Diabetes: Types, Care of Patients and Medications

Introduction

Out of the most common diseases in the world that affects people of all ages is diabetes. Many factors can contribute to different people suffering from diabetes, some of them include the lifestyles people to adapt, genetic inheritance, and ethnicity among other reasons. It is critical to identify what diabetes is. It is a metabolic disorder that leads to high blood sugar, also referred to as hyperglycaemia. In other simpler terms, diabetes is a chronic condition that alters the way the body metabolizes glucose There Aare two types of diabetes, one and two. Type 1 diabetes is caused when the immune system of the body is fighting all kind of infections, attacks which end up destroying the insulin-producing beta cells in the pancreases. According to scientists, type one is caused by environmental factors like viruses and genes which trigger it. Type 2 diabetes, on the contrary, is a long-term condition that affects the way the body does not utilize insulin appropriately thus leading to abnormal blood sugar levels

The history of diabetes

Normally, when food is broken down to its simpler structures (digested), the enclouded glucose is absorbed into the bloodstream thus leading to the increased blood sugar levels in the body. The pancreases, on the other hand, are known to produce a very vital hormone called insulin. The islets of Langerhans help in regulating the amount of glucose in the blood by attaching it to the insulin receptor. This allows an opening to the glucose channel for a series of reactions to take place.

Diffusion then occurs when glucose in the bloodstream moves from a region of high concentration to a low one and the cells be used for generating energy. It is expected that when the diffusion in the blood occurs the sugars will lower in terms of amount to its normal level, but the case is different in diabetic patients. In a diabetic patient, glucose is not permeable through the cells because of two unlike contexts from the two types of diabetes, type one and two. The first reason is that the pancreases are not able to produce enough insulin. This will cause an increase in blood sugar since glucose will require insulin first before entering through the walls of the blood cells. This situation will more likely occur in type one diabetes due to the cells which contain genetic disorders. The second scenario can occur in diabetes type two due to many reasons below;

1. Diabetes type one affects patients in their early ages while type two in their old age.
2. The other reason is that insulin receptors are desensitized.

Considering how medication adherence is complicated, there is reason to support the fact that there are factors like ethnicity and age.based on a report that highlights a patient’s adherence to drugs that treat diabetes type 2 can gage in between 36% and 93%. This would depend on the diverse populations ( Aloudah et al,. 2018).

Symptoms and signs of diabetes

1. Some several noticeable signs and symptoms are as a result of this disease. They include;
2. Unexplainable increased thirst
3. Frequent urination
4. One is fatigued even though they engaged in fewer activities during the day
5. Blurred vision
6. Excessive Hunger attacks
7. Wounds take time before they eventually heal
8. Drastic weight gain or patients can just lose a lot of weight.

How to take care of patients suffering from diabetes

Diet

It is important to take note of what diabetes patients eat. Type two diabetes requires the patient to eat healthily and ensuring a properly balanced diet is maintained. This comprises of the complex carbohydrates like quinoa, whole wheat products (brown bread and sugar), oatmeal, cereals and vegetables. The simple carbohydrates (processed foods) that are luxuries and fancied by many are supposed to be avoided since they are liabilities to the body. They include pasta, white bread, cookies, sugar etc.

Sedentary lifestyles

A sedentary lifestyle refers to involving a person in little or no physical activity. The doctor would many recommend that a diabetic sit and lay down most of the time while engaging in less extraneous activities like watching tv, reading books, socializing with friends and family and many more. This kind of lifestyle is advised for them as it will make them not to be over fatigued. On the contrary, all the resting with no play makes the body quite lazy and can cause great damage to the health of a person, i.e. gaining excess weight, high blood pressure or even the coronary heart disease. When one is active, automatically the insulin resistance decreases and thus helps to effectively work in the body.

Role of the pharmacist

The aim is to help the diabetics attain the best clinical outcomes by educating and supporting their self-management. Their role also pertains working hand in hand with doctors and advise accordingly based on their requirements. They also assist them to follow their medical regime and consider their beliefs too.

Awareness creation by the community

The community can also play a very essential role by creating awareness among the people. They may decide to come up with fliers or posters to help them educate the rest of the community on diabetes in general. What it is, its symptoms and signs, how to treat it and ways of avoiding it. This would give them a rough idea of how it is even acquired and how to go about it.

Diseases that arise as a result of diabetes

Many health complications are likely to arise as a result of diabetes, they include;

1. Nephropathy (diabetic kidney damage)
2. Alzheimer’s disease
3. Cardiovascular disease
4. Neuropathy (nerve damage)
5. Damage of the foot (foot problems)
6. Diabetic Skin conditions
7. Diabetic eye and ear problems
8. Bladder problems
9. The gum diseases

Medications to treat type two diabetes

The patient must always ensure that he/she has taken the diabetes drugs prescribed to them even though they feel better. There are specific drugs that are used to treat diabetes. There are moredrugs that are currently being developed and very close to being approved (Rendell and Kirchin, 2000). Although there are many drugs that can treat diabetes 2, it is important for the medical practitioner to first consider factors like side effects, costs, effectiveness and the patient’s own preference (Excellence, 2019). In addition, healthcare givers need to make sure that the regimen of the patient is well tailored as well as the concurrent medication of the patient especially if he or she has past medical history. The first line treatment of diabetes type 2 is by using the Metformin drug, as long as there are no issues with tolerance ( Tschope et al, 2013).

Based the dosing requirement of BNF, metformin is to be administered as follows; the initial dosage is 500mg one time daily for a minimum of one week which is to be taken during breakfast. Later, 500mg is to be taken twice on a daily basisfor a week with both dinner and breakfast . lastly, 500mg is to be taken thrice daily for a whole week with all the three meals. Howvwer, it is important to take note that 2g is the maximum allowance of metformin.

Socioeconomic issues faced by the diabetics while taking their medicine

They include the; cultural norms, prejudice, ethnicity, and the varying needs of patients and caregivers

1. The cultural beliefs according to adherence, use and perception medicines.

There are some cultures which brand those people with diabetes as a taboo in their community. This can lower the self-esteem of the diabetic.

There are some religions such as Islam which strictly expect everyone to comply with the rules. I.e. during the fasting period. This would completely deter with the diet plan of a diabetic since he or she needs to adhere t their medicine intakes as instructed by the physician.

2. Prejudice, discrimination linked with diabetes.

Diabetics suffer preconceived opinions of their colleagues at work which is not based on reason or physical experience. This also leads to unjust treatment by other people based on their illness. Most times people with diabetes experience a lack of support and understanding from those around them. This builds up stigmatization and thus damaging their self-actualization potential. Employers should revise their workplace policies so that the whole environment is conducive for everyone to work comfortably.

3. Ethnicity/gender/ age groups that are at risk of being diabetic

According to researchers, male domination is more susceptible to having diabetes than women.

People who range from the middle age to the old are at a higher risk of developing diabetes along the way. Only a few develop diabetes type 1 while still young.

People who live in Asia, North Africa and the Middle East are more predisposed troy experience diabetes types two than those who have settled in other countries.

4. The role caregivers play in the lives of friends and family who suffer from diabetes.

• They support them by escorting them to support group.
• Impact knowledge they have on diabetes to the diabetics and encourage them daily not to lose hope.
• Ensuring that they take their medicines on time
• They also help keep track of their blood sugar levels.
• They take care of all the chores in the home so that the diabetics get enough rest
• They are on the lookout for any accidents that may cause injuries to their feet. ( may keep away all sharp objects)
• They ensure that the doctor’s appointments are on point and are attended.
• They exercise accordingly and check on their weight.
• Lastly, they ensure the ones they administer care to have a properly balanced diet.

5. Economic stability in states and individual families

We can not assume that every individual can afford the right treatment for diabetes. There are countries whose economic stability is wanting. Most people lie in the lower class level. The drugs and treatment are costly for them considering how many of them lack medical insurance. This greatly incapacitates their ability to access medical attention.

Practicing care through personalization

There are situations when the patient does not experience any of the symptoms above. (This is dangerous). The above-listed signs should indicate that care is administered immediately. For example, the patient is supposed to floss and brush their teeth daily to ensure healthy gums, teeth and mouth. They should also avoid smoking to maintain a trace of their blood sugar levels. They are to avoid cuts, blisters and swellings on their feet too by checking now and then.

The potential application of genomics to the prediction, prevention and treatment of diabetes

The human genome project has been anticipated to have undergone completion of 10 yrs. ago where new approaches of discovery, prediction and treatment are improved. The new drug targets and genomic details can be used to predict this disease. Meigs et al conclude that the genetic risk scores that had 18 variants were linked to the possibility of developing type 2 diabetes. Biological channels apart from heritable changes in DNA and metabolomics profiles of amino acids also play a role in predicting diabetes. The diabetes prevention program tends to reduce the risk of type2 diabetes by more than half. Genetic tests not only predict and prevent diabetes but also discriminate the two types of diabetes, and improved the glucose-lowering treatment. However, classifying individual cases into subtypes based on the genetic evaluation is difficult.

Challenges faced when conducting genomic research

1. Pharmacists have proven that identifying pharmacogenomics associations with phenotypes that are complex like stroke/ quantitative traits like cholesterol-lowering is difficult.
2. There is limited power to detect associations
3. The more user are restricted from consuming a drug the more studies in that area of research are limited
4. Most reported pharmacogenomics findings fail to replicate leading to lack of clinical validity

Pharmacokinetics affecting drug response

Pharmacotherapy of diabetes mellitus

Diabetes is diagnosed once the fasting plasma glucose is greater than or equal to 126mg/dl, (Naser Tadvi., n.d)

Type1 is due to absolute insulin deficiency and islet cell damage while type 2 is as a result of insulin deficiency and beta cells that have been impaired.

Type 1 Type 2

Genetic predisposition moderate very strong

Deficiency beta cells are destroyed. Insulin resistance as a result of

Production is eliminated beta cells being unable to

Produce quantities

Nutritional status frequent malnutrition presence of obesity

Prevalence 5 to 10% of diagnosed diabetics 90 to 95% of diagnosed diabetics

Complying with the treatment regime

Patients are required to adhere to taking their prescribed medications as instructed. Studies conclude that all those patients who truthfully take their medication end up achieving recommended glycaemic goals. However, those who do not comply may experience NHS due to increased costs

Effects of metformin to the patient.

The patient may have side effects like general body weakness, gas/bloated stomach and diarrhoea. Some of the toxic effects of diabetes that is left untreated can cause great damage to the circulatory system, lactic acidosis and kidney

The misuse and use of medicines in populations

There have been reported cases of lack of enough medicines for diabetes type 2.

Treatment Strategy

• Prevention of hyperglycaemia and other chronic illnesses can be controlled if:
• Blood sugar levels are maintained
• Medication is strictly adhered to
• The health practitioners can play their role by helping them and guiding them on how to stick to their medication regime
• By considering the faith of their patients
• Healthy screening
• Ensuring that they exercise regularly, eat balanced diets and go for health checkups
• Drug misuse comes about when a person develops a habitual desire to consume it. This often is linked to drug abuse as a result

Reflection

As I reflect on the module comprehensively, I have faith that the group worked cohesively to produce a high stard portfolio. It is was daunting in the beginning as we have not had any piece of work in the past but seeked reassuaranceafrtre the first support session of this coursework. Many of us were strong minded thereby causing us to shift focus severally. This explains the ability to contribute ideas and later settled for an effective title, distributed the chapters randomly and came up with the final copy. The team work taught me a couple of things, ine is that collaboration equates better results and in return provide better services to the patients. The group work has enhanced my active listening skills which will improve my communication skills in future with patients as apharmacist. The team meetings allowed me to express my auguments through nonverbal skills and positive reinforcement (Mcdonough and benneyy, 2006).

I found it interesting and enjoyable working on the introduction even though I bumped into challenges as I tried condensing 4 pieces of work into a brief overview. My confidence increased as I started tackling the the research however it was challenging changing from a lecturebased to self directed learning. In order to be able to counsel patients effectively, I am forced to practice this skill. as a promising pharmacist, I now comprehend the relevance of interpreting reports from the internet as patients alos read them and consult me with their concerns.

References:

1. Aloudah, N.M., Scott, N.W., Aljadhey, H.S., Araujo-Soares, V., Alrubeaan, K.A. and Watson, M.C., 2018. Medication adherence among patients with Type 2 diabetes: A mixed methods study. PloS one, 13(12).
2. Rung, J., Cauchi, S., Albrechtsen, A., Shen, L., Rocheleau, G., Cavalcanti-Proença, C., Bacot, F., Balkau, B., Belisle, A., Borch-Johnsen, K. and Charpentier, G., 2009. Genetic variant near IRS1 is associated with type 2 diabetes, insulin resistance and hyperinsulinemia. Nature genetics, 41(10), p.1110.
3. Chiasson, J.L. and Rabasa-Lhoret, R., 2004. Prevention of type 2 diabetes: insulin resistance and beta-cell function. Diabetes, 53(suppl 3), pp.S34-S38.
4. Thorn, C.F., Oshiro, C., Marsh, S., Hernandez-Boussard, T., McLeod, H., Klein, T.E. and Altman, R.B., 2011. Doxorubicin pathways: pharmacodynamics and adverse effects. Pharmacogenetics and genomics, 21(7), p.440.
5. McDonough, R.P. and Bennett, M.S., 2006. Improving communication skills of pharmacy students through effective precepting. American journal of pharmaceutical education, 70(3), p.58.
6. Renner, A., Zittermann, A., Aboud, A., Pühler, T., Hakim-Meibodi, K., Quester, W., Tschoepe, D., Börgermann, J. and Gummert, J.F., 2013. Coronary revascularization in diabetic patients: off-pump versus on-pump surgery. The Annals of thoracic surgery, 96(2), pp.528-534.