Categories
Pharmacology

Diabetes

Introduction

Diabetes has been in existence for thousands of years and was first discovered in ancient Egyptian times when individuals experienced weight loss and excessive amounts of urination without any specific explanation (Polonsky, 2012). In 1812, diabetes was clinically identified, but there was no cure and death was imminent because knowledge regarding insulin deficiency had not yet been discovered (Polonsky, 2012). Over the past two centuries, this condition continued to grow in prominence and additional indicators demonstrated its widespread impact throughout the world (Polonsky, 2012). Therefore, many different treatment options are now available to treat diabetes in patients and to provide them with the tools to achieve longer life spans a greater quality of life (Polonsky, 2012). The following discussion will address diabetes in greater detail, including some of the most popular treatments that are currently available, and will recognize the importance of the maintaining glycemic control and medication administration in supporting greater wellbeing for diabetes patients (Polonsky, 2012).

Body

The hyperglycemic condition has been evaluated in significant detail from a variety of research perspectives in order to identify treatments and other alternatives to maintain glycemic control and to reduce complications from diabetes (Polonsky, 2012). Insulin was identified in the early 20th Century by Edward Albert Sharpey-Schafer, who derived insulin from bovine pancreatic cells (Polansky, 2012). Upon administration of insulin to human patients, their life expectancy and quality of life increased dramatically and enabled them to lead normal lives (Polonsky, 2012). These developments led to the widespread derivation of insulin from natural sources and widespread manufacturing by using advanced DNA techniques to produce this substance in large quantities for diabetic patients throughout the world (Polansky, 2012).

Diabetes is a unique condition that is identified in two basic forms: type I diabetes in children and type II diabetes in adults (Polansky, 2012). This condition is complex and level of severity varies in each patient; therefore, treatments must be identified that will provide optimal glycemic regulation whenever possible (Polansky, 2012). Type 2 diabetes has its own set of unique treatment standards due to its presence in adults; therefore, it is expected that treatments will continue to evolve that support the management of this condition in the affected adult population (Nathan et.al, 2009). Regardless, diabetes is exacerbated by poor diet and limited physical activity, both of which contribute to weight gain in many patients (Authors, American Diabetes Association, 2012). When excess weight develops, there is a greater potential to prohibit effective glucose tolerance in patients, whereby the pancreas produces less insulin and glycemic control is no longer effective (Authors, American Diabetes Association, 2012). For these patients, hyperglycemia is identified as a blood glucose level over 200 mg/dL, which may be very dangerous for patients without proper insulin administration (Authors, American Diabetes Association, 2012). Under these circumstances, patients may face critical challenges and complications if treatment is not received or optimized to stabilize blood sugar levels (Authors, American Diabetes Association, 2012).  In recent years, hyperglycemia management guidelines have shifted to incorporate new insights into type 2 diabetes treatments, including such factors as pharmacological treatments, adverse events, and complications that may ensue from the continued management of glycemic control (Barclay, 2012). In the modern era, the most effective courses of action involve the following perspective: “Recommendations are tailored to individual patient needs, preferences, and tolerances and are based on differences in age and disease course. Other factors affecting individualized treatment plans include specific symptoms, comorbid conditions, weight, race/ethnicity, sex, and lifestyle” (Barclay, 2012). Therefore, it is important to develop strategies that will incorporate these guidelines so that patients with diabetes are provided with optimal treatment methods to meet their specific needs (Barclay, 2012).

Case Study Example

In evaluating the specific case study example, the patient requires a specific plan of care that will manage her diabetes condition as best as possible so that she reduces her risk of long-term complications. In this case, barriers to optimum management include cultural differences that may prevent her from obtaining routine care and treatment; language barriers that could prohibit effective communication regarding her condition; and lack of knowledge regarding the importance of healthy eating and regular physical activity. The proposed management plan must include culturally sensitive knowledge regarding diabetes and the development of principles that will encourage her to eat healthier, exercise regularly, and lose weight to reduce the risks associated with her diabetes condition. Common oral medications include the following:

Class Mechanisms of Action Common Drug Names Advantages/Disadvantages
Sulfonylureas Increased insulin release by the pancreas Glucotrol XL, Glucotrol, DiaBeta, Amaryl A: Increase insulin production

D: Less potent

Biguanides Allow insulin to move sugar to muscle cells Glucophage, Glucophage XR, Riomet, Fortamet A: Prevent the liver from releasing sugar

D: Risk for patients with heart or kidney failure

Thiazolidinediones Reduce insulin resistance Actos, Avandia A: Enable fat cells to respond to insulin

D: Cardiovascular risks

Alpha-glucosidase inhibitors Slow down blood sugar increases Precose, Glyset A: Block enzymes that work to digest starch products

D: Gas and diarrhea

Meglitinides Allow pancreas to increase its release of insulin Prandin, Starlix A: Dependent on glucose

D: Hypoglycemia

From: http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes

For the patient in question, there is great concern associated with the lack of control over her blood sugar levels and her inability to respond to oral medications. Therefore, the only feasible option is the administration of insulin to better manage her blood glucose levels on a consistent basis. These findings demonstrate that the patient must learn how to self-administer insulin and also prepare herself for days when her blood sugar levels are not able to be controlled. These incidents require a management plan that includes an understanding of how to administer insulin and at the required times and what to do if symptoms of hyperglycemia or hypoglycemia arise. For the former, the patient should be provided with alternative measures of increased insulin if she begins to feel unwell as a result of a hyperglycemic state. In addition, she must also recognize when her blood sugar drops too low and her blood sugar levels must be stabilized. This is best achieved by administering sugary substances quickly to restore normal blood sugar, which may include orange juice or candy. Therefore, the patient should have these available in the event that these incidents take place. Finally, since the patient currently has a BMI of 36, there is a natural inclination to consider bariatric surgery to reduce the size of the stomach and to promote less caloric intake. However, this instance is challenging because the patient is so young. At age 15, the patient is not even fully grown and developed; therefore, the process of bariatric surgery is not likely to be as effective as in adult patients. In addition, there are greater risks associated with this type of surgery for young patients. Therefore, it is recommended that patients within this age group should not be considered for bariatric surgery due to its risks and potential complications.

References

Authors, American Diabetes Association. (2012). Position statement: standards of medical care in diabetes-2012Diabetes Care (35), Suppl. S11-S63.

Barclay, L. (2012). ADA/EASD issue new hyperglycemia management guidelines. Medscape      Medical News, retrieved from http://www.medscape.com/viewarticle/762322

Nathan, D.M., Buse, J.B., Davidson, M.B., et al.  (2009). Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care; 32, 193-203.

Polonsky, K. (2012).  The past 200 years in diabetes.  New England Journal of Medicine, 367, 1332-1340.

WebMD (2013). Oral diabetes medications. Retrieved from

http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes