58 Year Old Female With Diabetes
uxtU bjbjnn 7aaiK8(hDv,(V OL 0 (M( ( (BF RUNNING HEAD 58-YEAR-OLD FEMALE WITH DIABETES
58 Year Old Female With Diabetes
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58 Year Old Female With Diabetes
According to various research studies it has been proved recently that diabetes and chronic kidney disease are interlinked because diabetes is one of the leading causes of kidney failure, and also it accounts for 44 of various new cases. Some of the recent research findings also suggest that by controlling the blood pressure it is possible to slow down the overall disease. According to some recent surveys, it is proved that every 1 in 4 adults who are diabetic have also kidney disease. The main job of the kidneys is to filter out the waste products of the body and extra water is also excreted from the blood in the form of urine. Kidneys not only help in regulating blood pressure but also they produce hormones which help an individual to stay healthy. Kidney damage as a result of diabetes occurs slowly and along with time. So it is possible to take effective steps in order to protect the kidneys and also delay the kidney damage. Kidneys due to their important functions inside the human body are directly involved in diabetes. Diabetes is the most common and prominent cause of end-stage renal disease in some parts of the world. When kidneys are affected due to diabetes then at that time other parts of the body are also affected directly or indirectly which results in the increase of mortality and morbidity. In case of untreated diabetic nephropathy a prominent reduction in the life expectancy of the individual occurs so it is very important to prevent this severe condition and early diagnosis and treatment of this disease is very important because of all these conditions. The prevalence of diabetes is very common nowadays due to the increased industrialization of societies and also due to the increased in immobility and lifestyle and changes in diets and also due to obesity. Some of the classic and most common symptoms in type 2 diabetes does not occur therefore it is very important to screen out these patients in order to identify the patients for kidney malfunction is very important ADDIN ZOTERO_ITEM CSL_CITATION citationIDz9csvPuk,propertiesformattedCitation(Shahbazian and Rezaii, 2013),plainCitation(Shahbazian and Rezaii, 2013),noteIndex0,citationItemsid1455,urishttp//zotero.org/users/local/4C6u8dIT/items/CV8KC35G,urihttp//zotero.org/users/local/4C6u8dIT/items/CV8KC35G,itemDataid1455,typearticle-journal,titleDiabetic kidney disease review of the current knowledge,container-titleJournal of Renal Injury Prevention,page73-80,volume2,issue2,sourcePubMed Central,abstractDiabetes is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in most parts of the world. 20 to 30 of diabetic patient have diabetic nephropathy in type 1 and type 2. Hyperglycemia is the key of nephropathy creation. Hyperglycemia also by production of toxic materials, advanced glycosylated end product (AGE), increased activity of aldose reductase has some role. Some metabolites of arachidonic acid, hemodynamic derangements and genetic factors have also some role. Although diabetic nephropathy is most common cause of nephropathy in these patients, but diabetic patients are also prone to other urinary tract and renal parenchymal disease and should not be confused with renal failure due to diabetic nephropathy. The principle of treatment of diabetic nephropathy is based on tight control of hyperglycemia, tight control of blood pressure and glomerular pressure, control of dyslipidemia, restriction of protein intake and smoking withdrawal.,DOI10.12861/jrip.2013.24,ISSN2345-2781,notePMID 25340133nPMCID PMC4206005,journalAbbreviationJ Renal Inj Prev,authorfamilyShahbazian,givenHeshmatollah,familyRezaii,givenIsa,issueddate-parts2013,6,1,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Shahbazian and Rezaii, 2013).
Although the risk of kidney failure is high because of diabetes but having said that it is also noteworthy that the risk of kidney damage in case of Type 1 diabetes is decreasing due to the advancements in technology which results in early diagnosis of the disease without doing much damage to the body which also includes good control of hyperglycemia. Around the globe, some 20-30 of individuals are suffering from kidney diseases due to diabetes ADDIN ZOTERO_ITEM CSL_CITATION citationIDw1ScLSux,propertiesformattedCitation(Toth-Manikowski and Atta, 2015),plainCitation(Toth-Manikowski and Atta, 2015),noteIndex0,citationItemsid1460,urishttp//zotero.org/users/local/4C6u8dIT/items/Z754GDPX,urihttp//zotero.org/users/local/4C6u8dIT/items/Z754GDPX,itemDataid1460,typearticle-journal,titleDiabetic kidney disease pathophysiology and therapeutic targets,container-titleJournal of diabetes research,volume2015,authorfamilyToth-Manikowski,givenStephanie,familyAtta,givenMohamed G.,issueddate-parts2015,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Toth-Manikowski and Atta, 2015). There are various drugs and treatments that are available in order to effectively treat the conditions of both diabetes and kidney disease and one of the most common drug that is currently in practice are the metformin. Metformin is an oral hypoglycemic agent which belongs to the class biguanide which helps in reducing the glucose level of blood majorly by decreasing the hepatic production of glucose and also by enhancing the sensitivity of insulin of the peripheral tissues by increasing the peripheral intake of glucose and its utilization. This drug was approved by the United States of America Food and Drug Administration in the year 1994and in most of the Type 2 diabetes mellitus cases it is recommended as the first line pharmacological agent due to its reduced price, safe administration of the drug and also association with reduced risk of cardiovascular diseases ADDIN ZOTERO_ITEM CSL_CITATION citationIDw6wACxwu,propertiesformattedCitation(Hsu et al., 2018),plainCitation(Hsu et al., 2018),noteIndex0,citationItemsid1463,urishttp//zotero.org/users/local/4C6u8dIT/items/CRVP7P5K,urihttp//zotero.org/users/local/4C6u8dIT/items/CRVP7P5K,itemDataid1463,typearticle-journal,titleEffect of metformin on kidney function in patients with type 2 diabetes mellitus and moderate chronic kidney disease,container-titleOncotarget,page5416-5423,volume9,issue4,sourcePubMed,abstractBackground Impaired renal function can lead to the accumulation of metformin, and elevated concentrations of metformin have been associated with lactic acidosis. The aim of this study was to evaluate the effect of continuous metformin treatment in patients with type 2 diabetes mellitus (DM) and moderate chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) 30-0 ml/min/1.73 m2) on renal function.nMethods A total of the 616 patients were enrolled from the research database of Kaohsiung Medical University Hospital from January 1 to 2009 and December 31, 2013. The patients were divided into two groups those who continued metformin treatment (continuation group n 484), and those who discontinued metformin treatment for at least 100 days (interruption group n 132).nResults The slope of eGFR in the metformin interruption group was statistically lower than that in the metformin continuation group (0.75 0.76 vs. -1.32 0.24 mL/min/1.73 m2/year, p 0.0007). After adjusting for baseline covariates in the multivariate linear regression analysis, the continuation of metformin (unstandardized coefficient , -2.072 95 confidence interval, -3.268- -0.876) was a risk factor for the patients with DM and moderate CKD.nConclusions Metformin may have an adverse effect on renal function in patients with type 2 DM and moderate CKD.,DOI10.18632/oncotarget.23387,ISSN1949-2553,notePMID 29435189nPMCID PMC5797060,journalAbbreviationOncotarget,languageeng,authorfamilyHsu,givenWei-Hao,familyHsiao,givenPi-Jung,familyLin,givenPi-Chen,familyChen,givenSzu-Chia,familyLee,givenMei-Yueh,familyShin,givenShyi-Jang,issueddate-parts2018,1,12,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Hsu et al., 2018). Diabetes nephropathy is linked with oxidative stress by the continuous hyperglycemia state which further enhances the advancement in the glycation end products. It was shown that hyperglycemia alters the equilibrium of redox, which results in the induction of oxidative stress that ultimately results in the damage of kidneys. So in order to reduce this effect metformin is used due to its multiple effects and associated benefits in both cases, through various studies it was shown that the administration of metformin is safe not only for diabetes but also for associated kidney problems ADDIN ZOTERO_ITEM CSL_CITATION citationIDXLlRnoJi,propertiesformattedCitation(Gong et al., 2012),plainCitation(Gong et al., 2012),noteIndex0,citationItemsid1466,urishttp//zotero.org/users/local/4C6u8dIT/items/QTVJ63LR,urihttp//zotero.org/users/local/4C6u8dIT/items/QTVJ63LR,itemDataid1466,typearticle-journal,titleMetformin pathways pharmacokinetics and pharmacodynamics,container-titlePharmacogenetics and genomics,page820-827,volume22,issue11,sourcePubMed Central,DOI10.1097/FPC.0b013e3283559b22,ISSN1744-6872,notePMID 22722338nPMCID PMC3651676,shortTitleMetformin pathways,journalAbbreviationPharmacogenet Genomics,authorfamilyGong,givenLi,familyGoswami,givenSrijib,familyGiacomini,givenKathleen M.,familyAltman,givenRuss B.,familyKlein,givenTeri E.,issueddate-parts2012,11,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Gong et al., 2012).
It was shown that Metformin reduces both the basal and also the PPG. It works by controlling the excessive hepatic glucose level production. By reducing the gluconeogenesis. There are other various potential effects of metformin that includes a higher uptake of glucose increase in the insulin signalling, reduction in fatty acids and triglyceride synthesis and also an increase in insulin signalling and Beta-oxidation of fatty acids. This particular drug can increase the utilization of glucose in the peripheral tissues and it can possibly reduce food intake and glucose absorption by the intestines. It is noteworthy here that there is no proof available yet that Metformin stimulates endogenous insulin secretion therefore so far along with reducing blood glucose levels it does not cause hypoglycemia or hyperinsulinemia which are some of the most common side effects of most drugs that are used as antidiabetic drugs. Given the increased risk of kidney problems in case of diabetic patients, it has been said that Metformin also helps in keeping safe the kidneys, therefore, it does not pose any risk to kidneys functioning ADDIN ZOTERO_ITEM CSL_CITATION citationIDBeHOdJIO,propertiesformattedCitation(Gong et al., 2012),plainCitation(Gong et al., 2012),noteIndex0,citationItemsid1466,urishttp//zotero.org/users/local/4C6u8dIT/items/QTVJ63LR,urihttp//zotero.org/users/local/4C6u8dIT/items/QTVJ63LR,itemDataid1466,typearticle-journal,titleMetformin pathways pharmacokinetics and pharmacodynamics,container-titlePharmacogenetics and genomics,page820-827,volume22,issue11,sourcePubMed Central,DOI10.1097/FPC.0b013e3283559b22,ISSN1744-6872,notePMID 22722338nPMCID PMC3651676,shortTitleMetformin pathways,journalAbbreviationPharmacogenet Genomics,authorfamilyGong,givenLi,familyGoswami,givenSrijib,familyGiacomini,givenKathleen M.,familyAltman,givenRuss B.,familyKlein,givenTeri E.,issueddate-parts2012,11,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Gong et al., 2012).
Understanding the blood glucose level can be vital for diabetes self-management. BGL refers to the amount of glucose that is present in the blood it is also referred to as blood glucose level, the concentration of glucose in the blood is expressed as mmol/ L. People who are non-diabetic their blood glucose level should be between 4-5.5mmol/L before eating something and it must be less than 8mmol/L two after eating something. In most people, diabetes is diagnosed when the blood glucose level in fasting is more than 7mmol/L. The glucose level in fasting which is between 5.5-6.9 shows a higher risk for type diabetis especially for those people who are obese and also a history of diabetes in the family ADDIN ZOTERO_ITEM CSL_CITATION citationID3lvvyAiv,propertiesformattedCitation(uc0u8220Diabetes and Hyperglycemia - Hyperglycemia Symptoms and Causes,uc0u8221 n.d.),plainCitation(Diabetes and Hyperglycemia - Hyperglycemia Symptoms and Causes, n.d.),noteIndex0,citationItemsid1469,urishttp//zotero.org/users/local/4C6u8dIT/items/QIMRVFRR,urihttp//zotero.org/users/local/4C6u8dIT/items/QIMRVFRR,itemDataid1469,typewebpage,titleDiabetes and Hyperglycemia - Hyperglycemia Symptoms and Causes,URLhttps//www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html,accesseddate-parts2019,4,12,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Diabetes and Hyperglycemia - Hyperglycemia Symptoms and Causes, n.d.). So in the case of Sharon, her BGL before eating something and after eating are much higher the normal values which mean that she has severe diabetes. In her condition, as she also has kidney problem so the BGL should have been slightly higher than her current BGL values but based on her condition as she has both diabetes and kidney problem her BGL is not very high.
Glucovance is another type of drug that is used to reduce the blood glucose level and its mode of action is also quite simple. In this case study as the BGL of the patient is high therefore along with the use of Metformin she was also recommended to use Glucovance. This type of medication is used along with a proper exercise and diet plan in order to control high levels of sugar in patients who have type 2 diabetes, mostly it is administered along with other diabetes medications. In this product, there are 2 medications that are used. Glyburide belongs to a drug class called sulfonylureas. Its function is to reduce the blood sugar level by releasing the bodys natural insulin and also by reducing the sugar amount that the liver makes ADDIN ZOTERO_ITEM CSL_CITATION citationIDa5Y8B8v3,propertiesformattedCitation(Bruce et al., 2006),plainCitation(Bruce et al., 2006),noteIndex0,citationItemsid1478,urishttp//zotero.org/users/local/4C6u8dIT/items/TR5X4CSW,urihttp//zotero.org/users/local/4C6u8dIT/items/TR5X4CSW,itemDataid1478,typearticle-journal,titleBeta cell response to metformin glibenclamide combination tablets (Glucovance) in patients with type 2 diabetes,container-titleInternational journal of clinical practice,page783-790,volume60,issue7,authorfamilyBruce,givenS.,familyPARK,givenJ.-S.,familyFiedorek,givenF. T.,familyHowlett,givenH. C. S.,issueddate-parts2006,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Bruce et al., 2006). Metformin works mainly by lowering the sugar level that is made by the liver and absorbed by the stomach. Both of these help in restoring the bodys response to the insulin that is produced naturally. But it is a high concern in this case because of the side effects of this particular drug. It causes various side effects like nausea, weight gain, diarrhea and other serious health conditions. As in the case of Sharon, she is already using Metformin 1000 mg twice per day so if Glucovance is added in her medication 500mg/ 2.5 mg then it can cause a serious side effect because she is also having kidney problems. So before adding any such medicines, she must be properly analyzed and then any such additions must be made.
As diabetes is becoming a growing concern for healthcare providers and policymakers, therefore, many studies are now on their way in order to design some effective drugs for this type of conditions many new drugs are also underway that can be possible effective treatments for diabetes and also kidney malfunctioning. Until now Metformin was used to treat diabetes but now a new drug is in clinical trials that is canagliflozin, this drug not only increases the blood insulin level in order to regulate the concentration of glucose in the blood but at the same time it can also inhibit the sodium-glucose cotransporter 2 in the kidneys but its proper function on the kidneys have not yet been identified therefore this new drug is still in the clinical trials ADDIN ZOTERO_ITEM CSL_CITATION citationIDOv9Slj7a,propertiesformattedCitation(uc0u8220New diabetes drug possibly protects the kidneys,uc0u8221 n.d.),plainCitation(New diabetes drug possibly protects the kidneys, n.d.),noteIndex0,citationItemsid1471,urishttp//zotero.org/users/local/4C6u8dIT/items/6HYN9K6I,urihttp//zotero.org/users/local/4C6u8dIT/items/6HYN9K6I,itemDataid1471,typewebpage,titleNew diabetes drug possibly protects the kidneys,abstractA new type of drug for treating type 2 diabetes does not only lower blood sugar levels, but also helps to protect the kidneys.,URLhttps//www.umcg.nl/EN/corporate/News/Paginas/New-diabetes-drug-possibly-protects-the-kidneys-.aspx,languageen,accesseddate-parts2019,4,12,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (New diabetes drug possibly protects the kidneys, n.d.).
In the case of Sharon other effective drugs can be used SGLT2 inhibitors and GLP-1 agonists which not only reduce the blood glucose level but it also maintains the blood pressure, heart failure and control kidney problems and they also help in reducing weights. As the diabetes effects other functions of the body therefore if these two can be used in combination then it is possible to treat this condition effectively along with dealing with other health problems ADDIN ZOTERO_ITEM CSL_CITATION citationID8mtwAurL,propertiesformattedCitation(Manski-Nankervis et al., 2019),plainCitation(Manski-Nankervis et al., 2019),noteIndex0,citationItemsid1473,urishttp//zotero.org/users/local/4C6u8dIT/items/ERJPXWPW,urihttp//zotero.org/users/local/4C6u8dIT/items/ERJPXWPW,itemDataid1473,typearticle-journal,titlePrescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease a national cross-sectional study,container-titleBMC family practice,page29,volume20,issue1,sourcePubMed,abstractBACKGROUND Previous studies in general practice and hospital settings have identified that prescribing of non-insulin diabetes medications may be sub-optimal in people with type 2 diabetes (T2D) and renal impairment. Since these publications, a number of new medications have become available for the management of T2D. Study aims were to, in a cohort of Australians with T2D and renal impairment attending general practice, (1) investigate whether the prescribing of non-insulin diabetes medications is consistent with dosing adjustments recommended within current Australian Diabetes Society (ADS) guidelines and (2) identify patient socio-demographic and clinical factors associated with at least one prescription of a non-insulin diabetes medication inconsistent with current ADS guidelines for medication doses.nMETHODS Cross-sectional study using data from the MedicineInsight general practice database managed by NPS MedicineWise. Patients with T2D who were aged 18 years and over, with an average eGFR 60 ml/min/1.73m2 and at least one prescription of a non-insulin diabetes medication between 1st January 2015 and 30th June 2017 were included. Descriptive statistics were used to summarise patient characteristics and medication use. Marginal logistic regression models were used to estimate associations between sociodemographic and clinical factors and prescribing of e1non-insulin diabetes medicine not consistent with ADS guidelines.nRESULTS The majority of the 3505 patients included (90.4) had an average eGFR of 30-59 ml/min/1.73m2. In terms of absolute numbers, metformin was the medication most frequently prescribed at a dose not consistent with current ADS guidelines for dosing in renal impairment (n 1601 patients), followed by DPP4 inhibitors (n 611) and sulphonylureas (n 278). The drug classes with the highest proportion of prescriptions with dosage not consistent with ADS guidelines were SGLT2 inhibitors (83), followed by biguanides (58) and DPP4 inhibitors (46). Higher HbA1c, longer known diabetes duration and diagnosis of retinopathy were associated with receiving e1prescription with a dosage not consistent with guidelines.nCONCLUSIONS Prescribing of non-insulin diabetes medications at doses inconsistent with current ADS guideline recommendations for dosing adjustments for people with renal impairment was common. Further research is needed to understand how general practitioners access, interpret and apply the ADS guidelines and the impact this may have on patient outcomes.,DOI10.1186/s12875-019-0915-x,ISSN1471-2296,notePMID 30777033nPMCID PMC6378720,shortTitlePrescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease,journalAbbreviationBMC Fam Pract,languageeng,authorfamilyManski-Nankervis,givenJo-Anne,familyThuraisingam,givenSharmala,familySluggett,givenJanet K.,familyKilov,givenGary,familyFurler,givenJohn,familyONeal,givenDavid,familyJenkins,givenAlicia,issueddate-parts2019,2,18,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Manski-Nankervis et al., 2019).
The registered nurse standards contain seven standards and among them the third standard can guide the nurse to deal with Sharon condition, the third standard which is the maintenance the capability for practice includes various key points which makes the nurse capable to deal with a variety of problems that include the provision of information to the patients which are required to improve control over various health condition ADDIN ZOTERO_ITEM CSL_CITATION citationID1C9tJev9,propertiesformattedCitation(uc0u8220Nursing and Midwifery Board of Australia - Registered nurse standards for practice,uc0u8221 n.d.),plainCitation(Nursing and Midwifery Board of Australia - Registered nurse standards for practice, n.d.),noteIndex0,citationItemsid1476,urishttp//zotero.org/users/local/4C6u8dIT/items/T7HB82H7,urihttp//zotero.org/users/local/4C6u8dIT/items/T7HB82H7,itemDataid1476,typewebpage,titleNursing and Midwifery Board of Australia - Registered nurse standards for practice,abstractAustralian Health Practitioner Regulation Agency,URLhttps//www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx,languageen,accesseddate-parts2019,4,12,schemahttps//github.com/citation-style-language/schema/raw/master/csl-citation.json (Nursing and Midwifery Board of Australia - Registered nurse standards for practice, n.d.)0589 / ptvjjjRFFhXCJOJQJaJheCJOJQJaJhCJOJQJaJhBCJOJQJaJhgCJOJQJaJh(CJOJQJaJhhlCJOJQJaJhY 5CJOJQJaJhY hY 5CJOJQJaJhjhx5CJOJQJaJhY CJOJQJaJhjh CJOJQJaJhjhxCJOJQJaJhv_CJOJQJaJhjhxCJOJQJaJ123456789pdagdY mpdgdY mpdagd mpdgd mp
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ADDIN ZOTERO_BIBL uncited,omitted,custom CSL_BIBLIOGRAPHY Bruce, S., PARK, J.-S., Fiedorek, F.T., Howlett, H.C.S., 2006. Beta cell response to metformin glibenclamide combination tablets (Glucovance) in patients with type 2 diabetes. International journal of clinical practice 60, 783 790.
Diabetes and Hyperglycemia - Hyperglycemia Symptoms and Causes WWW Document, n.d. URL https//www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html (accessed 4.12.19).
Gong, L., Goswami, S., Giacomini, K.M., Altman, R.B., Klein, T.E., 2012. Metformin pathways pharmacokinetics and pharmacodynamics. Pharmacogenet Genomics 22, 820827. https//doi.org/10.1097/FPC.0b013e3283559b22
Hsu, W.-H., Hsiao, P.-J., Lin, P.-C., Chen, S.-C., Lee, M.-Y., Shin, S.-J., 2018. Effect of metformin on kidney function in patients with type 2 diabetes mellitus and moderate chronic kidney disease. Oncotarget 9, 54165423. https//doi.org/10.18632/oncotarget.23387
Manski-Nankervis, J.-A., Thuraisingam, S., Sluggett, J.K., Kilov, G., Furler, J., ONeal, D., Jenkins, A., 2019. Prescribing of diabetes medications to people with type 2 diabetes and chronic kidney disease a national cross-sectional study. BMC Fam Pract 20, 29. https//doi.org/10.1186/s12875-019-0915-x
New diabetes drug possibly protects the kidneys WWW Document, n.d. URL https//www.umcg.nl/EN/corporate/News/Paginas/New-diabetes-drug-possibly-protects-the-kidneys-.aspx (accessed 4.12.19).
Nursing and Midwifery Board of Australia - Registered nurse standards for practice WWW Document, n.d. URL https//www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx (accessed 4.12.19).
Shahbazian, H., Rezaii, I., 2013. Diabetic kidney disease review of the current knowledge. J Renal Inj Prev 2, 7380. https//doi.org/10.12861/jrip.2013.24
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