Comprehensive and detailed Lecture notes
for Nur 243 including slideshow notes, in class notes, images, drug charts, tophat questions, etc covering topics of diabetes drugs and antimicrobial therapy and more....
*Essential Study Material!!
Key
regular: slideshow notes
italics: in class notes
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Pharmacological Management of Diabetes
Diabetes Overview
● Agenda
○ Epidemiology of diabetes mellitus (DM)
○ Pathophysiology of type 1 and type 2 diabetes mellitus
○ Overview of DM treatment
○ Treatment goals and approaches
● Learning objectives for the diabetes module
○ Discuss the pathogenesis of diabetes
○ Describe the treatment goals of diabetes
○ Discuss the pharmacological action of selected diabetic agents used in managing
diabetes
■ The worksheet on medications for diabetes will be very helpful
○ Identify various insulins’ onset, peak, and duration of action
○ Discuss pre-administration assessment and evaluation criteria for selected diabetic
agents
● Epidemiology of diabetes mellitus (DM)
○ 30 million in the US have DM
■ 9.4% of the population
○ 84.1 million adults in the US have prediabetes
■ 33.9% of population
○ Leading cause of
■ Adult blindness
■ End-stage kidney disease
■ Nontraumatic lower limb amputations
○ Major contributing factors to
■ Heart disease
● 2-4x higher than adults without diabetes
■ Stroke
● 2-4x higher than adults without diabetes
■ Hypertension
● Estimated that 67% of adults with diabetes have HTN
● Pathophysiology of type 1 and type 2 diabetes mellitus
○ Diabetes mellitus (DM)
, ■ Group of disorders characterized by elevated blood glucose levels
● Insulin deficiency: defects in insulin production (T1DM)
● Insulin resistance: defect in insulin action (T2DM)
● Insulin resistance during pregnancy (gestational DM)
○ Any degree of glucose intolerance with onset during
pregnancy
● T1DM and T2DM make up 90% of cases
○ Glucose arrives in the bloodstream from one of three sources
■ Carbohydrates eaten by mouth
● Converted to glucose via digestion
● Absorbed through GI tract
■ Glucose released from stored glycogen in muscles and liver cells
■ Glucose newly created
● Gluconeogenesis in the liver or kidney cells
○ Once in bloodstream, glucose transported to target cells
○ In response to increased blood glucose levels, insulin released from pancreatic
beta cells
○ At target cells insulin facilitates transport of glucose across the cell membrane to
the cell’s interior
○ Insulin is the key to the cell, allowing glucose to cross the cell membrane to be
metabolized
○ Inside the cell, glucose is metabolized as fuel, releasing the energy necessary for
normal cellular functioning
○ If blood glucose levels are high, more insulin is secreted by the pancreas
○ When blood glucose is driven into cells and metabolized, glucose levels in the
blood fall as a result
○ If blood glucose levels fall too low, insulin release is suppressed and glucose
remains in the bloodstream instead of being driven into the cells
○ In response to falling blood glucose levels, the hormone glucagon is released from
the pancreatic alpha cells
○ Glucagon stimulates production and release of glucose from glycogen stores in
the liver so that blood glucose levels rise to normal
,
, ○ DM
■ Combinations of causative factors
● Genetic
● Environmental
● Autoimmune
■ Primarily a disorder of glucose metabolism related to absent or
insufficient insulin supply and/or poor utilization of the insulin that is
available
○ Type 2 diabetes mellitus (T2DM)
■ Most prevalent type of DM
● 90-95% of all DM diagnoses in the U.S.
○ Far more common than T1DM
● Growing epidemic
○ 2000 – 3% of population
○ 2017 – 9.4% of population
● Becoming more common in juveniles due to increased levels of
obesity and inactivity in children
○ Called adult-onset diabetes in the past
○ In children, age of onset is typically 10-19 years old
● Present in all ethnic groups
○ More common in non-white groups
■ American indians
● 4.5 per 1000
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