NUR231 Drug Therapy Task 3 Written Piece This assessment comprises two parts: Part A – The goal is to provide professional-focused information on a medication; Part B – The goal is to provide person-centered information on a medication. As a nurse, you will be required to interpret and use pharmacotherapeutic information and reliable clinical evidence to support your colleagues and patients in the quality use of medicines. You will interpret and use evidence to inform safe and comprehensive practice when designing professional-focused and person-centered medication information.

1.    As a nursing student, your clinical facilitator has allocated you to care for Jarrah. After the morning handover, you are asked to explain the pathophysiology of type 1 diabetes to the clinical facilitator. What is your response?

2.    Your clinical facilitator tells you that Jarrah would rather not have multiple daily injections. He wants to know why he cannot just have tablets to manage his type 1 diabetes like his friend who has type 2 diabetes. What is your response?

1.    Jarrah suffers from diabetes type 1 which is a condition that has a rapid onset but one whose development takes a long process involving a progressive immunological damage. The condition is characterized by the invasion of the pancreatic islets by the T-lymphocytes destroying the beta cells (Kahanovitz et al., 2017). The antigen-presenting cell (APCs) travel to the pancreatic lymph nodes and interact with the autoreactive CD4+ T lymphocytes resulting in the activation of the autoreactive CD8+T cells. The destruction of the B-cells is amplified by the release of the pro-inflammatory cytokines as well as reactive oxygen species from the innate immune cells such as the neutrophils, macrophages, and the natural killer cells (DiMeglio et al., 2018). T cells, which are activated in the lymph nodes, stimulate the B-lymphocytes into producing antibodies against the b-cell proteins.

2.    Jarrah cannot have insulin pills. Instead, his condition needs to be managed using insulin shots. Type 1 diabetes patients cannot take insulin as pills since the digestive enzymes would break the insulin down before it is used in the body. Therefore, if Jarrah is put on insulin injections on the subcutaneous layer of the skin, they would be effective by enabling the continuous infusion of the insulin into the body to manage diabetes (Akil et al., 2021). The insulin injections would therefore be most effective in enabling Jarrah to achieve better glycaemic control without necessarily increasing the risk for hypoglycaemia.

Jarrah is disappointed that he has to administer two different types of insulin. Your clinical facilitator asks if you can explain to her how Jarrah’s prescribed regime works to achieve glycaemic control.

1.       Explain the ‘time-course’ of formulations of NovoRapid and Optisulin.

2.       Explain the principles underpinning a ‘basal-bolus’ regime of insulin (see Bryant & Knights, 2019, p. 682 – 683).

*See also MimsOnline 2022 Full Prescribing Information NovoRapid and Optisulin

3.       Explain the mechanism of the action of NovoRapid and Optisulin in attaining glycaemic control.

1.    NovoRapid is usually injected subcutaneously. The action of the medicine begins within 10 to 20 minutes after injection. Jarrah would be able to feel the maximum effect of the drug 1 to 3 hours after injection. The drug remains active after 3 to 5 hours of injection. Optisulin is a long-acting diabetes drug, which is only administered subcutaneously once a day (Hemmingsen et al., 2019). The drug can be administered any time of the day but he must maintain the same time every day.

2.    The Basal-bolus insulin regimen means the use of one or two doses of either intermediate or long-acting insulin, and three or four doses of short-acting insulin (Attri et al., 2020). Basal insulin works by regulating a rise in the blood glucose attributed to endogenous glucose production from the process of gluconeogenesis and glycogenolysis. On the other hand, bolus insulin works by preventing a rise in blood glucose levels that is related to meals. The basal-bolus regimen should be used when a patient has suboptimal blood glucose control with oral blood glucose drugs, when the use of oral blood glucose-lowering drugs is linked with organ dysfunction, during a transition f