Week 5: Endocrine System Disorders and the Treatment of Diabetes

The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. NURS 6521N Week 5: Endocrine System Disorders

As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include

This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management. NURS 6521N Week 5: Endocrine System Disorders

Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from https://www.niddk.nih.gov/health-information/endocrine-diseases

Learning Objectives

Students will:

• Differentiate types of diabetes
• Evaluate the impact of diabetes drugs on patients
• Evaluate alternative drug treatments and patient education strategies for diabetes management

Learning Resources – NURS 6521N Week 5: Endocrine System Disorders

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

• Chapter 46, “Drugs for Diabetes Mellitus” (pp. 485–509)
• Chapter 47, “Drugs for Thyroid Disorders” (pp. 511–520)

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

NURS 6521N Week 5: Endocrine System Disorders

This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.

Document: Mid-Term Summary & Study Guide (PDF)

Discussion: Diabetes and Drug Treatments

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/ NURS 6521N Week 5: Endocrine System Disorders

To Prepare

• Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
• Select one type of diabetes to focus on for this Discussion.
• Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment. NURS 6521N Week 5: Endocrine System Disorders
• Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

By Day 3 of Week 5

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples. NURS 6521N Week 5: Endocrine System Disorders

Example Discussion Approach

Diabetes and Drug Treatments

Type 1 Diabetes

Type 1 diabetes occurs when the body is unable to synthesize insulin for glucose absorption. An autoimmune process is responsible for the destruction of the pancreatic beta-cell in Type 1 Diabetes. The cause for this autoimmune response is not clearly known, but genetic, environmental, and infections might play a role.   The destroyed pancreatic beta-cell, responsible for insulin synthesis, is unable to release insulin into the bloodstream (Rosenthal, 2018). 

Juvenile Diabetes

Juvenile diabetes is similar to Type 1 diabetes, but it is based on early-onset. Juvenile diabetes develops during childhood and adolescence. The symptoms are abrupt, and these patients are insulin dependant  (Rosenthal, 2018). 

Type 2 Diabetes

Type 2 diabetes is a metabolic syndrome that occurs when the body becomes increasingly resistant to insulin.  Unlike type 1 diabetes, the body can synthesize insulin, but it is unable to couple to plasma glucose content making the patient insulin resistant.  Insulin release is also delayed, and its peak output is subnormal. Over time, the increase in demand for insulin synthesis in the pancreatic beta-cell due to the resistance of the affected organs causes more dysfunction of the pancreatic beta-cell (Rosenthal, 2018).  NURS 6521N Week 5: Endocrine System Disorders

Gestational Diabetes

Gestational diabetes is considered glucose intolerance with the onset or recognition of pregnancy.  Insulin sensitivity typically declines in pregnancy; however, there is an increase in insulin.  Three factors play a role in this pathology; the placenta produces hormones that antagonize insulin’s action. Second, the production of cortisol causes hyperglycemia. Lastly, glucose passes from mother to fetus, which stimulates excess insulin in the fetus.  The increase in insulin eventually diminishes the pancreatic beta-cell function, similar to type 2 diabetes. (Huether & McCance, 2019).  NURS 6521N Week 5: Endocrine System Disorders

Drug for Treating Type 2 Diabetes

Metformin is the drug of choice for treating type 2 diabetes.  Metformin, a biguanide, is started immediately after the first diagnosis of type 2 diabetes.  It is taken orally and does not require preparation.  It works by modulating the rise in glucose after meals.  This medication is suited for patients that skip meals because, unlike oral sulfonylurea medication, it does not drop blood glucose to clinical hypoglycemia.  Metformin does not stimulate insulin release; instead, it acts in the liver to reduce glucose production and increase glucose intake at the target tissue. (Rosenthal, 2018). 

Short -term and Long-term impact of Type 2 Diabetes

The short-term impact of type 2 diabetes is associated with the significant contributing factor, obesity. Obesity leads to an inflammation process that is linked to decreased insulin synthesis.   The inflammation process from obesity also leads to pancreatic beta cells death in a process called lipotoxicity.  Obesity leads to insulin resistance(Huether & McCance, 2019).  The long term impacts of type 2 diabetes lead to the eventual destruction of the pancreatic beta-cell, causing the patient to require insulin medication.

Another long-term effect of uncontrolled type 2 diabetes is that it can lead to a coronary artery, peripheral artery, and cerebrovascular disease (Huether & McCance, 2019). A long-term consideration of metformin is with patients with renal impairment; the medication can lead to a toxic level due to accumulation  (Rosenthal, 2018).  NURS 6521N Week 5: Endocrine System Disorders

References

Huether, S. & McCance, K. (2019). Understanding pathophysiology. (8^th ed.). St. Louis, MO: Mosby.

Rosenthal, J.B. L. (2018). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assistants. [MBS Direct]. Retrieved from https://mbsdirect.vitalsource.com/#/books/9780323447836/

By Day 6 of Week 5

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 5 Discussion Rubric

Post by Day 3 of Week 5 and Respond by Day 6 of Week 5

To Participate in this Discussion:

Week 5 Discussion