Drug Therapy- Sharon Case Scenario

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Drug Therapy- Sharon Case Scenario
Q.1
Sharon has both type 2 diabetes and chronic kidney disease. She is 58 years old, 170cm tall,
110cm waist circumference, and weighs 120kg. Sharon takes Metformin Sandoz 1000mg two
times per day because of her type 2 diabetes. Sharon has body index mass more than 30
indicating that she is obese and a waist circumference of more than 35 inches that indicate that
she has abnormal deposits of fats around her waist. Sharon has lived with type 2 diabetes for a
long period of time and it was diagnosed three years ago. Type 2 diabetescauses a long term
metabolic disorders of insulin that lead to increased blood sugar in the body. The B-cells become
dysfunction that lead to impaired insulin. This leads to a situation where insulin is produced and
the body is not able to use it properly (Kahn, Cooper, & Del Prato2014). The insulin is important
for converting glucose to energy that can be used by the body cells (Wanner et al. 2016). The
failure by the body to use insulin leads to high sugar level in the bloodstream. The high levels of
sugar for a prolonged period of time continually make it hard for kidney to filter the blood that
causes damage to the kidney (Wanner et al. 2016). The kidney blood vessels (glomeruli) get
injured and the kidneys are unable to clean the blood properly. The damage of the filters leads to
leakage of protein from the blood causing proteinuria. The body also retains more salt and water
above the normal level that result to weight gain (Calderon-Salinas et al.2011).Type 2 diabetes
also damages body nerves that cause difficulty emptying the bladder. The pressure from full
bladder back up and damage the kidneys (Wanner et al. 2016).
Metformin is a medication for type 2 diabetes treatment. The medicine is highly recommended
for patients who are obese or overweight. Metformin work to control by lowering the blood
glucose levels of a patient with type 2 diabetes condition (Parving et al. 2012). Metformin
controls the level of blood sugar by making the body cells to be more insulin sensitive for
conversion of glucose to energy. Secondly the metformin slows the release of glucose that is
stored in the liver hence minimizing the amount of glucose in the blood (Inzucchi et al. 2012).
The Metformin also lowers the blood sugar by slowing absorption of glucose from the intestines
between and after a meal.Therefore, the Metformin prescription for Sharon is important for
lowering blood sugar levels considering her obese condition.

Q.2
Sharon has blood glucose levels (BGLs) of 8 to 11mmol/L during the day and 7 to 8mmol/L
immediately after waking up. A normal blood sugar level should be less than 5.6mmol/L in the
morning (fasting) and less than 7.8mmol/L after meals (Strawbridge et al.2011). Comparing
Sharon’s BGLs and normal BGLs, she has slightly higher blood sugar. Sharon’s BGLs indicate
that she has high blood sugar even with her daily prescription of Metformin Sandoz 100mg of
two times a day.
Q.3
Sharon’s prescription has been suggested to add Glucovance 500mg/2 which raise concern to
me. Glucovance has Metformin hydrochloride and glibenclamide as the active ingredients
(Eppenga et al.2014). The medicine is used to control blood sugar levels in adults and is used in
condition when the patient diet, exercises and treatment with sulfonylurea or metformin are not
enough to lower blood glucose level or as a replacement to sulfonylurea or metformin medicines
(Eppenga et al.2014). My main concern with Glucovance being added on Sharon’s prescription
is lactic acid accumulation. Lactic acidosis is a metabolic complication where lactic acid
accumulates as a result of using metformin hydrochloride found in Glucovance. Lactic acidosis
decreases the blood pH and elevates blood lactate levels (Scale& Harvey 2011). The low pH in a
person’s bloodstream forms metabolic acidosis. There is concern that Glucovance 500mg/2.5mg
will lead to increased accumulation of lactic acid in the bloodstream while Sharon has consistent
evidence of chronic kidney disease. Kidneys have an important role in filtering acid from the
bloodstream to avoid lowering of the blood pH. The addition of Glucovance will therefore lead
to metabolic acidosis where the body will have excessive quantities of acid and the kidneys are
not able to remove enough acid from the bloodstream. Metabolic acidosis has serious
consequences such as coma and death (Scale& Harvey2011).Following consistent evidence that
Sharon has chronic kidney disease, Glucovance 500mg/2.5mg medicine in addition to her
prescription is not recommendable because of the likelihood of adverse consequences of
metabolic acidosis caused by accumulation of lactic acid in the bloodstream.