Hello xx, excellent post. I agree with you; even though metformin remains the number one front-line drug for type 2 diabetes, about 25 percent of patients on metformin suffer GI-related side effects. There are a couple of actions that may contribute to side effects. Metformin increases glucose uptake in the intestine and increases lactate levels in the erythrocyte, contributing to intolerance. Metformin also increases the bile acid pool within the intestine, altering stool consistency, GLP-1 secretion, and cholesterol levels (McCreight, Bailey & Pearson, 2019). Modified-release formulations of the drug have been developed to help increase tolerability by spreading absorption along the gut (such as ER or XR), which may be a solution for many patients suffering side effects . One study suggests that switching from metformin tablets to capsules provided a significant 21.3% reduction in GI side effects. In addition to slow-release forms of metformin, I would advise my patients to stay hydrated and increase their fiber intake either through diet or Metamucil (McCreight, Bailey & Pearson, 2019).

 

References

 

McCreight, L., Bailey, C., & Pearson, E. (2019). Metformin and the Gastrointestinal Tract. Diabetologia, 59(3), 426–435. doi:10.1007/s00125-015-3844-9

Gastrointestinal mechanisms underlying the cardiovascular effect of metformin. (2020). Pharmaceuticals, 13(11), 410. doi:http://dx.doi.org/10.3390/ph13110410

 

xx

                                                            Response 2

 

Diabetes

Your post was an awesome discussion to read. I agree with you regarding metformin being a drug of choice for diabetes. My cousin does suffer from diabetes type one and takes metformin every day. Type 1 diabetes is a type of diabetes that is characterized by insufficient insulin production by the pancreas. It has been thought that this disease is caused by an autoimmune reaction where the body attacks itself by mistake and destroys the cells in the pancreas that make insulin. Individuals are usually born with this type of diabetes and cannot respond to blood glucose with insulin, and so must be medicated with insulin instead. “Scientists believe that this form of diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as a TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease” (NIH, 2019). Type 2 diabetes is the most common form of diabetes and is caused by several factors including lifestyle factors and genes. It develops over time in response to poor dietary habits. Individuals with type 2 diabetes have typically consumed great amounts of simple sugars and saturated fats and have basically overexposed their bodies to insulin-sensitizing substrates. As a result, insulin sensitivity greatly decreases, and the pancreas becomes inefficient at dealing with elevated blood glucose (NIH, 2019). Gestational diabetes occurs during pregnancy and is the result of a hormonal blockage at the placenta, preventing insulin from effectively reducing blood glucose. According to researchers, “GDM occurs in about 5% of pregnancies but figures vary considerably depending upon the criteria used and demographic characteristics of the population” (Kampmann et al., 2015). This results in elevated blood glucose (hyperglycemia) in the mother; after giving birth the condition will go away.

Juvenile diabetes is now referred to as Type 1 Diabetes. It occurs in children and can happen randomly when a child’s pancreas fails to produce insulin. “Amongst children developing diabetes who lack anti-islet autoantibodies, approximately 10 percent have defined monogenic diabetes disorders” (Babu & Eisenbarth, 2012).

Type II diabetes

Type II diabetes is commonly treated with a drug called Metformin HCL (Glucophage), a type of biguanide. While the precise mechanism of action is unknown, this drug decreases sugar production in the liver and increases insulin sensitivity in muscle cells. Metformin HCL is usually administered orally and should be taken with meals to reduce stomach/bowel disturbances. Metformin HCL is usually started at 500 mg twice a day or 850 mg once a day. Patients that are treated for DM type 2 should restrict their diets by avoiding processed sugars, monitoring their glucose intake, avoiding saturated and trans fatty acids, and consuming small amounts of calories at a time. The short-term impact of DM type 2 is a failure to deal with blood glucose spikes, which leads to symptoms like dizziness, increased thirst/urination, and fatigue/irritability. Taking Metformin HCL can also lead to side effects like physical weakness, diarrhea, flatulence, and muscle pain. It is important that the patient sticks to a schedule as directed by their healthcare provider as well as incorporate a physical fitness regimen that will also assist in blood sugar regulation based on newly adapted healthy lifestyle changes.

Reference

Babu, S., & Eisenbarth, G. S. (2012). Juvenile diabetes. Indian Journal of Medical Research, 136(2), 179–181. Retrieved December 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461727/

 

Kampmann, U., Lene ring Madsen, Gitte Oeskov Skajaa, Ditte Smed Iversen, Moeller, N., & Ovesen, P. (2015, July 25). Gestational diabetes: A clinical update. World Journal Diabetes. Retrieved December 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515446/

 

NIH. (2019). Symptoms and Causes of Diabetes. National Institute of Diabetes; Digestive and Kidney Diseases. Retrieved December 30, 2020, from https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes

 

                                                           

 

 

xx

I enjoyed reading your week 5 discussion post. I found it interesting that both of us didn’t mention consulting a dietitian. Weight control is one of the recommendation to either eliminate the risk of having diabetes or eliminating and getting your diabetes under control. I’m also saying that from my own experience. I didn’t have a dietitian consult. According to (Sergeaant & Dyson, 2018) a dietician’s perceptive weight management programs which are unsuccessful  needs to address specific eating behaviors such emotional and binge eating behaviors  because they will likely not be successful over a long term. Mindfulness-based interventions has increased in interest as a component of weight management programs.

As we both mentioned medication management is also important.  According to (Yerevanian & Soukas, 2019), Metformin remains a primary treatment not only for type 2 diabetes but for obesity and as a weight loss agent. As nurse practitioners we should be mindful of multiple ways that we can help our patient’s be successful in their journey.

References

Sergeant, C., Dyson, P.A. Diabetes and Diet: A Patient and Dietitian’s Perspective. Diabetes  

               Ther 9, 1733–1739 (2018). https://doi.org/10.1007/s13300-018-0500-7

Yerevanian, A., & Soukas, A. A. (2019). Metformin: Mechanisms in Human Obesity and Weight

                Loss. Current Obesity Reports, 8(2), 156–164. https://doi.org/10.1007/s13679-019-

00335-3

Great information xx. Hypoglycemia is the main thing to worry about in the short-term. Another disadvantage of insulin is the potential for weight gain you see with long-term use. Considering that many of these patients are obese and this has been the trigger for their disease, you can understand why this may be a reason to look at alternatives. That is why the GLP-1 agonists are becoming preferred treatments for diabetes, because they offer similar A1C reductions without the weight gain.

Hello Nichole!  I found your post informative and interesting.  With Type 1, or Juvenille, Diabetes I have found that insulin pumps are literally a lifesaver for them!   I have a friend’s daughter that has an insulin pump.  It constantly monitors her blood glucose level and gives her insulin as needed.  It also has an app for her phone and shows trends, glucose levels, and how often she needed insulin.  The long term affects of having to monitor and control your disease process over the years leads to psychological burden (Kelly, 2021).  The insulin pump takes much of this burden away.  People with Type1 Diabetes that has constant glucose monitoring felt they had more freedom to live their lives due to more confidence in their ability to detect and control hypoglycemic conditions (Klak, Manczak, Owoc, & Olszewski, 2021).

 

References:

Kelly, B.  (2021).  Nursing interventions for people with type 1 diabetes and frequent hypoglycaemia.  British Journal of Community Nursing, 26(11), 544-552.

Klak, A., Maczak, M., Owoc, J., & Olszewski,  R.  (2021).  Impact of continuous glucose monitoring on improving emotional well‑being among adults with type 1 diabetes mellitus: A systematic review and meta‑analysis. Polish Archives of Internal Medicine, 131(9), 808-818 Diabetes and Drug Treatments Discussion post.

xx

Alternative Treatments

People with type 1 diabetes must take insulin since their bodies can not make insulin. You have covered prandial insulin, which covers increases in blood glucose levels following meals. Since insulin is the choice for type 1 diabetes, an alternative would be a different type of insulin. Some people can use long-acting insulin alone or with prandial insulin. Long-acting insulin helps to lower your blood glucose levels between meals in small amounts. Unlike short-acting insulin, long-acting insulin does not peak, and can help control your blood glucose levels for an entire day. There are currently four different types of long-acting insulin available. Lantus lasts 24 hours and some like Tresiba can lasts for 48 hours. You inject yourself once a day with long-acting insulin. It is best to take it at the same time everyday to avoid lags in insulin coverage (Watson, 2019). Some patients, however, may require twice daily injection to achieve the full 24-hour basal coverage. Lantus is an example of a long-acting insulin. It works by forming microprecipitates that slowly dissolve and thereby release the insulin in small amounts over an extended period (Rosenthal & Burchum, 2020, p 404).

Patient Education Strategies

A good website to give to patients for diabetes management, which includes type 1 and type 2 diabetes with treatments, self-care, nutrition, meal planning, etc. is https://www.hopkinsmedicine.org/gim/faculty-resources/core_resources/Patient%20Handouts/. This website provides easy to understand information to help inform the patient on how to handle type 1 diabetes. Another strategy is to provide the patient with a nutritionist. A nutritionist can help guide the patient on meal planning and carbohydrate counting. Having someone to answer questions and provide demonstration may be the best way some people learn Diabetes and Drug Treatments Discussion post. Also provide the patient with a diabetic specialist so that they can review the patient’s glucose log and go over food choices that may have impacted the results, as well as foot care. Telling someone that they cannot eat specific foods is less effective than helping them directly observe through monitoring what specific foods can eat through their blood glucose levels. Personalized education gives patients the information and motivation to make healthier choices. Also providing handouts with many pictures and the appropriate language would be beneficial. You can also do a teach back method, where the patient must demonstrate what has been taught to them, for example, the proper way to administer insulin injections or having the patient write out a meal plan that with the appropriate carbohydrate count so that you can go over the choices and the patients understanding. Although this information was found in an article for diabetes and pregnancy, the strategies can be used for any diabetic patient. (Goldschmidt & Colletta, 2016, p.101-104) Diabetes and Drug Treatments Discussion post.

References

Goldschmidt, V. J., & Colletta, B. (2016). The challenges of providing diabetes education in resource-limited settings to women with diabetes in pregnancy: Perspectives of an educator. Diabetes Spectrum, 29(2), 101-104. https://doi.org/10.2337/diaspect.29.2.101

Rosenthal, L., & Burchum, J. (2020). Lehne’s Pharmacotherapeutics for advanced practice providers (2nd ed.). Saunders.

Watson, S. (2019, September 27). Long-acting insulin: How it works. Healthline. https://www.healthline.com/health/diabetes/long-acting-insulin#right-for-you  Diabetes and Drug Treatments Discussion post