DIABETES AND DRUG TREATMEANT NURS 6521

DIABETES AND DRUG TREATMEANT NURS 6521

DIABETES AND DRUG TREATMEANT NURS 6521

According to the Center for Disease Control (CDC) 11.3% or 37.1 million people in the United States have diabetes mellitus.  Major complications of diabetes are neuropathy, heart disease, and hypertension.  Diabetes management should be aimed at preventing short and long-term complications.

Different Types of Diabetes

Type I diabetes, also known as juvenile diabetes, because the onset commonly occurs during childhood or adolescence and is abrupt.  Type I diabetes occurs when pancreatic beta cells are damaged or destroyed.  Pancreatic beta cells produce insulin and when they are damaged or destroyed by autoimmune disease, genetic or environmental factors or viral infections insulin production becomes insufficient.  Type II diabetes commonly occurs in middle age and progresses gradually.  In Type II diabetes a combination of increased tissue resistance to insulin and impaired pancreatic insulin secretion lead to hyperglycemia.  A third type of diabetes is gestational diabetes which occurs during pregnancy and subsides rapidly following delivery.  Gestational diabetes causes high birth weights, and hyperinsulinemia in infants (Rosenthal & Burchum, 2021).

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.

 

References

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes – 2018. Diabetes Care, 41(1), 573–585. Retrieved March 30, 2022, from https://doi.org/10.2337/dc18-S008

Food and Drug Administration & Eli Lilly and Company. (2012). Humalog (insulin lispro). FDA. https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/020563s115lbl.pdf

Gray, A., & Threlkeld, R. K. (2019). Endotext [Internet]. MD Text, Inc. https://www.ncbi.nlm.nih.gov/books/NBK279012/

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

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4 months ago

Cat Long

RE: Wk 5 Discussion Initial Post- Reply 1 – C. Long

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Another treatment option for type 1 diabetes is insulin human inhalation powder (Afrezza).   It is a dry powder form of human insulin which is mixed with fumaryl diketopiprazine crystalizing the mixture into microparticles which are easily deliver into the alveolar fluid in the lungs (Heinemann & Parkin, 2018). The mixture is very water soluble making it easy for it to be absorbed into the systemic circulation via the alveolar barrier (Heinemann & Parkin, 2018). This delivery allows for faster onset of action and are short acting (Heinemann & Parkin, 2018). Given the mechanism of action use of inhaled insulin would be contraindicated in patient to with asthma or chronic lung disease (Heinemann & Parkin, 2018).

 

 

References

 

Heinemann, L., & Parkin, C. G. (2018). Rethinking the Viability and Utility of Inhaled

 

Insulin in Clinical Practice. Journal of Diabetes Research2018, 4568903.

 

https://doi.org/10.1155/2018/4568903

 

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4 months ago

Tracey Sanchez

RE: Wk 5 Discussion Initial Post- Reply 1 – C. Long

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Hello Cat,

Thank you for your response.  I am glad you brought Afreeza to the discussion board.  I have heard of inhaled insulin and seen it in recommendations but have not explored it as an option for therapy.  On reading about Afreeza I realize the reason we do not actually see it being used very often is because of cost which is prohibitive for most patients.  I also noted that concerns associated with Afreeza include acute bronchospasm, throat and lung irritation, and hypoglycemia.  I will ask the physicians and APRNs I work with what their thoughts are on Afreeza prescribing as it does seem like an option patients would like to have for diabetes management.  Thanks again!

References

Mohanty, R. R., & Das, S. (2017). Inhaled Insulin – Current Direction of Insulin Research. Journal of clinical and diagnostic research : JCDR11(4), OE01–OE02. https://doi.org/10.7860/JCDR/2017/23626.9732

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4 months ago

Ana Trejo

RE: Wk 5 Discussion Initial Post

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Week 5 – Response 1

Tracey,

Great job on your discussion! It was very thorough and informative. I liked that you included information about Humalog (insulin lispro) and the different ways it is available and the methods it can be administered as well. I was wondering if you can expand on the cost-effective way it can be available for people who have no insurance or are limited on funds?

I would personally like to learn more about how we as health care providers can help those less fortunate in affording certain medications or treatments so that their health does not decline due to financial difficulties.  Upon my research I have learned that the insulin pens although convenient, are more expensive than the vials. There are pros and cons to each of them for example the pens are about 40% more expensive than the vials but are more convenient, easier to store and transport. The pens are also less painful. With the pens the dosage can be more accurate for the doses smaller than five units. However, if a patient is needing more than one type of insulin they cannot be mixed in the pen (Rosenthal et al, 2021).

What are your thoughts on Pramlintide an amylin analog? It has been approved by the Food and Drug Administration (FDA) for use with type 1 diabetes mellitus (T1DM) patients (American Diabetes Association (ADA), 2018). It can help with weight loss as well as requires lower insulin doses.

Nonetheless, there are different options for those with diabetes and we must encourage them to learn about their best fit to prevent any complications. We should also encourage our patients to  speak up on how they are feeling and what helps them feel better controlled of their diabetes. Again, great discussion Tracey!

References

American Diabetes Association; 8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018Diabetes Care 1 January 2018; 41 (Supplement_1): S73–S85. https://doi.org/10.2337/dc18-S008

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

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