Instructions – Read a selection of your colleagues’ responses and respond to at least two of your colleagues ( see below the two colleagues post ) who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Post 1 please focus on gestational diabetes in the response
Post 1 focus in diabetes type 1 treatment in the response
APA style 3 citations in each response
Diabetes and Drug Treatments
Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (McCance & Huether 2019). The symptoms of diabetes result from a deficiency of insulin or cellular resistance to insulin’s actions.
Type 1 diabetes
According to McCance & Huether (2019), type 1 diabetes mellitus (DM) is the most common pediatric chronic disease and affects 0.17% of US children, and the incidence is increasing. Rosenthal & Burchum (2021) notes that in autoimmune-mediated DM, environmental-genetic factors are thought to trigger cell-mediated destruction of pancreatic beta cells. Generally, type 1 diabetes develops during childhood or adolescence, and symptom onset is relatively abrupt (Rosenthal & Burchum 2021). It, however, needs to be noted that type 1 diabetes can also develop during adulthood. Type 1 diabetes was once called juvenile-onset diabetes mellitus or insulin-dependent diabetes mellitus (IDDM). This term is no longer commonly used because older children are frequently diagnosed with type 1 diabetes.
Peak onset at age 11–13 years four is slightly earlier for girls than boys. It is rare in children younger than one year and adults older than 30 years. Type 1 diabetes is characterized by severe insulin deficiency or no insulin secretion. Insulin is the mainstay of therapy for individuals with type 1 diabetes (American Diabetes Association, 2018).
Type 2 diabetes
Type 2 diabetes mellitus (DM) affects 9.3% of adults in the United States (Rosenthal & Burchum 2021). According to Rosenthal & Burchum (2021), age, obesity, hypertension, physical inactivity, and family history are the most well-recognized risk factors. Evidence shows that diet, including diet during pregnancy, influences the long-term risk of type 2 DM in children and adults. Type 2 diabetes is different from type 1 diabetes in that the risk of developing diabetes increases after age 40 years. In general, incidence increases with age into the 70s; among certain races, incidence peaks between 40 and 50 years, then falls with frequent contributing factors to precipitate type 2 diabetes among those susceptible. A significant factor in populations recently exposed to westernized environment increased risk related to duration, degree, and distribution of obesity.
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (McCance & Huether 2019). The management and care of gestational diabetes are much the same as any other diabetic pregnancy: blood glucose should be monitored and controlled with diet and insulin. Rosenthal & Burchum (2021) reports that the diabetic state disappears almost immediately after delivery in most cases, permitting discontinuation of insulin. However, if the diabetic state persists beyond parturition, it is no longer considered gestational and should be rediagnosed and treated accordingly. In women taking an oral drug for type 2 diabetes, the current practice is to discontinue the oral medication and switch to insulin (Rosenthal & Burchum 2021). The only exception is the oral agent Metformin, which is often satisfactory for managing type 2 diabetes in pregnancy. Patients who discontinue oral medications can resume oral therapy after delivery.
Type 2 diabetes
I want to focus more on type 2 diabetes because I have experience providing care to these kinds of patients. Type 2 diabetes can be treated with various oral and injectable drugs. Among the oral medicines, Metformin, and sulfonylureas (e.g., glipizide, Glucotrol) are mostly used. Among the injectable drugs, insulin is used most widely. As type 2 diabetes progresses, less and less insulin is produced. As a result, it is common for people with type 2 diabetes to require insulin therapy to manage glucose levels better eventually.
Treatment option: Metformin (Biguanide).
Metformin is available alone in immediate-release (IR) tablets (500, 850, and 1202 1000 mg) as Glucophage; in extended-release (ER) tablets (500, 750, and 1000 mg) as Glucophage XR, Fortamet, and Glumetza; and in an oral solution (500 mg/5 mL) as Riomet (Rosenthal & Burchum 2021). Typically, Metformin is started immediately after the diagnosis of type 2 diabetes. The most common side effects are gastrointestinal (GI) disturbances: lactic acidosis, a potentially fatal complication rarely noted. Metformin works by lowering blood glucose, improving glucose tolerance by inhibiting glucose production in the liver and by reducing glucose absorption in the gut (Rosenthal & Burchum 2021). Another benefit of Metformin is that it sensitizes insulin receptors in target tissues (fat and skeletal muscle), increasing glucose uptake in response to whatever insulin may be available.
If not contraindicated and if tolerated, Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes (American Diabetes Association, 2018). This therapy should not be discontinued once other therapy treatments are introduced to manage diabetes. Metformin should be continued when used with other agents, including insulin, if not contraindicated and if tolerated.
Complications related to diabetes and treatment option
Diabetes has short- and long-term complications on a patient. Hypoglycemia, upsent GI, unpleasant metallic taste in mouth is some of the short-term complication of diabetes type 2 treatment. The Long-term use of Metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy.
Long term complication includes diabetic neuropathy, cardiovascular disease, and stroke which is twice as common in those with diabetes; Peripheral vascular disease is atherosclerotic occlusive disease of the lower extremity. Diabetic microvascular complications can arise because of diabetes. Diabetic retinopathy which is a leading cause of blindness worldwide is common in diabetic patients. Diabetic kidney disease is the most common cause of chronic kidney disease and end-stage kidney disease (Rosenthal & Burchum 2021). Approximately 50% of individuals with DM develop diabetic kidney disease (McCance & Huether 2019).
A diet rich in fiber, especially cereal fiber, may reduce diabetes risk (Ley et al., 2014). Alcohol consumption has been shown to increase the risk for diabetes. According to Ley et al. (2014), greater intake of sugar-sweetened beverages (SSBs) has been associated with higher type 2 diabetes risk in a meta-analysis. Vegetarian diets devoid of animal products have been demonstrated to reduce diabetes risk.
Diagnosis of diabetes was once made solely by measuring blood levels of glucose. However, in 2010, the American Diabetes Association (ADA) recommended an alternative test based on measuring hemoglobin A1c—a test that provides an estimate of glycemic control over the previous 2 to 3 months. Once a patient receives a diagnosis of diabetes, together with their families, they should be familiar with the signs and symptoms of hypoglycemia. Rapid treatment of hypoglycemia is mandatory: if hypoglycemia is allowed to persist, irreversible brain damage or even death may result (Rosenthal & Burchum 2021).
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: Dietary components and nutritional strategies. The Lancet, 383(9933), 1999–2007.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Differences Between the Types of Diabetes
Diabetes mellitus (DM) is a metabolic disease of inadequate control of blood levels of glucose (Genuth et al., 2018). Different symptoms characterize different types of diabetes. This discussion will focus on type 1, type 2, gestational and juvenile diabetes.
Type 1 diabetes is also referred to as juvenile diabetes and is an autoimmune attack on the pancreatic beta cells resulting in severe insulin deficiency. Type 1 diabetes represents approximately 5% of all diabetes, and B cell-formed autoantibodies to islet antigens are used as markers of the disease and used to diagnose type 1 diabetes (Genuth et al., 2018). Type 1 diabetes is usually diagnosed early as patients with this disorder are typically born with it. Type 1 or juvenile diabetes are treated with insulin and are generally referred to as insulin dependent.
Type 2 diabetes is the other primary type of diabetes and comprises 90%–95% of the total cases of diabetes in the United States and worldwide (Genuth et al., 2018). Patients usually are diagnosed later in life and are generally triggered mainly due to poor diet, obesity, genetic and sedentary lifestyle.
Gestational diabetes is triggered by pregnancy. The onset of diabetes during pregnancy is caused by insufficient insulin secretion to compensate for the marked increase in insulin resistance during pregnancy, especially during the second and third trimesters.
Type 2 Diabetes and Medication use
Metformin is usually the drug of choice in treating type 2 diabetes. Metformin is effective and safe, is inexpensive, and may reduce the risk of cardiovascular events and death (American Diabetes Association, 2018). Metformin works by decreasing intestinal glucose absorption, improving peripheral glucose uptake, lowering fasting plasma insulin levels, and increasing insulin sensitivity, which reduces blood glucose concentrations without causing overt hypoglycemia (American Diabetes Association, 2018). Metformin is an oral medication that can be taken with or without food, but it is advisable to avoid common side effects. It is advisable to avoid alcohol when on metformin, as alcohol can raise lactic acid.
Short- and Long-term Impact of Type 2 Diabetes on Patients
Short-term diabetes type 2 are symptoms of hypo/hyperglycemia, which may vary from person to person. Some of the symptoms include polyuria, polydipsia, dizziness, confusion, inability to concentrate, blurry vision, and unconsciousness.
Long-term complications of diabetes include retinopathy, nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot’s joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction (Diagnosis and Classification of Diabetes Mellitus, 2011).
American Diabetes Association (2018). Pharmacologic approaches to glycemic treatment:
Standard of medical care in diabetes. Diabetes Care, 41(sup 1), S73-S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.fulltext.pdf
Diagnosis and Classification of Diabetes Mellitus. (2011). Diabetes Care, 35(Supplement_1), S64–S71. https://doi.org/10.2337/dc12-s064
Genuth, S. M., Palmer, J. P. & Nathan, D. M. (2018). Diabetes in America (3rd ed.). National Institutes of Diabetes and Kidney Disease. https://www.ncbi.nlm.nih.gov/books/NBK568014/
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