Describe two types of diabetes medications including one oral and one subcutaneous and their effects on blood glucose in relation to Diabetes Mellitus (pharm kinetics and pharmacodynamics).
diabetes825 words (please wrthout In text references)12 referencesStructure and presentation:Your response should include a brief (one sentence) introduction followed by the caseanalysis (one paragraph for each of your chosen topics) and a brief (one/two sentence/s)conclusion. Do not use dot points headings or tables.Questions:This question is based on the case studies(Nick and Marty). Nick has Type 1 DiabetesMellitus and Marty has Type 2 Diabetes Mellitus. They are both managed by the sameGeneral Practitioner and see the Community Diabetes Nurse. You notice that theirdiagnosis is different in that Nick has Type 1 Diabetes Mellitus and Marty has Type 2Diabetes Mellitus and that their management plans including their medications are alsovery different.1. Discuss the potential causes for the loss of the pancreatic beta cells function in theDM1 and the DMZ.2. Describe two types of diabetes medications including one oral and onesubcutaneous and their effects on blood glucose in relation to Diabetes Mellitus(pharm kinetics and pharmacodynamics).Evaluation of Thinking-_Clear detailed description of pathophysiology identifying theScience alterations from the normal anatomy and physiology thoroughly5?5 PathophySIology revnews and Integrates current and relevant literature.E Succinct description of the drug including mechanism of action.8 Pharmacology Detailed description of the pharmacodynamics.3 Logic and flow Development is logical and clear to reader; points are addressed2 individually and linked appropriatelyThe paper presented will address 2 questions.Marty Jones visits the Indigenous health clinicMarty Jones seeks helpMarty visits the clinicYou are on clinical placement at an Indigenous primary health clinic. Marty Jones a 67year old local man presents to the clinic asking to see a health care worker. You andStacey an experienced Indigenous Registered Nurse are assigned to assess Mr Jones.He reports that he has been in good health until about two months ago when he startedto feel weak and tired more rapidly than usual. On questioning he admitted to getting uptwo or three times a night to urinate. He also is often thirsty at those times and drinks aglass of water each time.His weight was average through high school when he was on the rugby league team.After leaving school he has gradually gained weight over the years. His appetite remainsgood but he is now losing weight and describes feeling weak.He reports that he gets pain in his feet but the pain is worse at night and sometimeskeeps him awake. It is burning in character and sometimes his toes feel numb. Thetingling and numbness in his fingers is causing him problems at his work as an automechanic because he frequently drops small parts or has difficulty making fine manualadjustments to engines.His vision is blurry at times especially in the afternoon.Apart from an appendectomy in 1976 he reports no surgeries or chronic illnesses. Hislast dental visit was 6 years ago.Martys family historyBoth Martys parents are deceased. His father died at age 69 from a massive stroke. Hismother died at age 62 from end-stage kidney disease. She was found to have type 2diabetes mellitus at age 48 which was marked by major complications including partialamputation of her right foot. She was on dialysis for three years before her death. Martywas primarily responsible for his mothers care during her later years. He administeredher insulin twice a day and transported her to and from the dialysis centre.Marty is the youngest of four children and weighed 4.6 kg (10 lb 3 oz) at birth. Bothparents were overweight as are his siblings two of whom have diabetes.Social history and habitsHe is married and lives at home with his wife. He has three adult children. He works asan auto mechanic. He does not smoke. He drinks an occasional beer. He takes nomedications nutritional supplements or herbal remedies.Physical examination
Weight: 98 kgHeight: 180cmPulse: 76 regularBP: 142/78Mild bleeding of gums reported with tooth brushing. Halitosis present.Chest and abdomen examination normal.Feet skin dry with calluses on the medial side of the big toes. Nails normal. Pulsesstrong and equal. Sensation normal.Urinalysis 4+ glucose negative for ketones and proteinRandom blood glucose 13.5mmol/L ?Medical diagnosis and treatmentDr Smith the centres doctor diagnoses Marty as having type 2 diabetes mellitus andstarts him on Metformin 500mg tds. He refers him to the centres diabetes nurse foreducation.After the diagnosisOn the way out from the doctors visit Mr Jones admits to you that hes scared now. Hehad hoped it wasnt diabetes like his mother and siblings and is frightened that hell haveto lose his legs.Marty seeks further helpMarty revisits the clinic2 weeks has passed and you are now in the final week of your cinical placement whenMarty returns to the clinic concerned about his foot. On a previous review at the clinicMary mentioned that he was having some burning pain and numbness in his feet butnow Martyl has noticed that one of his socks is sometimes blood stained and dampstating that sometimes this smells funny. He asks you to take a look at his feet.On review you can identify a diabetic ulcer under Martys big toe on his right foot. Martythinks this was caused by a stone in his shoe. Before you dress the wound the doctorreviews his wound orders a wound swab and commences Marty on empiric oralantibiotics (Amoxycillin-Clavulanate 500mgs QID). You clean and dress Martys woundas instructed by your clinical facilitator meanwhile she contacts the community nurse toarrange a referral for daily dressings. The RN also contacts the community diabetic nurseeducator who already knows Marty from his diagnosis a few weeks ago to inform her ofMartys current health issue.Marty worries about loosing his legsPsychological concerns regarding complicationsMarty once again mentions that he is worried about loosing his legs. Marty has a friendwho has had a below knee amputation and has seen how devastating this complicationof diabetes can be.The RN discusses Martys medication regime his diet blood glucose monitoring and footcare reassuring Marty that if he remains vigilant with his diabetes management thatthere is minimal risk of this. The RN also relays these concerns of Martys to the diabeticeducator for her to followup with Marty on her next visit.Nicks health is suffering as he starts to live life inthe fast laneNick begins universityNick at uniNick 18 has just begun his first semester in his first year of an engineering degree atUniversity of Sydney. He was diagnosed with type 1 diabetes mellitus at age six and priorto his first semester at uni Nicks parents had helped Nick maintain strict control over hisblood glucose levels insulin administration diet exercise and overall health. He iscurrently prescribed Humulin R Twice a day. When Nick was in high school severalteachers on staff were very supportive of his condition and encouraged Nick to maintainregular eating schedules and inject insulin at regular intervals. For years his diabeteswas managed well.He is living away from his parents and siblings for the first time and lives in on-campusdormitory university accommodation. Over the past several months Nick has beenintroduced to many stressors that he is challenged by. He is away from the support of hisfamily he is responsible for his own meals and insulin management he is involved in awhole new social group and he is struggling to keep up with the workload of his course.In addition Nick is on the universitys rugby team and feels peer pressure from histeammates to engage in activities such as chasing girls binge-drinking late night fastfood runs skipping class pulling all-nighters before exams and extreme trainingschedules.Presentation to EmergencyAfter a night of hard-core partying friends found Nick looking unwell in the dormscommon room and brought him to the hospitals Emergency Department. Nicks friendsreported that they found him shaking and sweating uncontrollably and floating betweenbeing unconscious and irritable and uncooperative. They put him in their car and broughthim straight to the Emergency Department.Observations on arrivalUpon arrival Nicks observations were:
Blood pressure 140/94Pulse rate 116bpmRespiratory rate 26 breaths/min shallowTemperature 37.5oCO2 Sat 93%.
Skin diaphoretic warm and paleTremblingBlood glucose level 2.5mmol/LMedical diagnosis and treatment planThe doctor diagnoses Nick as having a hypoglycaemic episode. Nicks immediatetreatment includes the administration of SC 1mg glucagon and 50mL of 50% Glucose IVover 2 hours.Nick in the medical wardOn the wardIt is now three days later and Nicks condition is stable. You are the nurse assigned toNick for the duration of your shift on the medical ward. Nicks current vital signs are asfollows:BPPulseRRTemp O2 sats128/78 60 beats/min 16 breaths/min 37.5oC 97%He is alert and oriented to person place and time with no subjective complaints of pain.He is neurologically intact. His blood glucose level has stabilized to his pre-universitystate of 7.8 mmol/L (non-fasting state). He is eating regularly and his fluid intake is equalto his fluid output.Where to from here?Nick does not want his parents to discover that he is in the hospital for the second time inseven months and has asked the team not to inform his parents. After his last admissionin his first semester his parents were threatening to pull him out of university and havehim attend a local university so that he can return home.Nick is readmitted to hospital and transferred to themedical wardNick becomes unwell againIt is now at the end of the university year and Nick has represented to the local hospital.He presented to the Emergency Department late the previous evening very unwellcomplaining of vomiting for the past two days and admitted to skipping several doses ofinsulin recently. He mentioned that he was feeling feverish at home and reported anoccasional cough. He was transferred to the medical ward this evening from theEmergency Department and is assigned to your care.Whilst reading through Nicks notes from his assessment in the Emergency Departmentyou find the following: pain throughout all abdominal quadrants with cramping reportedin all four abdominal quadrants. He was extremely lethargic and difficult to rouse at times.He complained of severe thirst. His skin was extremely dry. Electrocardiogram (ECG)showed a sinus tachycardia at 120 bpm. Lungs were clear bilaterally but respirationswere deep and rapid. There was an acetone smell to Nicks breath. He denied alcoholand illicit drug use and could recall no drug or food allergies. He did report that one of hisaunts has type 1 diabetes mellitus.You are aware of Nicks social history as a university student. You notice Nicks lasthospital admission was for hypoglycaemia resulting from his university life style.However since Nick has presented with a different health issue related to his Type 1Diabetes you ask him about his current situation. Nick states I often struggle with thecosts of university and rugby and sometimes my medication runs out or I forget to get myscripts filled.During the past year Nick has been admitted to the hospital with the diagnosis ofhypoglycaemia once and diabetic ketoacidosis (DKA) once. In addition he had failed toattend two of his follow up appointments because he couldnt take time off university toattend appointments.On arrival at the EDObservationsOn arrival at emergency Nicks observations were:
BP 124/80HR 122 bpmRespirations 32/minTemperature 35.8o CUrinalysisHis initial urinalysis revealed:
Specific gravity: 1.015Ketones: 4+Leukocytes: fewGlucose: 4+Nitrates: 0RBCs: manyBloodsHis initial blood studies revealed:
Hgb: 14.5 g/dlHct: 58%Ca+: 8.8 mmol/LPhosphate: 6.8 mg/dlNa+: 126 mmol/LK+: 5.3 mmol/LCl-: 95 mmol/LCreatinine: 0.9 mg/dlBUN: 52 mg/dlGlucose: 254 mg/dlKetones positiveArterial blood gases
pH: 7.19PO2: 100 mm HgHCO3: 10 mEq/lPCO2: 20 mm HgSAO2: 98% (room air)MedicationsNicks daily insulin doses are as follows:
mane 16U 30/70 Humulinnocte 12U 30/70 HumulinWhilst in Emergency the priority of care for Nick was the correction of the following: fluidloss with intravenous fluids hyperglycaemia with insulin electrolyte disturbanceparticularly potassium loss and his acid-base balance. Fortunately he responded well tohis treatment and once his blood studies began to improve and he was able to tolerateoral fluids and food he was transferred to the medical ward for ongoing assessment overthe next three to five days.
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