TYPE 2 DIABETES NR 508 – Advanced Pharmacology by Jesty George

CASE STUDY • Terin, a 32 year old female, comes to the clinic with complaints of frequent urination, frequent thirst, and a constant hunger. She had been diagnosed with gestational diabetes during her first pregnancy 3 years ago, but stated,“My doctor said I don’t have diabetes when I went in for my check-up a few months after I had my baby”. No other medical history. Terin has a family history of her father and paternal grandfather having Type 2 diabetes. Pt last visited her PCP “a few years ago”. She has noticed a recent weight gain of an unknown amount. Terin is not physically active. Pt stated she had a “sweet tooth” and diet history revealed an excess carbohydrate intake which consisted of candy, cake, and pasta on a regular basis. Height: 63 in. Weight: 180 lbs. Labs were drawn and vitals signs were checked. Physical exam was unremarkable. • HbA1C: 8.6% • Fasting blood glucose: 210 mg/dL • Creatinine: 1.0 mg/dL • Sodium: 140 mg/dL • BP: 138/78 • HR: 85 • Temp: 98.3 F • Respiration rate: 18 TREATMENT: BIGUANIDE ••••••••Generic Name: Metformin Trade Names: Glucophage, Carbophage XR, Riomet, Fortamet, Glumetza, Obimet, Diabex, Diaformin, & Gluformin. According to the American Diabetes Association (ADA), Metformin is the preferred initial pharmacologic agent for treating Type 2 DM. Typical dosage: 500-1000 mg Side effects: Lactic acidosis, diarrhea, nausea, flatulence, & Vitamin B12 deficiency (Edmunds & Mayhew, 2013). Mechanism of Action: Metformin activates AMP- activated protein kinase (AMPK). This causes the expression of GLUT-4, which increases glucose uptake from the blood. When AMPK is activated in the liver, it inhibits gluconeogenesis and reduces hepatic output of glucose to the blood (Bourassa, 2014). Contraindications: Pt’s with advanced cirrhosis, late stage chronic kidney disease, vitamin B12 deficiency, & pt’s with a condition causing lactic acidosis. Interactions: Metformin reacts with iodine containing contrast. Medication interactions include beta blockers (may mask signs of hypoglycemia), cationic drugs (e.g. cimetidine, amloride, digoxin, ranitidine, trimethoprim, vancomycin)