A 35 year old women reported with an HbA1c level of 12% with no previous diagnosis of DM. Her last pregnancy was at the age of 30 when she was informed of slightly high levels random blood glucose but was not required to take any medication during or post pregnancy. The patient was alarmed by her values. She was started on oral hypoglycemic. Her lab values were repeated in 3 months and her HbA1c dropped to 6%. This drastic change in her lab values were resultant of her proactive approach to change her lifestyle and assume responsibility for her health alongside the medication regimen. On further enquiry she stated to have used fenugreek as advised by her mother. Her compliance with diet, exercise and medication caused a significant change in her lab values. She continued to maintain her adherence to the renewed lifestyle and for the last 5 years has not required any further medications.
While pharmacokinetics may be defined as the movement of drugs through the body (absorption, distribution, metabolism and excretion), the process of pharmacodynamics involves the body’s biological response to drugs (receptor binding, post receptor effect and chemical interactions).
It is reported that concomitant administration of fenugreek extract with certain hypoglycemic agents maintains lower blood glucose levels than medication alone. In a study conducted by the pharmacokinetic study showed that concurrent administration of fenugreek significantly increased the bioavailability of metformin and doubled the time required to reach the peak plasma concentration (Abdelwahab et al., 2021).
Natural remedies such as the use of fenugreek mediate enhancement of glucose uptake and suppression of hepatic glucose output by stimulating glycolysis, glucose oxidation and glycogenesis, along with reducing glycogen degradation and gluconeogenesis (D’souza, 2021).
The patient did show significant improvement in her lab values. Her commitment to medication regimen and her diet and lifestyle changes, all contributed effectively to her health care plan. Continuing to motivate her in her compliance and keeping her abreast with the latest information in the management of her condition will facilitate her adherence to her overall health.
Abdelwahab, N. S., Morsi, A., Ahmed, Y. M., Hassan, H. M., & AboulMagd, A. M. (2021). Ecological HPLC method for analyzing an antidiabetic drug in real rat plasma samples and studying the effects of concurrently administered fenugreek extract on its pharmacokinetics. RSC Advances, 11(8), 4740-4750.
D’souza, M. R. (2021). Traditional Indian Herbs for the Management of Diabetes Mellitus and their Herb–Drug Interaction Potentials: An Evidence-Based Review. Structure and Health Effects of Natural Products on Diabetes Mellitus, 279-296.
Pharmacokinetics and pharmacodynamics are important when managing the health of patients. Pharmacokinetics is defined as the study of drug movement throughout the body (Rosenthal and Burchum, 2021). It consists of four processes including absorption, distribution, metabolism, and excretion. These processes can have an effect on the therapeutic management of drug therapy in patients. Pharmacodynamics is the study of biochemical and physiologic effects on the body and the molecular mechanisms by which these effects are produced (Rosenthal and Burchum, 2021). The results of these effects are based on the time and intensity of the therapeutic effects, as well as the occurrence of adverse drug reactions. There are several factors that can influence the pharmacokinetics and pharmacodynamic processes, including age, gender, ethnicity, behavior, genetics, and disease processes. It is important for the health care provider to have an understanding of pharmacokinetics and pharmacodynamics and its influence on drug therapy in order to develop an effective the plan of care for patients.
One previously worked as a home care nurse and took care of K.S. in her home. K.S. is a 70-year-old, African American female who was recently discharged from the hospital after undergoing a tricuspid valve repair. K.S. medical history includes right-sided heart failure, hypertension, hepatitis C, and ascites of the liver. K.S. was diagnosed post-surgery with chronic kidney disease, hypotension, and atrial fibrillation. K.S. discharge instructions were to include continuing taking previous medications prescribed along with midodrine and warfarin. K.S. was unsure of why she was taking certain medications, if and when her blood pressure should be checked, blood pressure parameters when taking midodrine and other prescribed hypertensive medications, the daily of dosag
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