Drugs Used to Treat and Manage Diabetes
Question One: Explain in detail the difference between type 1 and type 2 Diabetes.
Type 1 and type 2 diabetes have three main differences.
- i)
First, the defect that causes type 1 diabetes is the destruction of the cells are responsible for the production of insulin beta cells. Virus infections cause autoimmune mediated processes, which damage the beta cells. This destruction results in the complete elimination of the production of insulin leading to diabetes type 1. In contrast, the defect that causes type 2 diabetes is due to insulin resistance and the inability of beta cells to produce sufficient amounts of insulin.
- ii)
Second, people with Type 1 diabetes are mostly malnourished with a characteristic loss of muscle mass while patients with type 2 diabetes mostly present with obese. The malnutrition is often because of the inability of the body cells to take in glucose. The body then starts using the available lipid and protein reserves for its metabolism. This metabolism results in loss of muscle mass for the type 1. On the other hand, Type 2 diabetic patients will be obese since obesity forms part of their risk factors for type 2 diabetes.
iii)
Third, Type 1 diabetes is often diagnosed in adolescent patients or younger children because of an absolute deficiency of insulin while type 2 diabetes is commonly found in adults of over 35 years of age). The age differenc is because of the risk factors for type 1 is immunologic and it affects the weak immune system during person’s young age.
Question2: Choose one medication used to treat Type II Diabetes and explain in detail TWO things a pharmacy technician MUST know about this medication (explain what you need to know, why you need to know it and how you will use the information)
Type 2 diabetes is treated using Sulfonylurea. The pharmacist needs to know about the drug-drug interaction of sulfonylurea with other substances and the side effects caused by the drug to the patient. The Knowledge helps to advise the patient appropriately. For instance, patients under Sulfonylurea medication should avoid drugs like Phenobarbitone and Corticosteroids. The reason is that they decrease the standard action of Sulfonylurea resulting in more complications such as increased metabolism induction and insulin release suppression.
This information about drug interaction can determine the dosage administration of patients having multiple conditions at the same time. The pharmacist can use the information to find a suitable alternative to drugs that are inhibitory to Sulfonylurea. For example, the pharmacist can prescribe Cyclophosphamide and Sulfonylurea to a diabetic type 2 patient having rheumatoid arthritis instead of Corticosteroids and Sulfonylurea.
Qustion Three: Define hypoglycemia and explain how it is treated
Hypoglycemia is the condition in which the body has blood glucose level below the normal level. It is treated by raising the level of blood glucose through the administration of glucose. The glucose can be given through the diet or intravenously for those who are hypoglycemic due to fasting. Drugs like Acarbose and Miglitol are given to the reactive hypoglycemics. The reason behind Acarbose and Miglitol administration is that they prevent excessive production of insulin after taking a meal having high carbohydrates by preventing postprandial hyperglycemia. The prevention of excess insulin release helps to delay glucose uptake by the cells thus keeping the blood glucose concentration normal.
Question Four: Scenario: Ms. B.G. has had type 1 Diabetes for 25 years and has a very hard time keeping her blood glucose levels well controlled. She has started to experience both micro and macro vascular complications.
- Explain two such complications she may be experiencing in detail and explain what can be done to control/treat them.
i)Mascovascular complication
The macrovascular complication is due to the effects of atherosclerosis. The high blood sugar level, elevated triglycerides and fatty acids lead to the formation of stickier walls. The sticky walls encourage cells attachment to the walls of the arteries hence producing local tissue reaction. This tissue reaction traps floating particles in the blood and a variety of blood cells thus hardening the artery.
ii)Miscovascular complication
The microvascular complication is due to the effects of diabetic microangiopathies. The microangiopathies include arteriolosclerosis, diabetic nephropathy and interstitial fibrosis hyperglycemia. Arteriolosclerosis makes the small blood vessels to be thickened. Diabetic nephropathy affects the capillaries of the glomerulus resulting in their diffuse scarring.
iii) How to control the complications
The above conditions can be treated through the regulation of glucose and lipid levels in the blood. High glucose level can be lowered using oral hypoglycemic drugs such as sulfonylurea, biguanides and thiazolidinediones. On the other hand, hyperlipidemia can be managed using lipid-lowering drugs such as 3-hydroxy-3-methyl-glutaryl-co-enzyme A reductase inhibitor, fibrates, nicotinic acid and nicotinic acid derivatives.
- What steps might Ms. B.G. have taken to attempt to prevent these complications.
Ms. B.G.’s complications can be prevented by taking measures to avoid things that will cause hyperglycemia or hyperlipidemia. These measures vary from basic lifestyle therapy to more complicated measures requiring clinical treatment. Lifestyle style therapy includes activities such as weight loss and doing regular exercises to burn excess calories in the body.
Question 5: Using the drug TRULICITY answer the following.
Find five facts and explain why a pharmacy technician needs to know them and how you will apply these facts. Remember EVERYTHING about why you need to know pharmacology – starting with how the drug is supplied through to rare adverse effects
- i)
The mechanism of action of tulicity is by acting as an acylated human Glucagon-Like Peptide-1 receptor agonist. Through this agonistic activity, tulicity increases the intracellular cyclic adenosine monophosphate, which causes insulin to be released when blood glucose level rises to levels above the normal range. Knowledge about the drug mechanism of action is essential because it helps the pharmacist to give a proper dosage since it will be easy for the pharmacist to monitor the target pathway in the patient.
ii)
Another fact is pharmacokinetic properties. These properties contain information about the movement of the drug in the body and how the body affects the drug. For tulicity, the body absorbs it from the subcutaneous administration and distributes it through idiopathic ways. It then metabolizes it through protein catabolic processes. The metabolism and degradation make it have a half life of 5 days.
iii)
Tulicity’s bioavailability is also a core factor of tulicity that gives the pharmacist information about how the amount of the drug that’s effectively available to the body after absorption. Tulicity has a bioavailability of 0.75mg/0.5ml when given as a single-dose pen or single dose prefilled syringe and 1.5mg/0.5ml single-use pen. This data makes the single-use pen the best route of administration of the drug as it has the highest bioavailability.
iv)
The adverse effects that result from the use of tulicity are also importan in understanding tulicity and its effects.These effects depend on the part of the body that is affected. It causes fatigue, pruritis, thyroid cell tumors, pancreatitis and acute renal failure if it affects the central nervous system, thyroid gland, pancreas and the kidney respectively. This makes it necessary for the pharmacist to know about to avoid using the drug so as to advise the patients appropriately.
v)
Lastly, the drug-drug interaction properties of the drug is important for the pharmacist to know about this to avoid serious undesirable effects that the drugs might cause when used together. For instance, the pharmacist will not give the drug to a patient who is under insulin therapy. The interaction of tulicity and insulin therapy drugs might cause a serious hypoglycemic condition to the patient.
