Patients With Type 2 Diabetes Mellitus

Answer: The combination of Insulin as well as oral hyperglycaemic drugs may be prescribed for Diabetes because they help in lowering the blood glucose levels. However the primary treatment doesn’t consist of these drugs. The primary treatment comprises of Diet control, Physical activity and Weight control. If after following the primary treatment strictly, no improvement in the blood glucose level is achieved then medication is suggested for the same. Insulin helps in maintaining the blood sugar levels. Note that insulin is not to be taken orally because the acids and digestive juices in the stomach destroy it. It has to be injected under the skin only. Taking insulin leads patient to experience Hyperglycaemic condition. The Hyperglycaemic drugs helps our body to react appropriately with the insulin so that the insulin hormone is able to help transfer glucose from blood to the cells successfully.

The person is on an oral drug that increases the risk of hypoglycaemia whilst driving or operating heavy machinery (e.g. sulphonylureas)•

Diabetes is a growing but preventable health concern in the United States.1 It is a problem in the body where blood glucose levels rise higher than normal.1 According to the facts released by the American Diabetes Association in 2013, 25.8 million Americans (8.3%) have diabetes 2 and approximately 90% of all cases of diabetes worldwide are considered type 2 diabetes.3 Type 2 diabetes is a progressive disease where the body cannot use insulin properly and the patient ends up using an oral hypoglycemic agent.1 One of the many classes of medications to help manage diabetes is sulfonylureas, including glyburide and glipizide. These drugs close K-ATP channels on Beta cell membranes and cause the pancreas to release more insulin to lower blood sugar.4 Both glipizide and glyburide are metabolized in the liver5, have high protein binding5, and can decrease hemoglobin A1c (HbA1c) up to 1%-2%.6 According to the Health Insurance Association of America, health insurance is defined as "coverage that provides for the payments of benefits as a result of sickness or injury".7 Insurance companies always strive to achieve their target glycemic goal via the most effective and cost effective therapeutic strategy.8 A literature search was conducted to find data on the benefits of converting patients from glyburide to glipizide to find out why insurance prefers the switch.

Reason for Referral: Mrs. R was misdiagnosed with Type two diabetes a few years ago. She was re-tested and found to have Type one. The misdiagnosis by her general practitioner (GP) caused her to lose weight, become anemic, depressed, and unable to sleep as a result of taking the wrong medications. It has taken her two-and-a-half-months to have an appointment with an endocrinologist to find out she was misdiagnosed. She has been diabetic for at least 9 years.

Tina does not regularly monitor her blood sugars, and has stopped taking Metformin the medication that stimulates the pancreas to make more insulin. Tina's present condition of uncontrolled Diabetes Mellitus, manifested by a blood glucose level of 238, combined with her poor dietary habits, and sedimentary lifestyle

The estimated time for the teaching session is approximately 3 hours. In the first hour I will give a brief overview of what diabetes is and how it can be controlled with insulin. First I will include a very simple explanation of the pathophysiology of the disease and the signs and symptoms that are common. Next, I will explain that when controlling diabetes, her blood sugar can become too high or too low. High blood sugar, or hyperglycemia is caused by eating too much food, eating sugary foods, or by not taking insulin as prescribed. Signs of high blood sugar include: dry mouth, thirsty, having to urinate often, blurry vision, feeling tired, and weight loss. If high blood sugar is not treated, it can cause you to go into a coma (Aldridge, 2005 p.36-37). When you have high blood sugar, drink water and take your insulin according to the sliding scale your doctor has provided. Low blood sugar, or hypoglycemia, can occur

The American Association of Clinical Endocrinologist (AACE) treatment goals are individualized and aimed at lowering A1C and prevention of hypoglycemia along with decreased comorbidities associated with diabetes. Diabetics who are at an increased risk for hypoglycemia include: a diagnosis of greater than 15 years, advanced macrovascular disease, hypoglycemia unawareness, limited life expectancy and severe comorbidities (Garber, Blonde, Bush, Einhorn, & Garber,et al., 2017). In addition Fowler (2010) notes that those with renal or hepatic dysfunction are at an increased risk for hypoglycemia due to the combination of less endogenous glucose production and longer insulin half life. This combination can result in a rapid lowering of glucose.

It was 2 a.m. when Mr. H, a 52 year old man, arrived to the Emergency Department accompanied by his brother complaining of dizziness and hyperglycemia. Upon arrival Mr. H’s glucose level was 500 mg/dl. It was not the first time for Mr. H to visit the Emergency Department complaining of glucose intolerance; he is a regular visitor. In addition to diabetes, Mr. H has a history of hypertension, dyslipidemia, vision and respiratory problems. He was treated with insulin and put under supervision for 24 hours. Once his glucose reached normal level, he was given brief instructions and discharged.

Diabetes is one the most critical medical issues of our time. According to the Center of Disease Control and Prevention nearly 26 million Americans (approximately 8% of all Americans) have diabetes and an estimated of 79 million adults are pre-diabetes. Approximately $200 billion per year is lost due to diabetes because of medical treatments and lost wages. Insulin resistance and the dysfunction of beta cells are the two pathogenic hallmarks of the development and progression of T2DM. Studies have shown that pancreatic beta cell functional mass is affected in T2DM (1, 2). Secretion of insulin stimulated by glucose is lower in human islets of Langerhans isolated from patients with T2DM than from normal individuals (1, 3). Knowledge of the molecular mechanism underlying defects in beta cell function found in humans and animal models of T2DM is incomplete. Without a more complete understanding of the mechanisms that regulate beta cell insulin secretion we will be unable to develop new approaches to prevent and treat diabetes.

Diabetes Mellitus is a chronic health condition in which the level of glucose in the blood is higher than usual. Type 1 diabetes occurs when the pancreas does not create enough insulin and type 2 diabetes occurs when insulin is produced, but is not adequate in lowering blood glucose levels or there is resistance to the insulin (Edwards, 2007, p. 9). Diabetes mellitus is the leading cause of end-stage kidney disease, foot and leg amputations, and new cases of blindness in the United States (Ignatavicius & Workman, 2010, p. 1465-66). People with type 1 diabetes are required to take insulin to manage their glucose levels. People with type 2 diabetes are usually prescribed oral medications such as sulfonylurea agents, meglitinide

The nursing process takes several aspects. It takes it consideration the pathophysiology of the diabetes and life and activities of the prognosis patients. Parents should be able to instill discipline on their diseased children on the need to follow religiously the dose and also discipline in testing. In contrast, treatment is considered a burden for many juveniles. There are major complications or problems associated with this chronic disease. They are linked with low blood sugar and also high blood sugar. For instance, low blood sugar is responsible for causing seizures and periods of unconsciousness. Such symptoms usually call for emergency treatment. On the other hand, high blood sugar levels lead to heightened fatigue which can damage important internal functional body organs.

Hypoglycemia- frequent monitoring of blood glucose levels, monitoring for symptoms of hypoglycemia, such as, but not limited to anxiety, feeling shaky or nervous, having chills, feeling sweaty, but skin is cool and clammy. Also becoming confused, with an increased heart rate, and being light headed or dizzy. ("Diabetes Forecast," 2013) Intervention as needed to increase blood

• If the repeat blood glucose level is still at or below 70 mg/dL (3.9 mmol/L), take 15–20 grams of a carbohydrate again.

Hypoglycemia is a condition characterized with abnormally low blood sugar. Some symptoms include: nervousness or anxiety, shakiness, sweating, chills, clamminess, impatience or irritability, confusion, dizziness, rapid heartbeat, hunger or nausea, impaired or blurred vision, headache, weakness or fatigue, lack of coordination, and if severe enough unconsciousness and seizures. (diabete.org) This condition is also known as hyperinsulinism, which is caused by “excessive insulin secretion, resulting in low blood glucose levels.” (Marieb pg. 624.) For those with diabetes hypoglycemia can “result if a person takes too much insulin, does not eat enough food, or the right kinds of foods.” (Smith, pg. 264) This condition, for both diabetic and non-diabetic,

This is the first case report on blood glucose management with these conditions in worldwide. Clinical pharmacists assisted physicians in making individualized regimen to improve the therapeutic efficacy and ensure the patient safety.