Ms. Jones is 60 years old and obese. She has been diagnosed with type 2 diabetes and will be started on glyburide. She is very nervous about this diagnosis and concerned that she will need to give herself “shots.”
1. Explain the difference between diabetes mellitus type 1 and type 2.
2. How does glyburide help decrease blood sugar levels?
3. What are the key teaching points for patients taking oral antidiabetic agents?
SOLUTION TO CASE STUDIES
Difference Between Diabetes Mellitus Type 1 And 2
Although there are other types of diabetes mellitus (DM), it is commonly classified into type 1 and 2. Type 1 DM has an autoimmune etiology where the body’s immune response generates autoantibodies and T cells which attack the pancreatic islet beta cells (Genuth et al., 2018). Destruction of approximately over 80% of pancreatic eta cells results in insulin deficiency which leads to hyperglycemia and consequently ketosis. Other clinical manifestations due to hyperglycemia include osmotic diuresis leading to polyuria, increased thirst, and weight loss. Its treatment majorly relies on insulin therapy (Genuth et al., 2018).
On the other hand, type 2 DM is milder that type 1 and occurs due to insulin resistance and insufficient insulin secretion in the system. It is more common among adults, especially those with obesity and live a sedentary lifestyle. Deficient insulin secretion is attributed to various causes which are primarily metabolic (Galicia-Garcia et al., 2020). There is progressive insulin secretion deficiency when one changes from a normal to impaired glucose tolerance to diabetic state. The classical symptoms include polydipsia, polyuria, polyphagia, and weight loss (Galicia-Garcia et al., 2020). Treating type 2 DM largely involves diet modification, physical activity, healthy lifestyle, and in extreme cases, the individuals might need medications too.
How Does Glyburide Help Decrease Blood Sugar Levels?
Glyburide belongs to the second generation of sulfonylureas class. It helps regulates blood sugar levels through its mechanism of action by increasing insulin secretion from the pancreatic beta cells. Particularly, the sulfonylureas exert its activity on SURI receptors found on the beta cells membranes on the potassium ATP-dependent channels. Once these channels are blocked, depolarization occurs and the cell releases insulin (Hardin & Jacobs, 2019).
Alternatively, sulfonylureas exert their action by blocking SURI2 key teaching points for patients taking oral antidiabetic agents receptors on cells within the cardiac tissue and endothelium. Other that enhancing insulin secretion, glyburide decreases hepatic insulin clearance, contributing to high plasma insulin levels key teaching points for patients taking oral antidiabetic agents. the high potency and elimination difference associated with Glyburide makes it the best option for use in patients with renal and liver failure (Hardin & Jacobs, 2019).
Key Teaching Points For Patients Taking Oral Antidiabetic Agents
DM is a chronic disease and once contracted, it requires a lifetime treatment. Unstable blood sugar levels can cause vascular complications; thus prevention is necessary as treatments are administered. Drug compliance is among the contributors to the presence or absence of DM complications; as such, health education is essential in ensuring patient’s adherence to the therapy. Also, health education supports health programs in managing DM to produce positive lifestyle changes and empower client’s on how to control their blood sugars.
According to Ganesan et al. (2022), the key teaching points about medications include taking drugs approximately thirty minutes before a meal. The patient should take some sugary drink such as honey or glucose when they feel symptoms of low blood sugar. These symptoms include, weakness, hunger, cold sweating, trembling and dizziness. The patient should inform the physician if they are taking other drugs. On lifestyle adaptations, the patient should strictly adhere to their dosing schedule. They should have regular urinalysis and blood tests to evaluate their progress. They should also maintain high standards of personal hygiene to avoid complications related to infections. They should not delay their mealtimes, but eat the appropriate amounts of food at regular intervals. Lastly, they should quit alcohol consumption and smoking.
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275.
Ganesan, K., Rana, M. B. M., & Sultan, S. (2018). Oral hypoglycemic medications. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK482386/
Genuth, S. M., Palmer, J. P., & Nathan, D. M. (2021). Classification and diagnosis of diabetes.
Hardin, M. D., & Jacobs, T. F. (2019). Glyburide. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK545313/#:~:text=Glyburide%2C%20along%20with%20others%20in,of%20potassium%20ATP%2Ddependent%20channels.
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