Week 4 discussion resp 1 prac 6540
.docx
keyboard_arrow_up
School
Walden University *
*We aren’t endorsed by this school
Course
6540
Subject
Biology
Date
Jan 9, 2024
Type
docx
Pages
2
Uploaded by PresidentToad515 on coursehero.com
Ms. Peters has been on Metformin, and her HgbA1c is 7.2%. Do you think it is time to introduce another anti-glycemic agent? If yes, which one, and why?
Hello Martha,
Great post, and to answer your question, I will add that long-term, most people with Type
2 diabetes (T2DM) will need drugs to attain and maintain glycemic control, even though lifestyle
adjustments, including dietary modification and increased physical activity, can be quite effective in improving glycemic control short term.
First-line treatment of type 2 diabetes mellitus often consists of biguanide metformin, which is effective alone and in conjunction with other glucose-lowering drugs. It has low costs, few adverse effects, and is safe for most people. It has low costs, few adverse effects, and is safe for most people. Although metformin's safety and efficacy have been established, there is debate about whether it should remain the primary choice for therapy because other anti-hyperglycemic drugs display significant advantages in some patient categories.
Metformin inhibits hepatic gluconeogenesis, decreases intestinal glucose absorption, enhances tissue glucose uptake, and elevates GLP-1 secretion are all mechanisms by which metformin lowers blood sugar levels(Baker et al., 2021
)
. Alterations in gut flora decreased inflammation, and fewer cases of cancer and depression are a few more of metformin's many benefits. Caenorhabditis elegans live longer after being treated with metformin. Metformin decreases mitochondrial complex I activity, leading to lower ATP levels, higher adenosine monophosphate (AMP) levels, and activation of AMP-activated protein kinase (Baker et al., 2021
)
.
Regarding Ms. Peters, I do not think she would benefit from adding another antihyperglycemic drug to her current regimen. Metformin, at a minimum dose of 500 mg daily, has been shown to reduce glycated hemoglobin (HbA1c) levels by an average of 0.9% (Baker et al., 2021
)
. The maximum metformin dose is 2500 mg, although most doctors only prescribe 2000
mg daily because going higher does not do much to lower HbA1c and causes more harmful effects. Her elevated HBA1C can be reduced to average with a dose increase of 2000 mg. Optimizing metformin to 2000 mg daily or the maximum tolerable lower dose improves glycemia in type 2 diabetes, according to a recent study, providing more evidence that metformin's efficacy is dose-dependent(Baker et al., 2021
)
.
Ms. Peters should be given a prescription with the increased dose and monitored for another three months with a repeat blood work to check for improvement. If there is none, then a second agent can be added. References
Baker,
C., Retzik-Stahr,
C., Singh,
V., Plomondon,
R., Anderson,
V., & Rasouli,
N. (2021). Should metformin remain the first-line therapy for treatment of type 2 diabetes?
Therapeutic Advances in Endocrinology and Metabolism
,
12
, 204201882098022.
https://doi.org/10.1177/2042018820980225
Feingold KR. Oral and Injectable (Non-Insulin) Pharmacological Agents for the Treatment of Type 2 Diabetes. [Updated 2022 Aug 26]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK279141/
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Related Questions
Which of the following scenarios would lead to severe hypoglycemia?
Choice 1 of 6: A non-diabetic individual injecting themselves with a small amount of glucagon after eating chips and guacamole
Choice 2 of 6: A type 2 diabetic person taking a 45-minute indoor cycling class while fasting
Choice 3 of 6: A type 1 diabetic eating a dozen Krispy Kreme donuts
Choice 4 of 6: A type 1 diabetic that injects themselves with high amounts of insulin after eating a low carbohydrate meal
Choice 5 of 6: An individual with a mutation that renders their pancreatic beta cells nonfunctional
Choice 6 of 6: An individual with a mutation that renders their GLUT4 transporters nonfunctional
arrow_forward
Which of the following is true about the pathophysiology of hypoglycemia?
Question 62 options:
a)
Glucagon decreases glycogenolysis and gluconeogenesis in the liver
b)
Autonomic symptoms are caused by increased levels of glucagon which then stimulates the hypothalamic-pituitary-adrenal axis
c)
Beta cells suppress insulin secretion at a plasma glucose level of 3 mmol/L
d)
Abrupt cessation of glucose delivery to the brain results in confusion, drowsiness, vision changes, and headache
arrow_forward
If a type I diabetic client takes too much insulin, what clinical manifestations would alert the nurse to the fact that the client has become hypoglycemic?
Question 11 options:
confusion and cool, clammy skin
fruity smelling breath and urinary ketones
tremors of the limbs and bradycardia
complaints of abdominal pain and nausea
arrow_forward
Given a case of a patient with type 1 diabetes, how would you adjust their care plan if they report frequent hypoglycemic episodes?
arrow_forward
An unresponsive client who has diabetes is brought to the emergency department with rapid, deep respirations. Additional findings include: blood glucose 24.9 mmol/L, arterial pH 7.2 and urinalysis showing presence of ketones and glucose. Which of the following statements best describes the underlying cause of this patient’s presentation?
Question 64 options:
a)
Relative insulin deficiency, causing hyperglycemia, oxidative stress, renal dysfunction and acidosis
b)
Nocturnal elevation of growth hormone resulting in hyperglycemia in the morning
c)
Absolute insulin deficiency, increased counter-regulatory hormone, lipolysis and free fatty acid release
d)
Hypoglycemia causes release of glucagon, resulting in glycogenolysis and hyperglycemia
arrow_forward
Which of the following describes a feature of the pathophysiology of type 2 diabetes?
Question 15 options:
a)
It is usually an autoimmune disease
b)
The pancreas makes little or no insulin
c)
Diabetic ketoacidosis is a common complication
d)
The liver increases production of glucose
arrow_forward
Which of the following medications, when taken prior to eating, is especially effective for correcting postprandial hyperglycemia after a high-carbohydrate meal, so that hypoglycemia post dosing is minimized?
Acarbose
Glyburide
Glitazone
Tolbutamide
arrow_forward
Which of the following best describes the role of the hexosamine pathway in the pathogenesis of the chronic complications of diabetes mellitus?
Question 79 options:
a)
It involves irreversible binding of glucose to proteins, lipids and nucleic acids which damages components of the microcirculation leading to retinopathy, etc.
b)
It promotes the O-linked glycosylation of proteins and transcription factors, resulting in altered gene expression contributing to insulin resistance & cardiovascular complications
c)
It promotes the synthesis of DAG which increases pro-inflammatory gene expression and endothelial ET-1 production resulting in blood flow abnormalities
d)
It leads to intracellular accumulation of osmotically active sorbitol and fructose which damages Schwann cells, erythrocytes and the lens of the eye
arrow_forward
If Elaine is diagnosed with Diabetes Mellitus Type II, which of the following is NOT true?
Her body cells have likely become insulin resistant.
She will need to make lifestyle changes, including changes to her diet and exercise routine.
If she does not treat her condition, she could develop metabolic ketoacidosis.
Insulin injections will likely be required.
arrow_forward
Insulin should be prescribed under all of the following circumstances, except:A. Status post pancreatectomyB. Type 2 diabetes with diabetic foot syndrome C. Type 1 diabetesD. Gestational diabetesE. Type 2 diabetes
arrow_forward
Patient T., 26 y/o, is in the intensive care unit with a ketoacidotic coma. Her consciousness is clouded, eye ball tone is lowered, arterial pressure - 90/60, pulse - 130 beats/minute, glycemia -35 mmol/l, PH - 7.1. The content of ketone bodies is 18 mg %. How would you manage this patients?
A. Introducing 10-20 units of insulin at first by stream infusion and then by drip infusion during 1 hour by 0.05-0.1 units/kg/hour till the termination of ketoacidosisB. Introducing 500ml 5% glucose solutionC. Introducing 4% sodium carbonate 2.5 ml/kgD. Introducing 40 – 60 units of insulin hourlyE. Introducing 500 ml 0.9% sodium chloride
arrow_forward
Discuss the role of carbohydrates in managing patients diagnosed with Diabetes mellitus
arrow_forward
SEE MORE QUESTIONS
Recommended textbooks for you
Essentials of Pharmacology for Health Professions
Nursing
ISBN:9781305441620
Author:WOODROW
Publisher:Cengage
Related Questions
- Which of the following scenarios would lead to severe hypoglycemia? Choice 1 of 6: A non-diabetic individual injecting themselves with a small amount of glucagon after eating chips and guacamole Choice 2 of 6: A type 2 diabetic person taking a 45-minute indoor cycling class while fasting Choice 3 of 6: A type 1 diabetic eating a dozen Krispy Kreme donuts Choice 4 of 6: A type 1 diabetic that injects themselves with high amounts of insulin after eating a low carbohydrate meal Choice 5 of 6: An individual with a mutation that renders their pancreatic beta cells nonfunctional Choice 6 of 6: An individual with a mutation that renders their GLUT4 transporters nonfunctionalarrow_forwardWhich of the following is true about the pathophysiology of hypoglycemia? Question 62 options: a) Glucagon decreases glycogenolysis and gluconeogenesis in the liver b) Autonomic symptoms are caused by increased levels of glucagon which then stimulates the hypothalamic-pituitary-adrenal axis c) Beta cells suppress insulin secretion at a plasma glucose level of 3 mmol/L d) Abrupt cessation of glucose delivery to the brain results in confusion, drowsiness, vision changes, and headachearrow_forwardIf a type I diabetic client takes too much insulin, what clinical manifestations would alert the nurse to the fact that the client has become hypoglycemic? Question 11 options: confusion and cool, clammy skin fruity smelling breath and urinary ketones tremors of the limbs and bradycardia complaints of abdominal pain and nauseaarrow_forward
- Given a case of a patient with type 1 diabetes, how would you adjust their care plan if they report frequent hypoglycemic episodes?arrow_forwardAn unresponsive client who has diabetes is brought to the emergency department with rapid, deep respirations. Additional findings include: blood glucose 24.9 mmol/L, arterial pH 7.2 and urinalysis showing presence of ketones and glucose. Which of the following statements best describes the underlying cause of this patient’s presentation? Question 64 options: a) Relative insulin deficiency, causing hyperglycemia, oxidative stress, renal dysfunction and acidosis b) Nocturnal elevation of growth hormone resulting in hyperglycemia in the morning c) Absolute insulin deficiency, increased counter-regulatory hormone, lipolysis and free fatty acid release d) Hypoglycemia causes release of glucagon, resulting in glycogenolysis and hyperglycemiaarrow_forwardWhich of the following describes a feature of the pathophysiology of type 2 diabetes? Question 15 options: a) It is usually an autoimmune disease b) The pancreas makes little or no insulin c) Diabetic ketoacidosis is a common complication d) The liver increases production of glucosearrow_forward
- Which of the following medications, when taken prior to eating, is especially effective for correcting postprandial hyperglycemia after a high-carbohydrate meal, so that hypoglycemia post dosing is minimized? Acarbose Glyburide Glitazone Tolbutamidearrow_forwardWhich of the following best describes the role of the hexosamine pathway in the pathogenesis of the chronic complications of diabetes mellitus? Question 79 options: a) It involves irreversible binding of glucose to proteins, lipids and nucleic acids which damages components of the microcirculation leading to retinopathy, etc. b) It promotes the O-linked glycosylation of proteins and transcription factors, resulting in altered gene expression contributing to insulin resistance & cardiovascular complications c) It promotes the synthesis of DAG which increases pro-inflammatory gene expression and endothelial ET-1 production resulting in blood flow abnormalities d) It leads to intracellular accumulation of osmotically active sorbitol and fructose which damages Schwann cells, erythrocytes and the lens of the eyearrow_forwardIf Elaine is diagnosed with Diabetes Mellitus Type II, which of the following is NOT true? Her body cells have likely become insulin resistant. She will need to make lifestyle changes, including changes to her diet and exercise routine. If she does not treat her condition, she could develop metabolic ketoacidosis. Insulin injections will likely be required.arrow_forward
- Insulin should be prescribed under all of the following circumstances, except:A. Status post pancreatectomyB. Type 2 diabetes with diabetic foot syndrome C. Type 1 diabetesD. Gestational diabetesE. Type 2 diabetesarrow_forwardPatient T., 26 y/o, is in the intensive care unit with a ketoacidotic coma. Her consciousness is clouded, eye ball tone is lowered, arterial pressure - 90/60, pulse - 130 beats/minute, glycemia -35 mmol/l, PH - 7.1. The content of ketone bodies is 18 mg %. How would you manage this patients? A. Introducing 10-20 units of insulin at first by stream infusion and then by drip infusion during 1 hour by 0.05-0.1 units/kg/hour till the termination of ketoacidosisB. Introducing 500ml 5% glucose solutionC. Introducing 4% sodium carbonate 2.5 ml/kgD. Introducing 40 – 60 units of insulin hourlyE. Introducing 500 ml 0.9% sodium chloridearrow_forwardDiscuss the role of carbohydrates in managing patients diagnosed with Diabetes mellitusarrow_forward
arrow_back_ios
arrow_forward_ios
Recommended textbooks for you
- Essentials of Pharmacology for Health ProfessionsNursingISBN:9781305441620Author:WOODROWPublisher:Cengage
Essentials of Pharmacology for Health Professions
Nursing
ISBN:9781305441620
Author:WOODROW
Publisher:Cengage