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Instructions: Response must be at least 300 words written in current APA format with at least two academic references cited. References must be within the last five years. Response must extend, correct/refute, or add additional nuance.

According to Khan et al. (2019), type 2 diabetes affects an estimated 462 million people worldwide, making it one of the most common disease of the developed world.  The researchers in this article state that the rise of sedentary lifestyle and an increase of unhealthy diets has contributed to rising body mass index (BMI) that has been associated with the diagnosis of type 2 diabetes (Khan et al., 2019).  They also state that higher BMIs with increased age places a person at greater risk for the disease. 

Diabetes Mellitus is a group of disorders that present as elevated blood glucose levels due to insulin dysregulation in the body (Arcangelo et al., 2017).  The two most commonly confused diabetes is one and two.  In many patients understanding the differences between these two diseases can be challenging.  Type 1 diabetes is an autoimmune disease characterized by the bodies inability to produce insulin due to the destruction of pancreatic beta cells (Arcangelo et al., 2017).  Without the production of insulin, the body has no way of controlling blood glucose levels, creating sustained states of hypoglycemia. 

Type 1 diabetes is most often seen in patients younger than 30, making it one of the most common chronic diseases in children, but can occur at anytime during one’s lifetime (Arcangelo et al., 2017).  It has been proposed that the etiology of this disorder could be from the genetic predisposition of beta cell damage from viral infection, autoimmunity, and environmental factors (Arcangelo et al., 2017).  The main feature of this disorder is that after destruction of pancreatic beta cells, the body loses its ability to create insulin.

Type 2 diabetes the cells in tissue like adipose and muscle become increasingly less sensitive to insulin, or the pancreas becomes so overworked that it decreases the production of insulin needed to reduce blood glucose levels.  According to Galicia-Garcia et al. (2020), high levels of oxidative stress caused by inflammation due to poor western diets is one factor that contributes to the destruction of pancreatic beta cells.  The combination of insulin resistance by body cells and decreased insulin secretion places the patient at risk for high blood glucose levels (Arcangelo et al., 2017).  Unlike type 1 diabetes, type 2 is reversible and can be treated with oral medication and lifestyle changes (Galicia-Garcia et al., 2020).

Glyburide (Glynase) is a hypoglycemic agent apart of the first-generation sulfonylureas.  The main mechanism of action with this drug is closing of ATP-dependent potassium channels on pancreatic beta cells (Arcangelo et al., 2017).  This in turn opens calcium channels and allows for increased cytoplasmic calcium to occur.  This stimulates the release of insulin which can then reduce serum glucose levels throughout the body (Arcangelo et al., 2017). 

Some of the key teaching points for Ms. Jones taking oral antidiabetic agents is that this does not necessarily mean she will have to give herself “shots”.  Type 2 diabetes main goal of treatment is weight loss through diet and exercise (Arcangelo et al., 2017).  It is also necessary to explain that this medication works best with proper adherence to a prescribed diet that controls the patient’s weight.  Though this medication may cause a weight gain of about 2 to 3 kg in patients. 

The main concern with glyburide is the complication of hypoglycemia.  The patient should be educated on what to look for such as: dizziness, shakiness, sweating, confusion, hunger, and irritability to name a few (Arcangelo et al., 2017).  The patient should be instructed to drink high sugar drinks like apple juice or consume glucose tablets if this occurs.  A careful review of Ms. Jones medication list and medical history should be reviewed as drugs with active metabolites increase hypoglycemia in patients with renal impairment.  This drug should not be given if Ms. Jones has an allergy to sulfa drugs.  Lastly renal and hepatic functional levels should be drawn before starting this drug (Arcangelo et al., 2017).  The last education to be given is that this medication will start off at a low dose and be titrated up as needed to target blood glucose levels.

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