Agents to Control Blood Glucose Levels
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Agents to Control Blood Glucose Levels
Miscellaneous changes in diabetic patients, including metabolic abnormalities and alterations of basement membranes (Kottaisamy et al., 2021). Diabetes is a disease characterized by inadequate supply or lack of sensitivity of the body cells to insulin, leading to raised blood sugar levels. The liver raises glucose generation because insulin is low or unable to perform the usual function, known as gluconeogenesis. There is also increased lipolysis; there is the detection of hyper-Fa and increased ketogenesis where excess Fa is converted to ketone bodies, thus resulting in the manifestation of ketoacidosis. It also raises protein catalysis, wherein muscle proteins are brought into storage, the by-products of which are used for gluconeogenesis. So, merely hyperglycemia leads to the thickening of the basement membrane, affecting the kidney, especially the glomeruli and the retina. Protein-bound glucose undergoing enzyme glycation accumulates in the basement membranes in the form of AGEs, which gives rise to complications of diabetes. This thickening and glycation subsequently reduces the proper function of capillaries, which leads to microvascular complications such as diabetic nephropathy, retinopathy, and neuropathy.
Given the preceding, the following nursing intervention considerations are critical for patients using insulin. Blood glucose levels must always be checked to avoid administering excessive or too little insulin. Awareness regarding how to identify hypoglycemia and how to treat it, along with maintaining immediate sources of sugar, is mandatory. Some measures that must be taken to prevent lipodystrophy include adherence to the proper injection technique and site rotation. Another issue is the cooperation with dietitians on the choice of meals and adherence to a permanent physical training program. Explaining the proper storage conditions of insulin and precautions that the patients should take to note adverse effects like allergy and hypoglycemia is mandatory. Promoting compliance with the recommended insulin schedule and pro-appointments is also significant.
The drug acarbose falls under alpha-glucosidase inhibitors (Fisher, 2022). It is used to manage type 2 diabetes mellitus by providing better glycemic control paired with exercise and diet in the adult population. In particular, it is quite useful for lowering postprandial blood glucose levels by slowing the absorption of carbohydrates in the intestine.
They include hypoglycemia, more common in senior and impaired patients; gastrointestinal disturbances; diaphoresis; and, very rarely, allergic manifestations. Nausea, heartburn, and a full, bloated feeling in the abdomen are also frequently experienced by patients. The increase in insulin levels causes an anabolic effect, resulting in weight gain. Skin reactions that may be allergic, such as rash, pruritus, or urticaria, may be observed along with some infrequent hematologic effects like leukopenia, thrombocytopenia, or even hemolytic anemia.
The following are therapeutic uses of metformin (Fortamet, Glumetza, Riomet). (Gavhale et al., 2023) This one decreases hepatic glucose production, decreasing gluconeogenesis in the liver and plasma glucose concentration. It enhances the effect of insulin, particularly on the uptake and utilization of glucose in the peripheral tissues, especially in muscles and adipose tissues. Metformin also decreases the intestinal absorption of glucose by delaying the rate of its gastrointestinal absorption. That is why it is often linked to weight maintenance or even slight weight loss, which is helpful for patients with type 2 diabetes and obesity. Also, metformin positively affected lipid profiles by decreasing triglycerides and LDL cholesterol.
Reference
Kottaisamy, C. P. D., Raj, D. S., Prasanth Kumar, V., & Sankaran, U. (2021). Experimental animal models for diabetes and its related complications—a review. Laboratory Animal Research, 37(1). https://doi.org/10.1186/s42826-021-00101-4
Gavhale, S., Kadam, M., & Phalke, P. (2023). ANTIDIABETIC DRUGS: AN OVERVIEW. Certified Journal │ Gavhale et Al. World Journal of Pharmaceutical Research World Journal of Pharmaceutical Research SJIF Impact Factor 8.084, 12, 237–246. https://wjpr.s3.ap-south-1.amazonaws.com/article_issue/4e31b73bdc3beaabefd49a3e65ca911e.pdf
Fisher, M. (2022). Acarbose and Alpha Glucosidase Inhibitors. Diabetes Drug Notes, 229–238. https://doi.org/10.1002/9781119785033.ch11