BETH MARTINS

Explain the difference  between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes 

Type I Diabetes is hyperglycemia due to insulin deficiency. This is caused by autoimmune destruction of B cells that are within the islets of Langerhans (Chetan, Thrower,& Narendran, 2019). Some signs surrounding Type I DM is polydipsia, polyuria, and weight loss. This is more common in children, but can be diagnosed at any age throughout life. Type I diabetes used to be called juvenile diabetes,but this is now known to not be the correct way to view this disease. 

Type 2 Diabetes is impaired insulin secretion and abnormal suppression of postprandial (Hurtado & Vella, 2019). Type 2 DM the pancreas resists insulin, or does not produce enough insulin on  its own. Often Type I and Type 2 DM  are diagnosed incorrectly or mistaken for each other as signs and symptoms are similar. Being overweight or reduced amount of exercise is though to be a contributing factor as well as genetics, but this is till not fully understood. 

Gestational diabetes is characterized by spontaneous hyperglycemia during pregnancy. Some risk factors include family history of diabetes, obesity during pregnancy, and advanced maternal age (Plows, Stanley, Baker, 2019). B cell dysfunction which lacks the ability to release insulin when the body needs it is what causes gestational 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.

Patients who have Type 2 DM have both insulin resistance and impaired insulin secretion (Rosenthal & Burchum, 2021). The liver, muscle and adipose tissue are insulin resistant and increased blood sugar causes B cell function to fail. Insulin secretion decreases and B cells must increase how hard they must work to work against insulin resistance within the tissues (Rosenthal & Burchum, 2021).  

The medication I chose os Metformin from the class of Biguanide medications for treatment of Type 2 DM. Metformin uses 3 mechanisms to help lower blood sugar. 

• Inhibits glucose production in the liver
• Reduces glucose absorption in the gut
• Sensitizes insulin receptors in fat and skeletal muscle 

Metformin is taken by mouth and is absorbed by the small intestines and excreted by the kidneys. Metformin is known to be a great choice for those who skip meals as it will not make blood sugar levels become dangerously low. Those with DM Type 2 should eat healthy carbs such as fruits and vegetables and not indulge in sugary drinks. Protein and polyunsaturated fats should be a staple in the everyday diet. Alcohol should be avoided, and the patient should try to eat several small “meals” per day tp keep blood sugar steady. If blood sugar becomes low  having a sugary snack with a complex carbohydrate such as peanut butter and crackers should be on hand.

Short-term and long-term impact of DM Type 2, including effects of drug treatments.

Metformin is not considered to be a good consideration of DM Type 2 treatment with patients who have impaired kidney function. Patients with liver impairment, history of lactic acidosis, severe infection, or are heavy drinkers are not appropriate for treatment with Metformin as it can cause metabolic acidosis and can be deadly (Rosenthal & Burchum, 2021). Metformin can commonly cause decreased appetite, nausea and gastrointestinal upset. Metformin can also be helpful with some weight loss along with proper diet and nutrition. Chronic issues with diabetes type 2 are mitochondrial overproduction of oxidative gree radicals which causes damage to micro- and macrovascular system and causes many of the complications diabetics suffer from (McCance & Huether, 2019) This can be the cause of cardiovascular disease, stroke, infection, PAD, neuropathy, retinopathy, and kidney disease to name a few complications. 

 Chetan, Thrower, Narendran, (2019) What is type 1 diabetes?(2019),ISSN 1357-3039,https://doi.org/10.1016/j.mpmed.2018.10.006.(http://www.sciencedirect.com/science/article/pii/S1357303918302664) Medicine,Volume 47, Issue 1

Hurtado, M. D., & Vella, A. (2019). What is type 2 diabetes? Medicine, 47(1), 10–15. https://doi-org.ezp.waldenulibrary.org/10.1016/j.mpmed.2018.10.010 

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Plows, J. F., Stanley, J. L., Baker, P. N., Reynolds, C. M., & Vickers, M. H. (2018). The Pathophysiology of Gestational Diabetes Mellitus. International journal of molecular sciences, 19(11), 3342. https://doi.org/10.3390/ijms19113342 

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

AUGUSTA URUBISI

Endocrine System Disorder and the Treatment of Diabetes

In the United States, approximately 34.2 million people have diabetes which covers 10.5% of the total population. Other than this, around 88 million people above 18 years old are considered to be pre-diabetic which is 34.5% of the adult US population. This makes diabetes as one of the top public health issues in the country (Centers for Disease Control and Prevention, 2020).

Diabetes mellitus or commonly known as diabetes is a metabolic disorder that is further divided into several classifications – type 1 or juvenile diabetes, type 2 diabetes and gestational diabetes. All of these share a common feature which is hyperglycemia caused by defects in insulin production, action, or both. Type 1 diabetes is an autoimmune disease wherein there is destruction of the pancreatic β-cell resulting in an absolute deficiency of insulin. It is the most common subtype diagnosed in patients below 20 years old, hence the name juvenile diabetes. Type 2 diabetes or T2D is caused by a combination peripheral resistance to insulin action and abnormal insulin secretion. It is classically considered “adult onset,” however, the prevalence of T2D in children and adolescents has been increasing at an alarming pace (Kumar, Abbas, & Aster, 2020). Lastly, gestational diabetes mellitus is the glucose intolerance developed during pregnancy. It occurs to around 7% of pregnant women in the US in which majority revert to normal postpartum but have an increased risk of developing DM in the next 10-20 years. It can also cause hyperglycemia in the fetus resulting in an increased birth weight and chance of caesarean section (Kasper et al., 2015). With the high prevalence of diabetes among children, adults and even pregnant women, it is important to know the different pharmacologic treatment for each type.

Pharmacologic treatment for gestational diabetes mellitus or GDM is similar to patients with pregnancy-associated diabetes. Insulin is the preferred anti-diabetic drug for managing GDM (Rosenthal & Burchum, 2018). Insulin works by promoting cellular glucose uptake and conversion of glucose to glycogen. Insulin can be divided into rapid-acting, short-acting, intermediate-acting, long-acting and super long-acting depending on the duration of the effects of the drug and its onset. The most common rapid-acting insulin is lispro. It is administered by subcutaneous injection, IV route, and continuous subcutaneous infusion (Katzung, 2018). In preparing the drug, it is important to ensure proper storage of insulin. Unopened vials of single type of insulin can be kept in the refrigerator until expiration date, however, vials that are in use should be stored at room temperature, avoiding proximity to sunlight or intense heat. Before administering insulin, proper dosage should be computed first depending on the patient’s caloric intake, activity, infection and stress. When administering the drug, appropriate needle length should be used as having too short could only reach the intradermal layer while having too long could reach the intramuscular layer. It is important to note that injection sites could affect the absorption of the drug. Highest absorption rate is in the abdomen while the least is in the thigh. When instructing patients, it is also important to ask for a return demo to make sure that the patient could administer the drug independently (ATI Nursing, 2019). Short term effects of this drug include hypoglycemia which is why it is also recommended to instruct the patient to have food always ready. Long term effects of the drug include hypokalemia. Patients are advised to report signs of hypokalemia such as muscle cramping and cardiac dysrhythmias since it can be fatal. Taking food high in potassium such as leafy green vegetables could help in avoiding hypokalemia. Gestational diabetes is usually short-term and resolves following delivery. Prolonged diabetes after parturition is no longer considered GDM and should be re-diagnosed and treated accordingly (Rosenthal & Burchum, 2018).

References

ATI Nursing (2019). RN Pharmacology for Nursing Review module edition 8.0. Assessment Technologies Institute, LLC.

Centers for Disease Control and Prevention (2020). National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/data/statistics-report/index.html

Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2015). Harrison’s Principles of Internal Medicine (19th edition). McGraw-Hill.

Katzung, B. (2018). Basic and clinical pharmacology (14th edition). McGraw-Hill.

Kumar, V., Abbas, A., & Aster, J. (2020). Robbins & Cotran Pathologic Basis of Disease (10th edition). Elsevier.

Rosenthal, L. D., & Burchum. J. R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.

PLS USE 3 SOURCES FOR EACH DISCUSSION