Discussion: Diabetes and Drug Treatments NURS 6521
Discussion: Diabetes and Drug Treatments NURS 6521
Diabetes is the most common endocrine disorder in the United States, and is caused by either an insulin deficiency or an insulin resistance. There are three types of diabetes: type 1, which was once referred to as juvenile diabetes, type 2, and gestational (Rosenthal & Burchum, 2021). This post will discuss the differences between these and touch on a medication option for type 2.
Type 1 (Formerly Juvenile)
Generally type 1 diabetes develops in childhood but can develop into adulthood as well. The body carries out an immune response that destroys pancreatic B cells, therefore the body does not synthesize insulin. Insulin levels eventually drop to zero and the body no longer produces the hormone (Rosenthal & Burchum, 2021).
Type 2 is more prevalent than type 1. It can occur at any age but typically develops in adulthood and keeps progressing. It is characterized by insulin resistance and impaired secretion of insulin. So unlike type 1, type 2 is still able to synthesize insulin but the release is delayed and it does not bind properly to receptors, so ultimately it is not used by the body how it should be (Rosenthal & Burchum, 2021).
The gestational form is developing diabetes while pregnant, but then it resolves postpartum. The placenta
produces certain hormones that affect the actions of insulin, cortisol production increases, and glucose passes between mother and fetus freely (Rosenthal & Burchum, 2021). Every year, almost 10 percent of pregnancies are affected by gestational diabetes in the United States (American Diabetes Association, n.d.).
Type 2 Diabetes & Insulin Therapy
The main goal of treating type 2 diabetes is preventing long-term complications. In order to do this, it is important to follow a healthy diet and lifestyle, as well as comply with any needed medication management. One form of insulin used to treat type 2 is insulin lispro, or Humalog. This is a rapid-acting insulin with a short duration time. It is known as an insulin analog because it has been modified for further benefits (Singh et al., 2009). Humalog is given by subcutaneous injection preferably right before meals but also can be given immediately after a meal because of its rapid onset of 15 – 30 minutes (Rosenthal & Burchum, 2021).
If left untreated or not properly maintained, diabetes can lead to several other comorbidities such as heart disease, stroke, renal failure, retinopathy, neuropathy, amputations, and others. Patients using insulin should be made aware of the signs, symptoms, and dangers of hypoglycemia (Rosenthal & Burchum, 2021).
American Diabetes Association. (n.d.). Diabetes overview. https://diabetes.org/diabetes Links to an external site..
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Singh, S., Ahmad, F., Lal, A., Yu, C., Bai, Z., & Bennett, H. (2009). Efficacy and safety of insulin analogues for the management of diabetes mellitus: A meta-analysis. Canadian Medical Association Journal, 180(4), 385-397.
Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). 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.
For this Discussion Discussion: Diabetes and Drug Treatments NURS 6521, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/
Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
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.
By Day 3 of Week 5
Post a brief explanation of the differences between the 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. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.
Diabetes mellitus, DM, is a group of metabolic diseases that results in hyperglycemia. It is caused by defects in insulin secretion, action, or both (McCance & Huether, 2019). DM is one of the leading causes of death. Diabetes is classified into four categories: type 1, type 2, gestational, and a genetic defect type of diabetes known as maturity-onset diabetes of youth. The focus of this post is on gestational diabetes and treatment with insulin.
The two most common types of DM are type 1 and type 2. Type 1 diabetes, also called juvenile diabetes, is absolute insulin deficiency from the destruction of beta-cells via cellular-mediated autoimmune destruction in many cases but may also be idiopathic. Individuals with type 1 diabetes are prone to ketoacidosis, have little to no insulin secretion, and are insulin dependent with specific diagnoses under 30 years of age. Type 2 diabetes differs from type 1 because it is a progressive loss of b-cell function with insulin resistance. Type 2 diabetics are not typically insulin-dependent, but insulin-requiring is not ketosis-prone and is commonly diagnosed in individuals older than 40. It is associated with hypertension and dyslipidemia, and there is a strong genetic predisposition (McCance & Huether, 2019).
A more uncommon form of diabetes is maturity-onset diabetes of youth (MODY). This commonly is presented in younger individuals that result from genetic abnormalities that decrease the function of b-cells (McCance & Huether, 2019). Six specific autosomal dominant mutations are associated with MODY, accounting for less than 5% of patients with DM (Hoffman & Anastasopoulou, 2022). The treatment depends on which gene mutation is present but is the same as type 1 and 2 diabetes.
Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with an onset during pregnancy, with an incidence of approximately 7% (McCance & Huether, 2019). It is caused by insulin resistance and inadequate insulin secretion, leading to hyperglycemia. Commonly, these individuals are first discovering that they are type 1 or 2 diabetics (McCance & Huether, 2019). The treatment that this post will focus on is insulin, specifically short-acting. The goal of treatment is to maintain glucose levels no higher than the upper limit of the target range while avoiding hypoglycemic episodes. Tight metabolic control of blood glucose levels has no benefits in GDM and increases the risk for growth restriction (Durnwald, n.d.). Patient self-monitoring at least four times a day, fasting and postprandial, and as needed, is required with titration of insulin dosage. Administering insulin is a subcutaneous syringe titrating on a scale according to current blood sugar and patient weight. It is vital to verify insulin concentrations and units of measure on the syringe to ensure no under or overdosing. Insulin therapy is associated with better outcomes for fetal overgrowth but can also lead to hypoglycemia.
Considerations with insulin pharmacotherapy about diet are more focused on blood glucose control. Initial treatment for GDM is dietary modifications followed by pharmacotherapy if glucose levels are not controlled. A diet with emphasis on elimination or reduction of sugar intake, restricting carbohydrate intake, and a meal plan of small to moderate frequent meals and snacks (Durnwald, n.d.).
American Diabetes Association. (2017). 8. pharmacologic approaches to glycemic treatment: standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement_1). https://doi.org/10.2337/dc18-s008
Durnwald, C. (n.d.). Gestational diabetes mellitus: Glucose management and maternal prognosis. UpToDate. Retrieved December 31, 2022, from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis
Hoffman, L. S., & Anastasopoulou, C. (2022). Maturity onset diabetes in the young – statpearls – NCBI bookshelf. Retrieved December 31, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK532900/
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.
Module 4 Week 5
In this week’s discussion, we are to reflect on differences between types of diabetes. Then, we are to select one type of diabetes to focus on and consider one type of drug used to treat the type of diabetes we selected including proper preparation and administration of this drug. Then we are to reflect on dietary considerations related to treatment. Finally, we are to think about the short-term and long-term impact of the diabetes selected, including effects of drug treatments. Type I diabetes (or juvenile diabetes) is the most common pediatric disease and is usually diagnosed from infancy to the late 30’s (McCance & Huether, 2019). There are two types: Autoimmune and Nonautoimmune. In this type of diabetes, a beta cells in the pancreas are destroyed. Symptoms for diagnosis are polydipsia, polyuria, polyphagia, weight loss, and hyperglycemia, and intermittent DKA. The patient is insulin dependent.
Type II diabetes usually affects those people over 40. Insulin resistance and obesity is associated with type II diabetes. The pancreas cannot use the insulin produced properly, and there is a reduction in beta cell mass and function (McCance & Huether, 2019). The cells become resistant to insulin, making an excess of insulin than is necessary to keep blood glucose levels within a normal range. The symptoms are obesity, dyslipidemia, and hypertension. The patient experiences polyuria and polydipsia. There are also recurrent infections, genital pruritus, visual changes, paresthesia, fatigue, and acanthosis nigricans. The patient is not usually insulin dependent, but may require insulin.
Gestational diabetes occurs during pregnancy. There is insulin resistance and inadequate insulin secretion. It is most likely to occur in women who are obese, 25-years-old, have a family history of diabetes, have a history of gestational diabetes, or are of Native American, Asian, or black (these ethnic groups have a higher incidence rate of gestational diabetes (McCance & Huether).
For this discussion I am focusing on type II diabetes mellitus. Those with this type of diabetes have a mortality rate twice that of the general population. Complications from this type of diabetes are myocardial infarction, stroke, nephropathy, retinopathy, and peripheral arterial disease and neuropathy resulting in amputation (Laursen et. al., 2017). One of the drugs used to treat this type of diabetes is in a class of drugs called biguanide named Metformin. This drug decreases glucose production by the liver, reduces glucose absorption in the gut, and sensitizes insulin receptors in fat and skeletal muscle. Metformin is slowly absorbed from the small intestine, and is excreted unchanged by the kidneys. If there is renal impairment, it can produce toxic levels (Rosenthal & Burchum, 2021). It can be used alone, or with insulin. Importantly, it can be used for patients who skip meals because it does not lower blood glucose. It can be taken during pregnancy.
Common side effects are decreased appetite, nausea, and diarrhea. Metformin decreases absorption of vitamin B12 and folic acid, thus causing vitamin B and folic acid deficiencies. It does not cause weight gain. It is important to eat healthy meals while taking Metformin, and not skip meals. Metformin can cause lactic acidosis. Initial dosing is immediate release 850-1000 mg daily or extended release 500 mg nightly.
Laursen, D., Christenssen, K., Christensen, U., & Frolich, A. (2017). Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnare (HeiQ). BMC Research Notes 10(213). https://doi10.1186/s13104-017-2536-6
McCance, L.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.
By Day 6 of Week 5
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! Discussion: Diabetes and Drug Treatments NURS 6521
The World Health Organization defines diabetes as a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces (American Diabetes Association, 2022 ). Insulin is a hormone that regulates blood glucose. The number of people being diagnosed with diabetes continues to raise as the Centers for Disease Control report released in 2018 showed that 7.3 million Americans, or 11.3% of the population. There are several types of diabetes with the most common including type 1 diabetes, type 2 diabetes, juvenile, and gestational diabetes. These types differ from each other significantly hence this makes it easy for physicians to make correct diagnoses.
Type 1 diabetes
Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in your pancreas that produce insulin. The damage is permanent. According to the ICD-10, Type 1 diabetes diagnostic criteria include unexplained weight loss, excessive production of urine, experiencing excess thirst, increased appetite, tiredness, and blurry vision as well as mood changes. If the condition is left untreated, it can lead to heart damage, kidney damage, eye damage, foot damage, nerve damage, and oral infections. According to American Diabetes Association, the American diagnostic criteria for type 1 diabetes includes a 2-hour plasma glucose level ≥200 mg/dL (11.1 mmol/L) or during a 75 oral glucose tolerance test (OGTT).
Type 2 diabetes
Type 2 diabetes starts out as insulin resistance. This means your body cannot use insulin efficiently, which causes your pancreas to produce more insulin until it cannot keep up with demand. Insulin production then decreases, which causes high blood sugar. The body is impaired in how it regulates insulin and in the long term, there is a higher presence of sugar in the bloodstream. The symptoms of type 2 diabetes are increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, unexplained weight loss, numbness or tingling in the hands, and areas of darkened skin, usually in the armpits and neck. If not treated it can lead to kidney damage, eye damage, hearing impairment, sleep apnea, and dementia (DeFronzo et al., 2015). Type 1 diabetes is characterized by the inability of the body to produce enough insulin, the type 2 diabetes is characterized by the inability of the body to utilize insulin hence having high sugar in the blood.
This type of diabetes occurs during pregnancy when insulin-blocking hormones are produced. Gestational diabetes occurs only in people who have preexisting diabetes or have family members who have been diagnosed with the condition. It affects how cells utilize insulin leading to high levels of blood sugar. Pregnancy influences the body significantly and these changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin. Gestational diabetes can go unnoticed as it has limited symptoms only frequent urination and increased thirst. Lack of early intervention can lead to stillbirth, obesity, early term, excessive birth weight, and difficulties breathing.
These three types of diabetes differ significantly in that while type 1 diabetes is characterized by the inability of the body to produce enough insulin, type 2 diabetes is characterized by the inability of the body to utilize insulin hence having high sugar in the blood. The gestational occurs only in pregnant women unlike the other which can occur in anybody.
Selected: Type 2 diabetes treatment
Metformin is the most common type of drug administered to people with type 2 diabetes. The drug works by lowering the glucose level in the liver and improves the body’s sensitivity to insulin so that the body uses insulin more effectively (Foretz et al., 2019). This drug can come comes as a tablet, liquid, and an extended-release tablet which is prepared by obtaining a solution of metformin hydrochloride in water. The tablet is taken with a glass of water before meals. those taking the solution, have to prepare it by adding the extended tablet, they prepare it by measuring the oral liquid with a marked spoon oral syringe, or medicine cup and adding water to make a solution. The liquid is usually taken with meals one or two times a day and the regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. The drug is taken orally.
People diagnosed with type 2 diabetes and prescribed metformin, have to consider some diet patterns. When taking metformin, avoid alcohol since it affects the drug’s effectiveness. Avoid too many refined carbs, especially white bread, white rice, white pasta, candy, soda, desserts, and snacks like chips or crackers (Ley et al., 2014). There are some foods that a patient taking metformin can consider and they include healthy fats, fiber, lean proteins, vegetables, and complex carbs such as brown rice, whole-grain oats, and whole-grain
Short-term and Long effects of type 2 diabetes and metformin
The short-term effects of diabetes type 2 involve developing the complications of hypoglycemia which are low blood sugar and this is linked to some medications such as insulin or a sulfonylurea drug. Other complications involve hyperglycemia which is having too much glucose in the body. Besides, the long-term effects of diabetes include increased risk of developing heart disease, stroke, high blood pressure, narrowing of blood vessels (atherosclerosis), and nerve damage (neuropathy) in limbs.
Taking metformin for a long time can cause vitamin b12 deficiency, lactic acidosis, lower back pain, decreased appetite, difficulty sleeping, and diarrhea.
American Diabetes Association. (2022). Statistics About Diabetes. https://diabetes.org/about-us/statistics/about-diabetes
DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., … & Weiss, R. (2015). Type 2 diabetes mellitus. Nature reviews Disease primers, 1(1), 1-22.
Foretz, M., Guigas, B., & Viollet, B. (2019). Understanding the glucoregulatory mechanisms of metformin in type 2 diabetes mellitus. Nature Reviews Endocrinology, 15(10), 569-589.
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.
Diabetes Types and Treatments
Diabetes is a complex disease that occurs when the pancreas is not producing enough insulin or the body cannot use the produced insulin effectively. According to the World Health Organization [WHO] (2023), there are four types of diabetes, including type 1, type 2, gestational, and juvenile diabetes (which can be used interchangeably with type 1 diabetes). Type 1 diabetes occurs when the body’s immune system mistakenly attacks and destroys insulin-producing cells in the pancreas, and thus, the patients require insulin therapy to manage their sugar levels. Gestational diabetes occurs during pregnancy when the blood sugar levels go above normal but below those diagnostic of diabetes, and it can increase complications during pregnancy and delivery (American Diabetes Association [ADA], 2022). However, gestational diabetes typically resolves after childbirth but can increase the risk of type 2 diabetes later in life. Type 2 diabetes is different from the two as it affects how the body uses glucose and is preventable through medication, which makes it unique.
Type 2 diabetes can lead to high blood sugar levels if not treated. According to ADA (2022), type 2 diabetes accounts for 90-95% of all diabetes. Obesity, genetics, and inadequate exercise are all risk factors for the development of type 2 diabetes. However, early detection can aid in its prevention through treatment with drugs like metformin with dietary modifications, and physical activity. Metformin is an oral medication that helps lower blood glucose levels, enhances peripheral tissues’ sensitivity to insulin, and slows the absorption of glucose from the digestive tract (Foretz et al., 2019). Mild side effects from metformin, such as diarrhea and nausea, can occur briefly but can be mitigated with dose adjustments. It is possible to advise those who have this condition to follow a balanced diet full of fiber, lean proteins, and complex carbohydrates (Care, 2022). In the long term, the condition can result in cardiovascular disease, kidney problems, vision problems, and nerve damage if not managed. Therefore, proper medication and change in lifestyle can help in mitigating the effects and overall well-being.
American Diabetes Association. (2022). Care in diabetes—2022. Diabetes care, 45, S17. https://healthy.arkansas.gov/images/uploads/pdf/ADA_Classification_and_Diagnosis_of_Diabetes.pdfLinks to an external site.
Foretz, M., Guigas, B., & Viollet, B. (2019). Understanding the glucoregulatory mechanisms of metformin in type 2 diabetes mellitus. Nature reviews. Endocrinology, 15(10), 569–589. https://doi.org/10.1038/s41574-019-0242-2Links to an external site.
World Health Organization [WHO]. (2023). Diabetes. WHO. https://www.who.int/news-room/fact-sheets/detail/diabetesLinks to an external site.
Submission and Grading Information
To access your rubric:
Week 5 Discussion Rubric
Post by Day 3 of Week 5 and Respond by Day 6 of Week 5
To Participate in this Discussion:
Week 5 Discussion
What’s Coming Up in Module 5?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In the next module, you will examine diagnoses for patients with neurologic and musculoskeletal disorders, and you will complete your Midterm Exam.
Looking Ahead: Midterm Exam
Please review the Resources and content in the previous modules in preparation for your Midterm Exam in Module 5.
To go to the next week:
Week 5: Endocrine System Disorders and the Treatment of Diabetes
The endocrine system includes eight major glands throughout the body which affect such things as growth and development, metabolism, sexual function, and mood (National Institutes of Health). Some of the most commonly diagnosed endocrine disorders include hypothyroidism, diabetes, and Hashimoto’s disease. Not surprisingly, treating any one endocrine disorder may have effects on other body systems or their functions. As an advanced practice nurse, treating patients who may suffer from endocrine disorders requires an acute understanding of the structure and function of the endocrine system. Additionally, a solid understanding of patient factors and behaviors will assist in developing the best drug therapy plans possible to treat your patients. Some of most commonly diagnosed endocrine disorders include
This week, you differentiate the types of diabetes and examine the impact of diabetes drugs on patients. You also evaluate alternative drug treatments and patient education strategies for diabetes management.
Reference: National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019 from https://www.niddk.nih.gov/health-information/endocrine-diseases
- Differentiate types of diabetes
- Evaluate the impact of diabetes drugs on patients
- Evaluate alternative drug treatments and patient education strategies for diabetes management
People with diabetes have elevated blood glucose levels. Type I, Type II, gestational, and juvenile diabetes are the four types of diabetes. The etiology and timing of onset are the main differences between the two types of diabetes. For instance, diabetes type one is primarily an autoimmune condition brought on by the body’s immune system attacking the pancreas, impairing its ability to produce enough insulin and causing an elevated level of glucose in the blood (Redondo et al., 2020). It usually starts during childhood and has a higher hereditary component than the others.Contrarily, type 2 diabetes can be brought on by either a decline in the body’s sensitivity to insulin or a decline in its capacity to produce insulin. T2DM typically appears later in life and is primarily triggered by food. Juvenile diabetes, like type 1 DM, advances in adolescents and young adults, whereas gestational diabetes is frequently characterized by uncontrollable sugar levels during the 2nd or 3rd trimester of pregnancy.
Type 1 Diabetes Treatment
The majority of clinical practice guidelines recommend starting Type 1 diabetes treatment with insulin (TID). Patients with type 1 diabetes should start their treatment with aggressive insulin therapy. Once or twice a day, 100 units of short-acting standard insulin are diluted in 1 ml of the liquid solution and administered intravenously (Tornese et al., 2020). Subcutaneous or insulin pump administration is an option for other insulin formulations. The dose is typically adjusted following the patient’s blood sugar levels.
To attain and retain acceptable blood sugar levels, T1D patients are frequently advised to eat foods with a lower glycemic index. Proteins and complex carbohydrates like brown rice are also appropriate for T1D patients. The timing of meals must be ideal to prevent hypoglycemia (Yuan et al., 2022).
The Short-Term and Long-Term Impacts
Patients with T1D frequently experience numerous side effects linked to higher risks of hypoglycemia during the first few months after diagnosis, including palpitations, anxiety, headaches, and disorientation (DiMeglio et al., 2018). Long-term, however, this condition can lead to significant organ failure, with kidney damage, nerve damage, heart disease, and ocular impairment being the most common. On the contrary, insulin administration for a brief period may result in weakened metabolic control. In addition to other issues, long-term insulin use can increase the likelihood of cardiovascular and psychiatric issues.
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DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449–2462. https://doi.org/10.1016/s0140-6736(18)31320-5
Redondo, M. J., Hagopian, W. A., Oram, R., Steck, A. K., Vehik, K., Weedon, M., Balasubramanyam, A., & Dabelea, D. (2020). The clinical consequences of heterogeneity within and between different diabetes types. Diabetologia, 63(10), 2040–2048. https://doi.org/10.1007/s00125-020-05211-7
Tornese, G., Ceconi, V., Monasta, L., Carletti, C., Faleschini, E., & Barbi, E. (2020). Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity. Diabetes Technology & Therapeutics, 22(6), 462–467. https://doi.org/10.1089/dia.2020.0169
Yuan, X., Wang, J., Chen, X., Yan, W., Niu, Q., Tang, N., Zhang, M. Z., Gu, W., & Wang, X. (2022). Effects of the timing of the initiation of dietary intake on pediatric type 1 diabetes for diabetic ketoacidosis. BMC Pediatrics, 22(1). https://doi.org/10.1186/s12887-022-03243-z
NURS 6521 Diabetes and Drug Treatments Lola
Diabetes is an endocrine system disorder that alters the body’s ability to metabolize food nutrients into energy. The condition can affect children or adults and is identified through measurement of glycosylated hemoglobin in addition to other diagnostic procedures. There are three main types of diabetes (Meng et al., 2020). Type 1 diabetes mellitus (T1DM), also known as juvenile diabetes, is an autoimmune reaction where the body secretes little or sometimes no insulin. The condition affects children, adolescents, and young adults. Type 2 diabetes on the other hand is an impairment where the body fails to regulate and utilize glucose in the blood. It can develop due to insulin resistance or from inability of the body to secrete sufficient insulin and it affects adults (Philippi et al., 2021). Gestational diabetes as the final type is a condition of glucose utilization that can occur in pregnancy and may disappear upon childbirth.
Even though Type 2 diabetes is the most common form in this category, no known cure has been established to treat the disorder. Instead, therapeutic and non-therapeutic options have been identified to manage it (Bourgeois et al., 2021). Metformin is used as an adjunct therapy in the first-line management of hyperglycemia in type 2 diabetes. Administer Metformin 500 mg 1 PO BID daily for the first week (Galicia-Garcia et al., 2020). The dosage is adjusted to 1000 mg 1 PO BID daily in the second week for seven days. Non-therapeutic strategies for the management of type 2 diabetes involve food choices that involve Mediterranean, DASH diets, or vegetarian patterns of feeding. Dietary fiber of above 50 g is encouraged.
Type 2 diabetes can lead to other comorbidities and there is therefore a need to address the condition at its early stages. The short-term complications linked to the condition include hyperglycemia and high blood glucose (Meng et al., 2020). Type 2 diabetes can lead to nephropathy, diabetic retinopathy as well as microvascular problems in the long run.
Bourgeois, S., Sawatani, T., Van Mulders, A., De Leu, N., Heremans, Y., Heimberg, H., … & Staels, W. (2021). Towards a functional cure for diabetes using stem cell-derived beta cells: are we there yet?. Cells, 10(1), 191. https://doi.org/10.3390/cells10010191
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … & Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences, 21(17), 6275. https://doi.10.3390/ijms21176275
Meng, L., Li, X. Y., Shen, L., & Ji, H. F. (2020). Type 2 diabetes mellitus drugs for Alzheimer’s disease: current evidence and therapeutic opportunities. Trends in Molecular Medicine, 26(6), 597-614. https://doi.org/10.1016/j.molmed.2020.02.002 Philippi, A., Heller, S., Costa, I. G., Senée, V., Breunig, M., Li, Z., … & Kleger, A. (2021). Mutations and variants of ONECUT1 in diabetes. Nature Medicine, 27(11), 1928-1940. https://doi.org/10.1038/s41591-021-01502-7
Diabetes Types, Management, and Effects
Diabetes is a disease process with a high prevalence in healthcare. This disease is characterized by elevated blood glucose levels that may lead to other negative implications such as cardiovascular disease, infection, neurological complications, and impaired skin integrity. There are three types of diabetes: type 1 diabetes (previously known as juvenile diabetes, type 2 diabetes, and gestational diabetes. Understanding the various types of diabetes is essential to the disease’s clinical and pharmacologic management.
Types of Diabetes
The varying types of diabetes have different pathologies and underlying causes. Type 1 diabetes is characterized by abrupt childhood onset and is autoimmune by nature, causing disruptions in insulin production (Rosenthal & Burchum, 2021). The loss of pancreatic beta cells renders the body unable to produce enough insulin to manage glucose levels (Rosenthal & Burchum, 2021). In type 1 diabetes, blood glucose levels often fluctuate, requiring injectable insulin and strict lifestyle alterations to manage the disease.
Type 2 diabetes is primarily characterized by advanced age, familial genetic history, and obesity (Rosenthal & Burchum, 2021). This disease process may be managed with oral or injectable medications and may involve low, normal, or high glucose levels. Most individuals diagnosed with diabetes are included in the type 2 category. Treatment for this process includes life changes such as diet and exercise and oral or injectable non-insulin/insulin medications (Rosenthal & Burchum, 2021).
The last type of diabetes to explore is gestational diabetes. Gestational diabetes is characterized by onset during pregnancy and can have various complications. These challenges include placental hormones altering insulin production, the ability of glucose to pass freely from mother to child, and increased cortisol production, which increases blood glucose (Rosenthal & Burchum, 2021). To be considered gestational diabetes, complications must subside after the pregnancy is complete. If this does not occur, diabetes must be diagnosed again and managed appropriately.
Metformin and Type 2 Diabetes
Metformin is an oral antidiabetic medication that is essential to the treatment of type 2 diabetes. This medication does not require specialized preparation and is generally taken by mouth one to two times per day at 500-1000 mg. The American Diabetes Association (ADA) states that Metformin is the first-line oral medication that should be implemented upon diagnosis of diabetes along with lifestyle alterations (ADA, 2018). Metformin has been shown to decrease weight, cholesterol, insulin requirements, and risk for cardiovascular disease (ADA, 2018). This drug decreases glucose production in the liver, reduces glucose absorption in the GI tract, and increases tissue response to insulin (Rosenthal & Burchum, 2021).
Lifestyle alterations are a significant component of diabetes management. Exercise is crucial as it increases glucose uptake in the muscles despite insulin levels (Rosenthal & Burchum, 2021). It is vital to monitor carbohydrate, fat, and sugar intake with diabetes as these foods increase blood glucose levels (Mohandas et al., 2022). The most beneficial things practitioners can do to promote compliance are to provide adequate education on a diet, involve the family in education to provide support and assess that the individual has resources to access supplies needed for self-care. (Mohandas et al., 2022).
Short and Long-Term Effects
Diabetes has numerous short-term and long-term effects on overall health. Diabetes can pose short-term effects such as frequent urination, malaise, fatigue, increased risk of infection, headache, and blurred vision. Diabetes can also cause long-term complications such as renal disease, dyslipidemia, neuropathy, retinopathy, hypertension, and cardiovascular disease (Rosenthal et al., 2021). Early identification, lifestyle alterations, and pharmacologic intervention with medications like Metformin produce the best outcomes (Rosenthal & Burchum, 2021). Educating patients on these effects can promote participation in the treatment plan and minimize adverse outcomes for this population.
In conclusion, it is essential in the management of diabetes to understand the different variations of this disease. Diabetes can vary from the genetic onset with no insulin production, mid-life onset impacted by lifestyle factors, and pregnancy-induced diabetes. Treatment of diabetes can include oral, non-insulin, and insulin-based antidiabetic medications. Diet modifications play a significant factor in disease management for all diabetes types. Understanding this disease process is the best way to educate and empower patients and improve outcomes.
American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes Links to an external site. Links to an external site.—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf
Mohandas, A., Bhasin, S. K., Upadhyay, M., & Madhu, S. V. (2022). A Cross Sectional Study on Compliance to Diet Self Care among Adult Diabetics in an Urban Resettlement Colony of East Delhi. International Journal of Nutrition Sciences, 7(1), 26–33. https://doi.org/10.30476/IJNS.2022.94528.1177
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Gestational diabetes is usually screened for within the 24th to 28th weeks of a woman’s pregnancy because, if present, it is best to “catch” it and start treatment very early in order to prevent serious harm to mother and child. The exact cause is unknown, but gestational diabetes has been associated with genetics and hormonal changes of pregnancy (American Diabetes Association, 2023; National Institute of Diabetes and Digestive and Kidney Diseases, 2023).
Though gestational diabetes is diagnosed in pregnant women who have never had diabetes before, being diagnosed with it means that the sufferer has an increased risk of recurrent diabetes in their subsequent pregnancies, and that the risk for developing type-2 diabetes as they age increases 10-fold, as compared to women who have never had gestational diabetes (American Diabetes Association, 2023).
The condition is mainly managed with dietary and lifestyle modification, with drug administration being the last resort. As you pointed out, insulin is the first drug-of-choice when it comes to pharmacological management of gestational diabetes. This is because it does not cross the placenta to cause harm to the growing fetus, and also because it is the most effective drug for fine-tuning blood glucose levels. Metformin and glyburide may be used if necessary, but long-term studies are still ongoing with regard to their safety during pregnancy (National Institute of Diabetes and Digestive and Kidney Diseases, 2023).
American Diabetes Association. (2023). Gestational diabetes and a healthy baby? Yes. https://diabetes.org/diabetes/gestational-diabetes
National Institute of Diabetes and Digestive and Kidney Diseases. (2023). Gestational Diabetes. U.S. Department of Health and Human Services, National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational
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