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1. Presentation HEALTH PROFESSIONAL ESSENTIALS
2. Question Diabetes mellitus is a major world health problem.
Treatment and management of diabetics is a very significant issue
for governments, society and both pharmacists and pharmaceutical
companies. Completing this assignment will help you to gain a
deeper understanding of diabetes mellitus. The length of this
assignment excluding graphs, figure legends and references should
be no more than 1000 words. The % of marks allocated to each
section is a guide to the word length for that section. Where
appropriate references should be included using the Harvard System
cited appropriately in the text with correct formatting in the
reference list. As a guide a minimum of 4 but no more than about 12
references should be used. You are advised to use references from
both primary and secondary sources. Assignments should be typed and
submitted using learnonline via the Course Website. Graphs should
be incorporated into the text or submitted as separate attachments.
Due date/time is 5:00pm 10th June
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3. Question 1a. What is the physiological basis of the disease
diabetes mellitus? 1b. What is the significance of the mellitus
suffix? (5% of assignment marks ) 2. Individuals with the disease
are classified into two main groups. What are they and what is the
basis of the classification system used? (5% of assignment marks )
3a. How are patients diagnosed as diabetics? 3b. How are diabetics
treated? (20% of assignment marks) 4. What changes in the storage
and mobilisation of glucose and fat (triglycerides) would you
expect to see in this disease? What symptoms might a diabetic show
as a result of these metabolic changes.
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4. Question 5. Two overnight fasting patients, A & B, were
each given a dose of 75g of glucose at time zero. Their blood
glucose levels were measured at 0, 30, 60, 90, 120 and 240 minutes
after ingestion of the glucose using a glucose specific assay. The
brief procedure for this assay is:- a. Add 5.0 ml of assay reagent
to sufficient tubes for the assay b. Add 0. 1 ml of each glucose
standard to a tube of assay reagent c. Add 0. 1 ml of each test
serum to a tube of assay reagent. d. Mix the contents of each tube
and read the absorbance at 625 nm. The results obtained are shown
in the two tables below. Table 1 - standards Glucose standard
(mmol/L) Absorbance @ 625 nm 0 0.02 3 0.21 6 0.43 9 0.65 12 0.83
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5. Question Table 2 patient results Time (min)
Absorbance-Patient A Absorbance- Patient B 0 0.26 0.47 30 0.48 0.63
60 0.25 0.80 90 0.23 0.76 120 0.24 0.63 240 0.30 0.58
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6. Question Plot a standard graph of absorbance at 625 nm
against glucose concentration You must use Excel. Determine the
concentration of glucose in each patient serum sample and plot
glucose concentration against the time over which the samples were
obtained. Comment on the results for the two patients (20% of
assignment marks ) 6. What existing and potential problems would a
pharmacist need to be aware of when treating a diabetic
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7. Diabetes Mellitus-Physiological Basis Diabetes mellitus-
metabolic disorder- causes due to poor uptake of glucose- increases
glucose level in the blood. Beta cells of the islets of Langerhans
in the pancreas secrete insulin- stimulated by the increased sugar
level. System breaks down carbohydrates into glucose that are
obtained from the diet. Absorption of this glucose is mediated by
the blood cells and produce energy. Cells require the hormone
insulin to absorb glucose. Either system fails to synthesize enough
amounts of insulin or cells become non respondent to insulin. Thus,
glucose level in the blood increases- leads to diabetes mellitus
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8. Diabetes Classification Type 1 diabetes mellitus It is also
called juvenile diabetes-prevalent in children. Partly inherited
and few are linked with certain viruses. Type 2 diabetes mellitus
Non-insulin dependent diabetes mellitus. In this type of diabetes-
beta cells fail to produce enough amounts of insulin or cells
become less responsive to insulin- situation is called insulin
resistance. The main reasons are genetic factors and lifestyle.
Gestational diabetes It affects pregnant women and generally
disappears after the child birth. Approximately, 2-10% of all the
pregnant women suffer from this type of diabetes
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9. Diabetes Diagnosis Measuring plasma glucose level Measuring
fasting plasma glucose level Measuring glycated haemoglobin
Symptoms of increased blood sugar level Oral glucose tolerance test
Glycated haemoglobin A1C test Confirmatory test: one of these tests
is repeated again on another day.
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10. Diabetes Treatments Monitoring blood glucose level Healthy
eating and regular physical activity help to monitor blood sugar
level. Consumption of fruits, whole grains and vegetables and
decreasing amount of sugar in regular diet help to maintain blood
sugar level. Regular aerobic exercises maintain blood sugar level
and reduce blood sugar level.
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11. Diabetes Treatments Insulin therapy Generally recommended
with type 1 diabetes. Different types of insulin available in the
market- type of insulin selected based on patients need. It is
administered mostly through injection. Medication Oral medication,
mainly metformin- acts as stimulus- increase insulin secretion by
pancreatic cells. Pancreas transplantation may be performed in
diabetes type1 and bariatric surgeries may be performed in diabetes
type 2 diabetes. Metformin
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12. Changes in Glucose and Fat Storage and Mobilisation In
Diabetes Due to decrease in insulin, absorption of glucose is
inhibited- cells start to metabolize the fatty acids It produces
ketone bodies that enters into circulation. Increased ketone bodies
leads to diabetic ketoacidosis development - cause serious health
issues. In the absence of insulin- mobilization of glucose from
blood to the cells diminished- blood sugar level increased.
Increased blood sugar increases glucose concentration in urine It
causes excessive electrolyte loss and fluid from the system.
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13. Problems, a Pharmacist Should Know Metformin is widely used
medication. It is associated with gastrointestinal side effects
such as nausea, weakness, diarrhoea, metallic taste in mouth and
vomiting may occur. To diminish side effects, medications can be
used. Metformin administration in empty stomach may cause
hypoglycaemia.
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14. References Brunton, S. (2014). Identification and
Prevention: Underutilized Tools in Diabetes Treatment?. Clinical
Diabetes, 32(1), 1-2. doi:10.2337/diaclin.32.1.1 BUSCHARD, K.
(2011). What causes type 1 diabetes? Lessons from animal models.
APMIS, 119, 1-19. doi:10.1111/j.1600- 0463.2011.02765.x Edgerton,
D., Moore, M., Winnick, J., Scott, M., Farmer, B., & Naver, H.
et al. (2014). Changes in Glucose and Fat Metabolism in Response to
the Administration of a Hepato-Preferential Insulin Analog.
Diabetes, 63(11), 3946-3954. doi:10.2337/db14- 0266 Florez, J.
(2014). Insights From Monogenic Diabetes and Glycemic Treatment
Goals for Common Types of Diabetes. JAMA, 311(3), 249.
doi:10.1001/jama.2013.283981
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15. References Fowler, M. (2010). Diagnosis, Classification,
and Lifestyle Treatment of Diabetes. Clinical Diabetes,28(2),
79-86. doi:10.2337/diaclin.28.2.79 Nash, J. (2015). Dealing with
diagnosis of diabetes. Practical Diabetes, 32(1), 19-23.
doi:10.1002/pdi.1915 Rubio-Cabezas, ., & Argente, J. (2008).
Current Insights into the Genetic Basis of Diabetes Mellitus in
Children and Adolescents. Journal Of Pediatric Endocrinology And
Metabolism, 21(10). doi:10.1515/jpem.2008.21.10.917 Taylor, R.
(2012). Insulin Resistance and Type 2 Diabetes. Diabetes, 61(4),
778-779. doi:10.2337/db12- 0073
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