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Consider the physiologic alterations in diabetes mellitus. Discuss at least five medications you might see prescribed...

Consider the physiologic alterations in diabetes mellitus. Discuss at least five medications you might see prescribed for a diabetic patient. Why would each be prescribed? What is its mechanism of action? What are the risks and benefits of each medication? What patient education is needed?

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Expert Solution

Diabetes: It is a metabolic disease it is mainly happens due to the high levels of glucose (blood sugar) in the blood or inadequate production of insulin. Diabetes Types:

Type I diabetes: It is also known as juvenile diabetes, or insulin-dependent diabetes (this name is not adequate as type II diabetes may become insulin-dependent), is the impaired production of insulin by the pancreas believed to be caused by destruction of cells of the islets of Langerhans by auto antibodies (autoimmunity).

Type II diabetes: It is happens due to the disorder in the metabolism characterized by elevated blood sugar levels, insulin resistance with symptoms of increased thirst (Polydipsia), urination (Polyuria), weight loss, tired, hunger (Polyphagia) etc. It mostly occurs in obese patients. Type 2 usually affects adults, but it can begin at any time in your life.

Most prescribed medications for a diabetic patient:

Metformin (Glucophage, Glumetza)

Byetta (exenatide)

GLP-1 receptor agonists

DPP-4 inhibitors

Thiazolidinediones

Meglitinides

Sulfonylureas

Example Medication: Byetta (exenatide)

Byetta is used to treat type 2 diabetes.This medication helps your pancreas produce insulin more efficiently.Byetta is used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes. Byetta is not for treating type 1 diabetes. Incretin is hormone that stimulates insulin secretion in response to meals.

Mechanism: It was hypothesized that glucose in the digestive tract activated a feed forward mechanism that increased insulin secretion, anticipating the rise in blood glucose that would occur following absorption of ingested carbohydrates.

GIP and GLP-1 . Both hormones are secreted by endocrine cells that are located in the epithelium of the small intestine. Incretin hormone release is regulated in a similar way to other digestive tract hormones. An increase in the concentration of a substance in the lumen of the digestive tract (in this case glucose) acts as the trigger for hormone secretion. The mechanism of incretin action is schematized in the figure below. Glucose in the small intestine stimulates incretin release. Incretins are carried through the circulation to their target tissue: the pancreatic beta cells. Incretin stimulation of beta cells causes them to secrete more insulin in response to the same amount of blood glucose.

Advantages:

In some people it can promotes weight loss. By using this medication an overweight person with diabetes and had a greater chance for weight loss.

Easier to inject, when compared with insulin.

By using insulin you had to worry about an exact dosage. Byetta is very different than insulin so one dose is enough, there is no need of worry about the exact dosage.

Disadvantages:

You should not use Byetta if you have severe kidney disease (or you are on dialysis), or if you have slowed digestion or diabetic ketoacidosis. You should not use Byetta together with fast-acting or short-acting insulins. Do not use Byetta together with Bydureon.

Stop using this medicine and call doctor at once if you have nausea and vomiting with severe pain in your upper stomach spreading to your back.

You should not use Byetta if you are allergic to exenatide, or if you have:

  • severe kidney disease (or if you are on dialysis);
  • a severe stomach disorder that causes slow digestion; or
  • diabetic ketoacidosis (call doctor for treatment with insulin).

Byetta can make birth control pills less effective. If you take birth control pills, take your pill at least 1 hour before your injection.It is not known whether exenatide passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using this medicine.


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