Diabetes And Drug Treatments
Type 1 diabetes occurs when the pancreas does not produce any insulin, or makes a small amount of insulin. When the body lacks insulin blood sugar can not be utilized properly by the cells, it is suspected that type 1 diabetes is the cause of an autoimmune reaction. Type 2 diabetes. Type 2 diabetes is the most common form of diabetes, it occurs when the body does not respond properly to the insulin it makes. Gestational diabetes is diabetes that is diagnosed for the first time during pregnancy. Gestational diabetes like other forms of diabetes affects how the body uses glucose and can ultimately affect the pregnancy and the health of the baby. Juvenile diabetes is diagnosed early on or in childhood and is the same as type 1 diabetes the body can not produce the insulin that is required to maintain a normal blood sugar.
Gestational diabetes can be treated with and without medication, it involves frequent monitoring for mother and baby to ensure there is no complications. Gestational diabetes involves most importantly a healthy diet and regular exercise if that treatment is not effective then insulin will be added. One way of having good blood sugar control is monitoring carbohydrates, carbohydrates turn into glucose there most impact blood sugar. When a woman is diagnosed with gestation diabetes it is recommended they meet with a dietician who can explain the proper amount of carbohydrates to have with each meal and snack.
Insulin is the first line treatment for glucose control during pregnancy because it is the most effective and also does not cross the placenta making it safe for the fetus. Insulin can come in vial or a pen, based on what kind of insulin is prescribed the administration will differ, and it is important that the patient is taught how to properly store, prepare and administer the insulin. Short term risks for the fetuses born to women with gestational diabetes include excessive birth weight, trauma during birth such as shoulder dystocia, and hypoglycemia immediately postpartum. Women who are diagnosed with gestational diabetes have a greater risk of developing type 2 diabetes later in life and should be monitored more closely. Long term risks for fetuses born to mothers with gestational diabetes are at an increased risk for obesity during all phases of life.
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Types of Diabetes
Type 1 diabetes, formally known as juvenile diabetes, typically presents symptoms in childhood. Patients diagnosed with type 1
diabetes suffer from an immune response that results in pancreatic beta cell destruction. These patients are insulin dependent. Type 2
diabetes is known as adult onset diabetes mellitus. Unfortunately, it is becoming more prevalent in children as well though. Patients with
type 2 diabetes mellitus produce some insulin, but it is not enough to keep up with constantly elevated glucose levels. Eventual beta cell
dysfunction takes place and insulin resistance increases. Gestational diabetes occurs during pregnancy and resolves after delivery of the
baby. It is a result of the placenta producing hormones that agitates the proper function of insulin as well as increased cortisol
production (Rosenthal & Burchum, 2021).
Type 1 Diabetes
Insulin is given to all patients with type 1 diabetes with the intention of achieving and maintaining optimal glucose control. There are
several different types of insulin with different onset and duration and they cannot be used interchangeably. Insulin needs may be
individualized to each patient as insulin needs increase in times of stress, growth spurts, and with infection. Dosage usually begins at 0.5-
0.6 units/kg/day. Typically a basal/bolus strategy is used to regulate glucose in those with type 1 diabetes. A long acting insulin, such as
Lantus, is used to release over time at a sustained rate. In addition to this, a short acting insulin, like regular insulin is used when needed
for elevated blood sugar levels or at meal time. Focusing on Lantus, it is given once a day subcutaneously, but sometimes requires twice
daily dosing dependent upon circumstances and need for more basal coverage. It can be given at any time during the day, but needs to
be given at the same time each day. Its onset is seventy minutes, has no peak and usually is effective for 18-24 hours (Rosenthal &
Burchum, 2021). The standard strength is 100 units of insulin per milliliter of fluid (American Diabetes Association, n.d.). Unlike short
acting insulin, it does not have to be adjusted at meal time to cover the amount of carbohydrates eaten. However, it is important to
educate the patient o the importance of diet, exercise, and glycemic control (Rosenthal & Burchum, 2021).
Impact of Insulin on Type 1 Diabetic Patients
Patients receiving insulin treatment are at risk for hypoglycemia related to multiple factors such as disproportion of insulin level
versus need, amount of food intake, alcohol consumption, exercise, vomiting and diarrhea. These patients will always have to monitor
their glucose levels many times each day to maintain proper control of their diabetes (Rosenthal & Burchum, 2021). Scar tissue build up
at the site of injection is another consideration. This is also known as lipohypertrophy and the build-up can affect absorption if injection
sites are not properly rotated (Cleveland Clinic, 2022). However, these patients will need insulin indefinitely so proper education and
compliance is very important.
American Diabetes Association. (n.d.). Insulin basics | ADA. Diabetes.org. https://diabetes.org/healthy-living/medication-
Links to an external site. injectables/insulin-basics
Lipohypertrophy: Symptoms, Causes, Treatment & Prevention. (2022). Cleveland Clinic.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Diabetes is an endocrine system disorder that affects millions of children and adults (ADA, 2011). If left untreated, diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. In this Assignment, you compare types of diabetes including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
To prepare:
· Review this week’s media presentation on the endocrine system and diabetes, as well as Chapter 46 of the Arcangelo and Peterson text and the Peterson et al. article in the Learning Resources.
· Reflect on differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.
· Select one type of diabetes.
· Consider one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
· Think about the short-term and long-term impact of the diabetes you selected on patients including effects of drug treatments.
Write a 2- to 3- page paper that addresses the following:
· Explain the differences between types of diabetes including type 1, type 2, gestational, and juvenile diabetes.
· Describe one type of drug used to treat the type of diabetes you selected including proper preparation and administration of this drug. Include dietary considerations related to treatment.
· Explain the short-term and long-term impact of this diabetes on patients including effects of drugs treatments.
– This work should have Introduction and conclusion
– This work should have at 4 to 6 current references (Year 2012 and up)
– Use at least 2 references from class Learning Resources
The following Resources are not acceptable:
1. Wikipedia
2. Cdc.gov- nonhealthcare professionals section
3. Webmd.com
4. Mayoclinic.com
Required Readings
**Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
- Chapter 36, “Osteoarthritis and Rheumatoid Arthritis” (pp. 591-609)
This chapter examines the causes, pathophysiology, and diagnostic criteria of osteoarthritis and rheumatoid arthritis. It then outlines the process of selecting, administering, and managing drug therapy for both disorders. - Chapter 46, “Diabetes Mellitus” (pp. 785-806)
This chapter begins by identifying the causes, pathophysiology, and diagnostic criteria of diabetes mellitus. It then examines the process of selecting, administering, and managing drug therapy for patients with diabetes mellitus. - Chapter 47, “Thyroid Disorders” (pp. 809-822)
This chapter explores the causes, pathophysiology, diagnostic criteria, and administration of drug therapy for patients with thyroid disorders, including hypothyroidism, hyperthyroidism, thyroid nodules, subclinical thyroid disease, and thyroiditis. It also discusses the mechanisms of prescribed drugs, as well as proper dosages and potential adverse reactions.
**Ben-Zacharia, A. (2011). Therapeutics for multiple sclerosis symptoms. The Mount Sinai Journal of Medicine, 78(2), 176–191.
Note: Retrieved from the Walden Library databases.
This article covers the diagnosis, treatment, and management of multiple sclerosis and explores methods for treating other health issues that arise from multiple sclerosis.
**Kargiotis, O., Paschali, A., Messinis, L., & Papathanasopoulos, P. (2010). Quality of life in multiple sclerosis: Effects of current treatment options. International Review of Psychiatry, 22(1), 67–82.
Note: Retrieved from the Walden Library databases.
This article examines the process of evaluating and diagnosing patients who present with symptoms of multiple sclerosis and explores treatment and rehabilitation methods.
**Peterson, K., Silverstein, J., Kaufman, F., & Warren-Boulton, E. (2007). Management of type 2 diabetes in youth: An update. American Family Physician, 76(5), 658–664.
Note: Retrieved from the Walden Library databases.
This article outlines the process of diagnosing, treating, and managing youths with or at risk of type 2 diabetes. It also suggests methods for body weight management and reducing cardiovascular disease risks.
**Drugs.com. (2012). Retrieved from http://www.drugs.com/
Required Media
Note: The approximate length of this media piece is 5 minutes.
Diabetes And Drug Treatments
Diabetes And Drug Treatments
DIABETES AND DRUG TREATMENTS
Diabetes mellitus (DM) is a significant risk factor for retinopathy, neuropathy, stroke, cardiovascular disease, and renal failure. It affects 1.5 million Americans annually (American Diabetic Association 2019). Furthermore, The International Diabetes Foundation Atlas has predicted a worldwide increase of 642 million people to be affected by 2040 (Ogurtsova et al., 2017). However, drug therapy, diet, and exercise can control and treat it. This discussion will compare the different types of DM, describe the treatment for gestational diabetes using drug therapy, the dietary considerations, and the short- and long-term effects of gestational diabetes.
Different types of diabetes
The types of DM are Type 1, Type 2, gestational, and juvenile diabetes. The underlying pathophysiology of Type 1 DM (T1DM), previously known as insulin-dependent diabetes or juvenile-onset diabetes, is an autoimmune disease resulting from beta-cell destruction due to the body’s immune system attacking the insulin-producing cells of the pancreatic islets, producing little or no insulin. Although the exact cause is unknown, genetic and environmental factors play a significant role (Saberzadeh-Ardestani et al., 2018). It typically presents among adolescence of both sexes, with its peak onset around puberty; however, it can occur at any age.
Type 2 DM (T2DM), previously known as non-insulin dependent diabetes or adult-onset diabetes, is a condition in which the pancreas produces insulin, resulting in elevated glucose levels. Still, the body develops a resistance to the effects of insulin, resulting in a small amount of insulin to meet the body’s needs. As the disease progresses, the insulin-producing ability of the pancreas decreases (Brutsaert et al., 2022).
Gestational diabetes mellitus (GDM) is a metabolic disorder that affects the mother and fetus during pregnancy, usually occurring in the second and third trimesters. It can develop in overweight insulin-resistant women or relatively thin insulin-deficient women. The contributing risk factors include obesity, uncontrolled weight gain, advanced gestational age, previous diabetic history of parents, and a sedentary lifestyle. It increases perinatal mortality and morbidity (Sharma et al., 2022). Within this disease process, chronic glucose intolerance corresponds to insulin resistance putting women with GDM at increased risk of T2DM in the future.
Treatment for gestational diabetes
A treatment plan is needed to safeguard both the mother and the fetus, with targeted drug delivery to the placenta having minimal side effects. Monitoring blood glucose levels, controlling the level, and managing complications are crucial to treatment (Friel 2022). Insulin is the drug of choice as it does not cross the placenta and provides predictable glucose control. Human insulin is used in some as it minimizes antibody formation. All pregnant women with TIGDM should have glucagon kits, and family members must be instructed on administering glucagon in severe hypoglycemia. For women with T2DM before pregnancy, insulin is most often preferred. If glucose levels remain above target values, treatment with metformin or glyburide can be used. Metformin has recently been introduced as a more user-friendly alternative to insulin. Metformin suppresses hepatic glucose production and is absorbed from the small intestine and excreted by the kidneys with no risk of hypoglycemia (Kattini, Kelly & Hummelen, 2023). The immediate-release dose is 500mg BID with breakfast and dinner, and the extended-release dose is 500mg once daily with dinner.
Along with medical treatment implementing lifestyle changes, nutritional therapy, physical activity, and weight management is vital. Adequate caloric intake is needed to promote fetal/maternal health. Dietary carbohydrates found in glucose, sucrose, and cooked starches found in pasta, potatoes, and white bread get digested quickly and absorbed in the small intestine, rapidly increasing blood glucose. The food should be based on nutrition assessment with guidance from Dietary Reference Intakes such as reduced carbohydrates as it impacts glucose levels, eating three small-sized meals with a snack or two during the day, limiting fats, avoiding trans fats, eating vegetables which also provide carbohydrates to the body and ideally consuming 175 g of carbohydrates, 71 g of proteins, and 28 g of fibers in a diet plan (Mustad et al., 2020).
Short-Term and long-term effects of GDM
With GDM, there is a risk of the fetus having a large gestational age birth weight, the mother having the risk for pre-eclampsia, and potentially a cesarean section delivery method. The fetus could have macrosomia, shoulder dystocia, congenital birth defects, hypoglycemia at birth, and risks of stillbirth (Christian et al., 2018). There is an increased risk of long-term maternal T2DM with a possibility of GDM in future pregnancies, and the offspring will have abnormal glucose metabolism and impaired glucose tolerance in childhood and obesity (Lowe et al., 2019).
Conclusion
DM is a metabolic disorder that constantly rings medical and self-management strategies to restrict complications of the disease process. Early diagnosis of GDM in the first trimester helps with effective long-term management. Further research is needed to develop a strategy to predict, diagnose and treat GDM, safeguarding the mother and the fetus.
References
American Diabetes Association. (2021). Management of diabetes in pregnancy: Standards of medical care in diabetes. Diabetes Care, 44(1).
https://diabetesjournals.org/
Brutsaert, E. F. (2022) Diabetes mellitus (DM) Merck Manual. Diabetes Mellitus (DM) – Hormonal and Metabolic Disorders – Merck Manuals Consumer Version
Christian, S. J., Boama, V., Satti, H., Ramawat, J., Elhadd, T. A., Ashawesh, K., Dukhan, K., & Beer, S. (2018). Metformin or insulin: logical treatment in women with gestational diabetes in the Middle East, our experience. BMC Research Notes, 11(1), 1–5. https://doi.org/10.1186/
Friel, L. A. (2022) Diabetes Mellitus in pregnancy Merk Manual Diabetes Mellitus in Pregnancy – Gynecology and Obstetrics – Merck Manuals Professional Edition
Kattini, R., Kelly, L., & Hummelen, R. (2023). Systematic review of the use of metformin compared to insulin for the management of gestational diabetes: Implications for low-resource settings. Canadian Journal of Rural Medicine : The Official Journal of the Society of Rural Physicians of Canada = Journal Canadien de La Medecine Rurale : Le Journal Officiel de La Societe de Medecine Rurale Du Canada, 28(2), 59–65. https://doi.org/10.4103/cjrm.
Lowe, W. L., Jr, Scholtens, D. M., Kuang, A., Linder, B., Lawrence, J. M., Lebenthal, Y., McCance, D., Hamilton, J., Nodzenski, M., Talbot, O., Brickman, W. J., Clayton, P., Ma, R. C., Tam, W. H., Dyer, A. R., Catalano, P. M., Lowe, L. P., & Metzger, B. E. (2019). Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): Maternal Gestational Diabetes Mellitus and Childhood Glucose Metabolism. Diabetes Care, 42(3), 372–380. https://doi.org/10.2337/dc18-
Mustad, V. A., Huynh, D. T. T., López-Pedrosa, J. M., Campoy, C., & Rueda, R. (2020). The Role of Dietary Carbohydrates in Gestational Diabetes. Nutrients, 12(2), 385. https://doi.org/10.3390/
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.)
Saberzadeh-Ardestani, B., Karamzadeh, R., Basiri, M., Hajizadeh-Saffar, E., Farhadi, A., Shapiro, A. M. J., Tahamtani, Y., & Baharvand, H. (2018). Type 1 Diabetes Mellitus: Cellular and Molecular Pathophysiology at A Glance. Cell Journal (Yakhteh), 20(3), 294–301. https://doi.org/10.22074/
Sharma, A. K., Singh, S., Singh, H., Mahajan, D., Kolli, P., Mandadapu, G., Kumar, B., Kumar, D., Kumar, S., & Jena, M. K. (2022). Deep Insight of the Pathophysiology of Gestational Diabetes Mellitus. Cells (2073-4409), 11(17), 2672. https://doi.org/10.3390/
Ogurtsova, K., da Rocha Fernandes, J. D., Huang, Y., Linnenkamp, U., Guariguata, L., Cho, N. H., Cavan, D., Shaw, J. E., & Makaroff, L. E. (2017). IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Research and Clinical Practice, 128, 40–50. https://doi.org/10.1016/j.
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