The Relationship between Diabetes and Chronic Kidney Disease

This document discusses the relationship between diabetes and chronic kidney disease, including the effects of blood sugar levels and the use of Glucovance medication. It also explores the need for new medications specifically for diabetic patients with kidney disease. The document provides information on how to guide the patient according to Registered Nurse Standards for Practice.

Student name
Student No.
Unit
Title: The Relationship between Diabetes and Chronic Kidney Disease

Comparison of blood sugar levels
For a non-diabetic person, their blood glucose level should be between 70 to 130
mg/dL which is dependent on when they had their last meal and the time of the day. New
research claims that the post meal blood sugar level for a non-diabetic person can go as high
as 140 mg/dL. The blood sugar level of a person under fast or before eating or I the morning
should range between 70 to 90 mg/dL. After around an hour of taking a meal the blood sugar
level should be between 90 and 130 mg/dL and between 90 and 110 mg/dL within 2 hours
after a meal. After 5 or more hours of a meal. The blood sugar level of a non-diabetic person
should range between 70 and 90 mg/dL. For a prediabetic, the HbA1c should range between
5.7 and 6.4 percent. During fasting a prediabetic person should show a blood glucose level
within the range of 100 and 125 mg/dL. After 2 hours of a meal the blood glucose level
should be between 140 mg/dL and 199 mg/dL. A person having either type 1 or 2 diabetes
shows 6.5 percent or higher after HBA1c test (McFarlane et al. 2014). During fasting or in
the morning, the blood sugar level for a diabetic person should be 126 mg/dL equal to 7.0
mmol/l or more (Witham et al. 2016). During 2 hours post prandial, the blood glucose level
should be 200 mg/dL or above (which is equivalent to 11.1 mmol/l or above) (Aguilar, 2016).
For the case of Sharon, her blood sugar level ranged between 8 and 11 mmol/l during the day
and 7 to 8 mmol/l in the morning. Her blood glucose level does not deviate from the values
for a person suffering from type 2 diabetes.
Effects of adding Glucovance in Sharon’s medication
Glucovance is a combination of two medications, glyburide and metformin. Glyburide
reduces the blood sugar level by stimulating secretion of insulin and reducing amount sugar
manufactured by the liver. Metformin reduces the amount of glucose made by the liver and
the amount absorbed in the intestines. Glucovance is administered with proper diet and

exercise program. This drug is associated with diarrhea, weight gain, stomach upset and
nausea. Other side effects of Glucovance are easy bleeding, yellowing of skin and eyes, dark
urine, persistent nausea and abdominal pains. It can also cause hypoglycemia in case one
does not take enough calories and if one takes heavy exercises. Before taking this medication,
one should be aware of the precautions associated with it. In case one has allergic reactions
with metformin or glyburide, one should tell the nurse before the prescription. The nurse
must also know about any medical history of kidney or liver disease or any other condition
that causes low oxygen levels in the blood. Administering Glucovance together with
metformin would be an overdose of metformin (Thomas, 2015). This is because metformin is
a component of Glucovance. Therefore, the patient should be prescribed with either
metformin or Glucovance but not both of them. Metformin overdose affects the lactase
metabolism by restraining pyruvate carboxylase. Increased lactase metabolism leads to
cardiac toxicity which results to reduced contraction of the cardiac muscles. This could even
lead to cases of cardiac arrest. High intake of metformin also causes issues with the
absorption of folic acid and folic acid.
New medications
Since diabetes mellitus is linked with chronic kidney disease and more than 40
percent of diabetic people are also suffering from kidney disease, coming up with a
medication for these patients would be better. This medication should be prescribed to only
diabetic people with kidney disease (Yang et al. 2018). This medicine should be a
combination of two medications whereby one of the medications would work to stimulate the
release of insulin by the pancreas and or reduce the amount of glucose manufactured by the
liver. People suffering from kidney diseases have issues with production of red blood cells,
with this in most cases leading to anaemia. The second component of this drug should be

such that it can stimulate the production of red blood cells. This would prevent cases of
anaemia among patients with kidney infections and also boost their metabolic processes.
Health kidneys uses vitamin D to create a balance between calcium and phosphorus
by controlling absorption of mineral salts. It also helps in the regulation of parathyroid
hormone. Defective kidneys cannot activate vitamin D and the levels of calcium, phosphorus
and parathyroid hormone are out of range. Vitamin D helps in controlling the levels of
calcium and also protecting the bones. People suffering from kidney infections have been
associated with cases of muscle weakness, weight loss, and increase in breakdown of
proteins. This could be the due to chronic acidosis. Bicarbonate prevents acid build up in the
body (Anguilar, 2016). Dysfuctioning of the kidneys lowers the levels of bicarbonate which
is a risk to the heart and the kidneys. Coming up with a medication that helps prevent the
buildup of acid and also trigger the action of Vitamin D would be of great importance. To add
more value to the drug and also make it more specific to diabetic patients with kidney
infections, it could include a substance that stimulates the release of insulin by the pancreas.
How to guide the patient according to Registered Nurse Standards for Practice
According to the registered nurse standards for practice, it is the responsibility of the
nurse to come up with the treatment plan then communicate it the relevant individuals. The
nurse must develop a plan for nursing practice. This plan should be developed in partnership
with the patient and other nurses (Arnott, Paliadelis, and Cruickshank, 2018). Therefore, in
developing the treatment plan I must involve Sharon. The plan should be based on
assessment data and any documented information about Sharon. Documentation, evaluation
and modification of the plan should be done accordingly in accordance to the agreed
outcomes (NMBA, 2017).

References
Arnott, N., Paliadelis, P. and Cruickshank, M. 2018. The road to nursing. New York:
Cambridge University Press.
Aguilar, D. (2016). Heart failure, diabetes mellitus and chronic kidney disease. AHA
Journals, Vol. 12, No. 4. Doi:
https://doi.org/10.1161/CIRCHEARTFAILURE.116.003316
Detournay, B., Simon, D., Guillausseau, P. J., Joly, D., Verges, B., Attali, C., Clement, O.,
Briad, Y. and Dalaitre, O. 2016. Chronic kidney disease in type 2 diabetes patients in
France: Prevalence, influence of glycaemic control and implications for the
pharmacological management of diabetes. Diabetes & amp., Vol. 38, No. 2, p. 102-
112. Doi : 10.1016/j.diabet.2011.11.005
De Cosmo, S., Viazzi, F., Pacilli, A., Giorda, C., Ceriello, A., and Gentile, S.AMD-Annals
Study Group (2016). Predictors of chronic kidney disease in type 2 diabetes: A
longitudinal study from the AMD Annals initiative. Medicine, 95(27), e4007.
doi:10.1097/MD.0000000000004007
Guariguata, L., Whiting, D.R., Hambleton, I., Beagley, J., Linnenkamp, U. and Shaw, J.E.,
2014. Global estimates of diabetes prevalence for 2013 and projections for 2035.
Diabetes research and clinical practice, 103(2), pp.137-149.
Lema, E. V. and Batuman, V. 2014. Diabetes and kidney disease. London: Springer
McFarlane, P., Gilbert, R. E., MacCallum, L. and Senior, P. 2014. Chronic kidney disease in
diabetes. Canadian Journal of Diabetes, Vol. 37, No. 1, pp. 129-136. Doi:
https://doi.org/10.1016/j.jcjd.2013.01.037

National Kidney Foundation, 2016. KDOQI clinical practice guideline for diabetes and CKD:
2012 update. American Journal of Kidney Diseases, 60(5), pp.850-886.
Nursing and Midwifery Board of Australia (NMBA). 2017. Registered nurse standards for
practice. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-
guidelines-statements/professional-standards/registered-nurse-standards-for-
practice.aspx
Strippoli, G. F. and Palmer, S. C. 2018. Metformin as first-line treatment for type 2 diabetes.
The Lancet, Vol. 392, No. 10142, pp. 120. Doi: https://doi.org/10.1016/S0140-
6736(18)31541-1
Thomas, M. 2015. Understanding type 2 diabetes: Fewer highs, fewer lows better health.
New Zealand: Exisle Publishing Pty Ltd.
Witham, M. D., Band, M. M., Littleford, R. C., Avenell, A., Soiza, R. L. and McMurdo, M.
E. BiCARB Study Group (2015). Does oral sodium bicarbonate therapy improve
function and quality of life in older patients with chronic kidney disease and low-
grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial.
Trials, 16, 326. doi:10.1186/s13063-015-0843-6
Yang, L., Chu, T. K., Lian, J., Lo, C. W., Lau, P. K., Nan, H. and Liang, J. 2018. Risk factors
of chronic kidney adults with type 2 diabetes. Scientific Report, Vo. 8, Article NO.
14686. Doi: 10.1038/s41598-018-32983-1