Diabetes and Chronic Kidney Disease

This report focuses on the case study of a 58 year old woman with diabetes and the risk of kidney failure. It discusses the relation between diabetes and chronic kidney disease, the mode of action of metformin, comparison of body glucose levels, prescription of Glucovance, potential new medications for diabetes, and the use of registered standard nurse practice in patient care.

Running head: NURSING ASSIGNEMENT
Nursing Assignment
Name of the student:
Name of the university:
Author note:

1Nursing Assignment
Introduction:
Diabetes is referred to as the increase level of glucose in the blood (Liamis et al.,
2014). In this report, this report focuses on the case study of a 58 year old woman, Sharon
who has be suffering from diabetes. Due to high blood glucose level there is high risk of
kidney failure which is discussed in the report. In addition, BGL is compared with the normal
BGL. New medication which could be potentially invented to treat diabetes. In addition, how
the registered standard of nursing practice is used in ten evaluation of patient care is also
mentioned.
Relation between diabetes and chronic kidney disease:
She was diagnosed with T2 diabetes mellitus. Her body glucose level is 8- 11 mmol/l
and 7-8 mmol/l throughout the day and in the morning respectively, which is more than that
of the normal blood glucose level (5.56 -6.69 mmol/l) (DiPiro et al., 2014). From the test her
eGFr is evaluated which is 85ml/minute, which states that she has been suffering from kidney
damage associated with mild reduction in GFR. Reduced GFR rate mans that the kidney is
not able to filtrate the waste of the body. Kidney helps in filtering waste and excess water
from the body through urine. It also helps in managing the blood pressure to the normal level
(120/80). In case of patient suffering from diabetes, due to the presence of high blood glucose
in the body, the blood vessel of the kidney is damaged (DiPiro et al., 2014). High blood
pressure and overweight also damages the blood vessel. When the blood vessel of the kidney
is damaged, it did not work properly (Thomas, Cooper and Zimmet 2016). In the case of
Sharon, her body glucose level, her blood pressure (140/95) and obesity (weight 120 kg) are
identified as the risk factor of chronic kidney disease.

2Nursing Assignment
Mode of action of metformin:
In order to minimise the negative impact of the diabetes, metformin Sandoz 1000mg
was prescribed to Sharon, twice a day. Metformin is a drug commonly used for diabetic
patient. It helps in decreasing the blood glucose level of the body realised from the liver.
Insulin is one of the major hormone responsible for managing the blood glucose level of the
body (Pernicova and Korbonits 2014). In case of patient suffering from type 2 diabetes,
sensitivity of insulin such as the insulin exerts no adequate effect on cells and tissues, is
decreased which results in the increase in the BGL. Administration of metformin reduces the
hepatic production of glucose in the body and as well as also decreases the absorption of
glucose in intestine by maximizing both per the peripheral glucose acceptance and utilization.
Unlike other medication it does not lead to hyperinsulinemia (Pernicova and Korbonits
2014). Hence in case of Sharon, metformin 1000mg helps in decreasing the blood glucose
level.
Comparison of body glucose level:
Body glucose level is referred to as the amount of glucose present in the blood.
Alteration of blood glucose level can cause chronic illness. Increase in the blood glucose
level can diabetes. Sharon’ blood glucose level is 8-11mmol/l through the whole day and
about 7-8 mmol/l in the morning is recorded. Normal fasting blood glucose level of a healthy
patient is below 5.6 mmol/l and if the fasting Body glucose level is increased to 7, the patient
is said to be suffering from diabetes (Kalsbeek, la Fleur and Fliers 2014). The fasting blood
glucose level of the Sharon is 8- 11 mmol/l which is much higher than that of the normal
level. The normal blood glucose level of a healthy individual is 5.56 – 7.71 mmol/l, but the
BGl level of the Sharon is 8- 11mmol/l throughout the day, which states that the patient is
suffering from diabetes.

3Nursing Assignment
By considering her current situation, her medical history, weight, age and sex, it is
concluded that her body glucose level is should not be different from the current body
glucose level.
Prescription of Gluconavce:
By considering the current situation of the patient, Glucovance is prescribed for her
further treatment. Glyburimide is combination with metformin is prescribed to Sharon.
Glucovance is an anti-diabetic medication, which is the combination of glyburide and
metformin. It is used to manage the blood glucose level in type 2 diabetic patient. In which,
glyburimide is used to lower the blood glucose level by stimulating the insulin release and
metformin decreases the over production of glucose in the liver. (Moore 2018). This
combination of medication is assumed be better in the treatment of diabetes as compared to
other medication. In helps in improving the fasting blood glucose level and post meal level of
blood glucose. In addition, it also helps in improving the HbA1c levels in the treatment.
As the patient is suffering from diabetes and the eGFR of the patient is also reduced.
In addition from the signs a d symptom is concluded that the patient is suffering from
proteinuria. Her body glucose level is high and metformin only helps in decreasing the
amount of glucose in the body which are released from the liver (Levey, Becker and Inker
2015). However, by considering her body glucose level metformin alone is not able to treat
the disease. Hence glyburide is also prescribed in addition to metformin to reduce the blood
glucose level by stimulating eh the release of insulin. As her glomerular filtration rate is
already reduced which states that she poses the risk kidney damage, hence if the blood
glucose level is no managed properly it can lead to kidney damage. To avoid the further
deterioration her health glyburimide addition with metformin (Glucovance) has been
prescribed.

4Nursing Assignment
New medication for diabetes:
There are many medication which help in the treatment of the diabetes, but apart from
the current medication, new medication could also be potentially invented.
Glucose is one of the major source energy supply to the body and kidney is designed
to stop the excretion of glucose from the body. Glucose absorption in the body occurs
through facilitated diffusion in the kidney (proximal tubes of the kidney). The absorption of
glucose in the kidney occurs through a carrier molecule known as SGLT2 (sodium glucose
transporter 2 inhibitor) (Taylor, Blau and Rother 2015). In the case of diabetic patient, the
blood glucose level is increased. Hence, if the sodium glucose co-transporter is inhibited it
would cause most of the glucose to get excreted from the body and reduces the blood glucose
level. If a new medicine named X (pseudonym) is introduced which can be used to prevent
the transporter is administered, it reduces the blood glucose level in the patient (Fralick,
Schneeweiss and Patorno 2017). As SGLT2 inhibitor is independent of the insulin production
and resistance. It will not rely on the pancreas to release insulin-resistant or insulin muscle
cells.
Another medication, Y (pseudonym) could be used in the treatment of diabetes which
is activates is the glucokinase activator. Glucokinase plays an important role in the different
cells. Glucokinase is used to phosphorylate glucose and forms glucose-6- phosphate. This
glucose 6 phosphate is used as a source of energy and in addition it also increases the
glycogen synthesis in liver and reduces the glycogenolysis (Kitao et al., 2018). Glucokinase
causes the release of insulin in the ß-cells present in the pancreases. If a drug is invented,
which would activate glucokainase, it can be used in the treatment of type 2 diabetes. As it
will increase the glucose uptake, which will increase the quantity of glucose that is being
converted into glycogen and helps in release of insulin (Agius 2016). As in the case of

5Nursing Assignment
diabetic patient amount of insulin is reduced, hence by the help of this medication amount of
insulin in the body will be decreased.
Registered standard nurse for practice in relation with the case study:
Registered standard nurse for practice is formulated for the nurses to follow during
their practice, there are total seven registered nurse practice. One of the registered nurse
standard is developing a plan for the nursing practice. In the case of Sharon, she has ben
suffering from type 2 diabetes from the last 3 years, which is causing negative impact on the
kidney. Her recorded GFR is 85ml/minute. Hence she has high risk of kidney failure. In
addition, she has been also suffering from obesity and high blood pressure (Melnyk 2014).
Hence, in order to prevent further deterioration of her health, high quality of patient care is
needed.
Nursing plan in case of Sharon involves the administration of mediation on
appropriate time such as metformin twice a day. As Sharon has obesity hence low-
cholesterol diet is also involved in the care plan and for the high blood pressure low sodium
containing diet should be included in the care plan.
Conclusion:
From the above report it can be concluded that, Sharon, who is a 58 year old lady has
been suffering from diabetes and is taking metformin for that. . Metformin helps in reducing
the blood glucose level which is released from the liver. Due to the high blood glucose level,
high blood pressure obesity, there is high risk of kidney damage. Her fasting body glucose
level and post meal body glucose level is much higher than that of the normal body glucose
level. In order to provide effective treatment, glucovance is prescribed to the patient. Anther
medication that could be potentially invented to treat diabetes are SGLT 2 inhibitor and

6Nursing Assignment
glucokinase activator. Hence in order to treat the patient effectively a quality patient care plan
is formulated.

7Nursing Assignment
References
Agius, L., 2016. Hormonal and metabolite regulation of hepatic glucokinase. Annual review
of nutrition, 36, 389-415.
DiPiro, J. T., Talbert, R. L., Yee, G. C., Matzke, G. R., Wells, B. G., and Posey, L. M.
(Eds.)., 2014. Pharmacotherapy: a pathophysiologic approach (Vol. 6). New York:
McGraw-Hill Education.
Fralick, M., Schneeweiss, S., and Patorno, E., 2017. Risk of diabetic ketoacidosis after
initiation of an SGLT2 inhibitor. New England Journal of Medicine, 376(23), 2300-2302.
Kalsbeek, A., la Fleur, S. and Fliers, E., 2014. Circadian control of glucose
metabolism. Molecular metabolism, 3(4), pp.372-383.
Kitao, N., Nakamura, A., Miyoshi, H., Nomoto, H., Takahashi, K., Omori, K., ... and Atsumi,
T., 2018. The role of glucokinase and insulin receptor substrate-2 in the proliferation of
pancreatic beta cells induced by short-term high-fat diet feeding in mice. Metabolism, 85, 48-
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Levey, A. S., Becker, C., and Inker, L. A., 2015. Glomerular filtration rate and albuminuria
for detection and staging of acute and chronic kidney disease in adults: a systematic review.
Jama, 313(8), 837-846.
Liamis, G., Liberopoulos, E., Barkas, F. and Elisaf, M., 2014. Diabetes mellitus and
electrolyte disorders. World Journal of Clinical Cases: WJCC, 2(10), p.488.

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Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., and Fineout‐Overholt, E., 2014. The
establishment of evidence‐based practice competencies for practicing registered nurses and
advanced practice nurses in real‐world clinical settings: Proficiencies to improve healthcare
quality, reliability, patient outcomes, and costs. Worldviews on Evidence‐Based Nursing,
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Moore, L.E., 2018. Oral Hypoglycemic Agents. In Diabetes in Pregnancy (pp. 103-110).
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Pernicova, I. and Korbonits, M., 2014. Metformin—mode of action and clinical implications
for diabetes and cancer. Nature Reviews Endocrinology, 10(3), p.143.
Taylor, S. I., Blau, J. E., and Rother, K. I. 2015. Possible adverse effects of SGLT2 inhibitors
on bone. The lancet Diabetes & endocrinology, 3(1), 8-10.
Thomas, M.C., Cooper, M.E. and Zimmet, P., 2016. Changing epidemiology of type 2
diabetes mellitus and associated chronic kidney disease. Nature Reviews Nephrology, 12(2),
p.73.