). They receive their long-acting insulin (most common is lantus) at 630 am and 330 pm. References American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care , 41 (Supplement 1), S73–S85. Retrieved July 1, 2020, from https://doi.org/10.2337/dc18-s008 Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants . Elsevier. REPLY QUOTE EMAIL AUTHOR RE: Main Post, COLLAPSE Hello M I like that you mentioned the use of insulin pumps. I have noticed that they are becoming much more popular, especially among younger patients. The continuous pumps can be set to automatically administer insulin dosages based on when patients eat. However, it is essential that patients eat a diet that is conducive to their glycemic goals. One study found that the use of an insulin pump resulted in significantly lower hemoglobin A1C levels compared to patients that injected themselves with insulin multiple times a day (Alzahrani et al., 2019). Patients with type I diabetes require supplemental insulin since their bodies do not produce it sufficiently. Insulin therapy is the recommended treatment for type I diabetics, and it requires close monitoring of blood glucose levels (American Diabetes Association, 2018). Patients with type I should also participate in regular physical activity. It is recommended that type I diabetics perform at least 150 minutes of moderately intense aerobic activity per week (Rosenthal, & Burchum, 2018). Exercise helps increase the body’s glucose tolerance. Effectively managing diabetes in the short-term helps to reduce complications in the long-term. Diabetes and Drug Treatment Discussion, Responses References Alzahrani, N. N., Mashrah, H. T., Alzahrani, S. M., Asiri, A. S., Faydh, A. A., Aljuaid, N. W., Alswat, H. K., Labib, N. M., & Atalla, A. A. (2019). Comparison of haemoglobin A1c level in insulin pump versus multi daily injections users for type one diabetes mellitus. Middle East Journal of Family Medicine, 17(11) , 22–27. https://doi-org.ezp.waldenulibrary.org/10.5742MEWFM.2019.93691 American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1) , S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. REPLY QUOTE EMAIL AUTHOR Hide 1 reply RE: Main Post, M COLLAPSE Good interactive discussion Matthew! REPLY QUOTE EMAIL AUTHOR RE: Main Post, COLLAPSE Hello M Although Type 1 diabetes is found in both children and adults, researchers are examining the difficulty of managing type 1 diabetes in adolescents. Adolescents are at a period in their development where being independent is essential. An adolescent being treated for type 1 diabetes are being managed by their parents. With their newfound independence, properly educating the adolescent on managing the disease could improve outcome. There are studies on adolescents managing their condition through education and continuous glucose monitoring. Before researchers began educating adolescents on management, they also observed their perception of the transition. They discovered that adolescents viewed the transition as a major responsibility and preferred to attend education courses on management of type 1 diabetes (Strand, Broström & Haugstvedt, 2019). During the courses on diabetes, adolescents were introduced to continuous glucose monitoring to improve hemoglobin A1c levels. Researchers believed that continuous glucose monitoring would decrease hemoglobin A1c levels after 20 weeks (Laffel et al., 2020). Those adolescents who participated in the study decreased hemoglobin A 1c levels as well as gained an understanding on how to properly manage type 1 diabetes. References Laffel, L. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., DeSalvo, D. J., Goland, R., Hood, K., Liljenquist, D., Messer, L. H., Monzavi, R., Mouse, T. J., Prahalad, P., Sherr, J., Simmons, J. H., Wadwa, R. P., Weinstock, R. S., Willi, S. M., & Miller, K. M. (2020). Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults with Type 1 Diabetes: A Randomized Clinical Trial. JAMA: Journal of the American Medical Association , 323 (23), 2388–2396. Strand, M., Broström, A., & Haugstvedt, A. (2019). Adolescents’ perceptions of the transition process from parental management to self?management of type 1 diabetes. Scandinavian Journal of Caring Sciences , 33 (1), 128–135. Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10