I decided to pick the topic of medical management because of my education in nursing school. I felt more comfortable because I have a lot of resources to educate my fellow classmates and myself. For this trip we will not be doing much intervention in regards to medications but it is an important piece of diabetes. It is also useful in providing information on compliance. Usually, if a patient is on insulin at a younger age it tells you that their diabetes has been poorly managed. However, diabetes is a progressive disease and it will progressively get worse even if tightly managed. As a nursing student I come across patients with diabetes on a daily basis. As a student I need to know what diabetes is and how to medically manage it. It is also important for people to understand the basics because not all individuals with diabetes are managed in a hospital. Families end up being the ones that have to help their loved one manage their diabetes and it is crucial for them to be educated on the medications they will be giving them.
My research for the pharmacology report included information on the most common oral medications used to manage type II diabetes. The three most common classes of oral drugs prescribed to a patient (in clinical practice) are first biguanides, secondly sulfonylureas, and lastly thiazolidinediones (glitazones).
Metformin, classified as a biguanide, is the drug of choice for initial therapy for patients with type II diabetes. They work by decreasing insulin resistance, hepatic gluconeogenisis, and gastrointestinal glucose absorption. Metformin is contraindicated in patients over 80 years old and individuals with renal insufficiency. Adverse reactions from taking metformin include: bloating, diarrhea, flatulence, nausea, metallic taste in mouth, and abdominal pain. Therapeutic use for biguanides is to lower blood sugar. When used in combination with other drugs to manage type II diabetes both drugs work more effectively than either drug alone. This can be true for each class of oral and injectable medications including insulin.
Sulfonylureas were introduced during the 1950s and were the first oral antidiabetic medication available. Their mechanism of action stimulates release of insulin from pancreatic islet cells by increasing sensitivity of insulin receptors on target cells. Individuals with sulfa allergies cannot take sulfonylureas because they contain sulfa. Elderly and alcoholics are at an increased risk of adverse drug reactions when taking these medications and should be closely monitored. Adverse effects include hypoglycemia, hypersensitivity reaction, and liver toxicity. Hypoglycemia is a problem with all types of diabetics because their medications increase circulating insulin or decrease glucose in their blood. This is something that needs to constantly be monitored for. An interesting fact about glipizide, a sulfonylurea, is that it is only effective for about seven years.
Glitazones are often referred to as “insulin sensitizers,” these drugs are most commonly known as Actos and Avandia. They are most effective for people who have insulin resistance. Glitazones improve insulin sensitivity, transport, and utilization at target tissues. A benefit to glitazones is that they do not cause hypoglycemia, when used alone, because they do not increase insulin production. However, when glitazones are used in combination with other drugs then there is that risk of hypoglycemia. Glitazones are contraindicated in patients with congestive heart failure, history of heart attacks, and liver disease. Adverse effects are edema and increased plasma volume. Avandia has been associated with an increased risk of heart attacks and stroke. Therefore, this drug is not used often in clinical practice.
I am curious to see what methods of medical management are used most commonly in the Bahamas and I am also curious about how often they receive their supplies.