Diabetes and Drug Treatments sample discussion essay

Types of Diabetes and Differences

Type 1 Diabetes Mellitus (DM) is considered an autoimmune chronic illness that results from the inability to produce insulin due to the destruction of beta cells in the pancreas. Diabetes and Drug Treatments sample discussion essay.  The onset of the disease is generally in childhood although it can occur in adults (Khardori, 2021). What was previously referred to as Juvenile Diabetes is now referred to as type 1 DM (Babu & Eisenbarth, 2012). The classical presentation is polyuria, polyphagia, polydipsia in hyperglycemic patients, and unexplained weight loss. Symptoms can be severe when the patient develops Diabetic ketoacidosis (Khardori, 2021). In contrast, type 2 DM develops because of resistance to insulin action, inadequate insulin secretion, and excessive glucagon secretion that also leads to hyperglycemia (Khardori, 2021) Diabetes and Drug Treatments sample discussion essay. Unlike patients with type 1 DM, type 2 DM patients are not completely dependent on insulin as endogenous secretion occurs although many patients end-up needing insulin injections. Patients may be asymptomatic or present with the same symptoms as those with type 1 DM (Khardori, 2021). Diabetes and Drug Treatments sample discussion essay. Pregnant patients can also develop DM. To be classified as Gestational Diabetes Mellitus (GDM), the onset must occur during pregnancy and is defined by any degree of glucose as well as carbohydrates intolerance and accounts for 90% of DM in pregnant patients (Al-Azemi et al., 2021).

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Treatment of Diabetes Type 1 and Dietary Considerations

For patients with type 1 DM, insulin is the mainstay of therapy. As per the literature review, there are minimal differences between administering insulin multiple times a day versus continuous subcutaneous insulin infusion CSII. Although, an infusion pump showed reduced nocturnal hypoglycemia without affecting the AIC (American Diabetes Association, 2018) Diabetes and Drug Treatments sample discussion essay. As for the type of insulin, analogs, whether it is long-acting or rapid-acting, are associated with better glycemic control. Analogs compared to human insulin result in less weight gain and hypoglycemia as well as a lower A1C (American Diabetes Association, 2018). The patient should be educated on special dietary considerations with the use of prandial insulins. The patient should become proficient in carbohydrate counting to adjust and administer the correct amount of insulin (American Diabetes Association, 2018). An agent that can be added to the insulin regimen is Pramlintide which is an amylin analog. The effects of this pancreatic enzyme analog are delay gastric emptying, a decrease in glucagon, and enhanced satiety. Special consideration is to decrease prandial insulin dosing (American Diabetes Association, 2018) Diabetes and Drug Treatments sample discussion essay. Lastly, if the treatment goals are to reduce body weight and LDL cholesterol, Metformin has shown to accomplish that. Moreover, insulin requirement was also reduced in these patients although glycemic control was not improved (American Diabetes Association, 2018).

Short-Term and Long-Term Impact of Type 1 DM and Treatment

The short-term complications of the disease that require special attention are hyperglycemia, hypoglycemia, and ketoacidosis. It is very difficult to achieve normal glycemic levels with exogenous insulin often leading to hyperglycemia (Kahanovitz et al., 2017). Symptoms of hyperglycemia as described above are the most frequent when the level of insulin decreases. When insulin levels decrease to a very low level, lipolysis occurs producing ketone bodies that accumulate to toxic levels and result in metabolic acidosis. Untreated ketoacidosis leads to cerebral edema, coma, and potential death (Kahanovitz et al., 2017) Diabetes and Drug Treatments sample discussion essay. On the other opposite end of the spectrum is hypoglycemia as a result of intensifying the insulin therapy to control hyperglycemia. Therefore, hypoglycemia results can be life-threatening (Kahanovitz et al., 2017). When a provider is devising a diabetic treatment plan for an older person, they must review the risks related to hypoglycemic complications and must compare them against the benefit of reducing microvascular and macrovascular complications.   Generally, a result of <7% on A1c goal is sufficient, but the provider may want to take a less aggressive goal.  When it comes to older people, you need to make sure than they do not get systematically hypoglycemic. The provider will want to avoid certain medications that are risk for hypoglycemia, such as Chlorpropamide, Glyburide, and Rosiglitazone. These should all be avoided with elderly patients (Fravel et al., 2011) Diabetes and Drug Treatments sample discussion essay.

Long-term complications of inadequate management lead to medium and small vessel damages. Medium vessel damages lead to heart diseases, strokes, and peripheral vascular diseases. Small vessel damages lead to retinopathy with potential blindness, nephropathy, and kidney failure as well as neuropathy from loss of function (Kahanovitz et al., 2017). Diabetes and Drug Treatments sample discussion essay.

 

References

Al-Azemi, N., Diejomaoh, M. F., Angelaki, E., & Mohammed, A. T. (2013). Clinical presentation and management of diabetes mellitus in pregnancy. International journal of women’s health, 6, 1–10. https://doi.org/10.2147/IJWH.S52391

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes. Diabetes Care, 41(Suplement 1), S73-S85. http:/care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

Babu, S. R., & Eisenbarth, G. S. (2012). Juvenile diabetes. The Indian journal of medical research, 136(2), 179–181. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461727/

Fravel, M., McDanel, D., Ross, M., Moores, K., & Starry, M. (2011). Special considerations for treatment of type 2 diabetes in the elderly. National Library of Medicine | PubMed. https://pubmed.ncbi.nlm.nih.gov/21378298/   Diabetes and Drug Treatments sample discussion essay

Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 Diabetes: A Clinical Perspective. Point of care, 16(1), 37–40. https://doi.org/10.1097/POC.0000000000000125

Khardori, R. (2021). Type 1 Diabetes Mellitus. https://emedicine.medscape.com/article/117739-overview

Khardori, R. (2021). Type 2 Diabetes Mellitus. https://emedicine.medscape.com/article/117853-overview

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

sample response

Great job on your discussion. Although it can appear at any age, it is interesting to learn there are two times when it seems to peak. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old; however, only 5% of people with diabetes have type 1 diabetes (Mayo Clinic, 2021). It is also interesting to learn that diabetes type 1 tends to increase as one travels from the equator (Mayo Clinic, 2021). Diabetic ketoacidosis (DKA) is a severe complication of diabetes that can be life-threatening.  Very high blood sugar and low insulin levels lead to DKA. The two most common causes are illness and missing insulin shots. Diabetes and Drug Treatments sample discussion essay. It is essential to manage stress because it is harder to control blood glucose if it remains stressed. To proper treatment for type 1 diabetes is insulin, requiring lifelong insulin therapy (Rosenthal & Burchum 2021). The patients will receive their insulin treatment in two different ways. They will receive it through an injection or an insulin pump.  The pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. Patients may also receive angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help keep the kidneys healthy or a daily aspirin to keep them heart-healthy. It is vital to keep up with regular exercise such as walking and swimming to keep the blood sugars down (Mayo Clinic, 2021) Diabetes and Drug Treatments sample discussion essay.

References

Mayo Clinic. (2021, March 27). Type 1 diabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice

            nurses and physician assistants (2^nd ed.) St. Louis, MO: Elsevier. Diabetes and Drug Treatments sample discussion essay

 

 

sample response 2

Thank you for the reply with additional information.  I agree with you that control is the key to complications and the goal is to keep the A1C and daily blood sugar levels controlled.

 Carbohydrate counting, premeal blood sugar, and anticipated activity level are all important in managing type one diabetes (Janež et al., 2020). Consistency is key with treatment. Patient education is very important in medication dosing during changes in illness, injury, and diet. Diabetes and Drug Treatments sample discussion essay.

 

 

 A consistent dietary intake of carbs, fats, and proteins will lead to better drug efficacy over time (Chen et al., 2017). In other words, the more consistent the diet, the fewer fluctuations there will be in the patient’s blood sugar. 

 

Long term, those with type one diabetes typically encounter problems at work and school due to managing their illness (Bronner et al., 2020) Diabetes and Drug Treatments sample discussion essay.

 

References

 

Bronner, M. B., Peeters, M. A. C., Sattoe, J. N. T., & van Staa, A. (2020). The impact of type 1 

diabetes on young adults’ health-related quality of life. Health and Quality of Life Outcomes, 18(1), 137. https://doi-org.ezp.waldenulibrary.org/10.1186/s12955-020-01370-8 Diabetes and Drug Treatments sample discussion essay

 

Chen, W., Qian, L., Watada, H., Li, P. F., Iwamoto, N., Imori, M., & Yang, W. Y. (2017). 

Impact of diet on the efficacy of insulin lispro mix 25 and insulin lispro mix 50 as starter insulin in East Asian patients with type 2 diabetes: Subgroup analysis of the Comparison Between Low Mixed Insulin and Mid Mixed Insulin as Starter Insulin For Patients with Type 2 Diabetes Mellitus (CLASSIFY Study) randomized trial. Journal of Diabetes Investigation, 8(1), 75–83. https://doi-org.ezp.waldenulibrary.org/10.1111/jdi.12547

 

Janež, A., Guja, C., Mitrakou, A., Lalic, N., Tankova, T., Czupryniak, L., Tabák, A. G., Prazny, 

M., Martinka, E., & Smircic-Duvnjak, L. (2020). Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review. Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders, 11(2), 387–409. https://doi-org.ezp.waldenulibrary.org/10.1007/s13300-019-00743-7

 

Discussion: Diabetes and Drug Treatments

For this Discussion, 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/

To Prepare

• 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 and Drug Treatments sample discussion essay

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.

 

 

Types of Diabetes

Type 1 diabetes, or insulin-dependent diabetes, is previously known as juvenile-onset diabetes (Mayo Clinic, 2021). It usually starts in childhood—the body’s system attack itself, where the pancreas cannot produce insulin (Mayo Clinic, 2021). Type 2 diabetes was previously known as non-insulin-dependent or adult-onset diabetes. The pancreas, at times,  creates some insulin; however, at times, it may not be enough, or the body is not using it (Mayo Clinic, 2021). Gestational diabetes is insulin resistance during pregnancy; However, glucose intolerance was not present or recognized before pregnancy(Gilmartin et al., 2018).  The woman’s pancreatic function is insufficient to overcome the diabetogenic pregnancy environment (Gilmartin et al., 2018).

Gestational Diabetes

Gestational diabetes is one of the most common health problems for pregnant women. It develops during pregnancy but subsidizes rapidly after delivery (Rosenthal & Burchum 2021). It is affecting about five percent of all pregnancies each year(Smyth, 2017). If not treated, it can cause health problems for the mother and fetus (Smyth, 2017) Diabetes and Drug Treatments sample discussion essay.

Dietary Considerations

Promoting a healthy pregnancy through a nutritious diet, the patient must work closely with the healthcare provider on a plan. For patients with gestational diabetes, a healthy diet also keeps blood sugar in the healthy range.  However, if the patient cannot control their glucose levels with diet alone, she will require insulin. Their blood glucose must monitor six to seven times a day while the insulin dosages and food intake monitor accordingly (Rosenthal & Burchum 2021). Diabetes and Drug Treatments sample discussion essay

Treatment for Gestational Diabetes

The treatment recommendation is to initiate insulin when the fasting blood glucose concentration is greater than 90 mg/dL on two or more occasions for two weeks or when the 1-hour postprandial blood glucose concentration is more significant than 120 mg/dL (Smyth, 2017). The insulin types most used are neutral protamine Hagedorn (NPH) and regular insulin. Diabetes and Drug Treatments sample discussion essay. NPH is an intermediate-acting insulin. It is typically used when the fasting glucose is high. The onset of action is 2 to 4 hours, the peak effect is at 6 to 12 hours, and the duration of action is 10 to 16 hours. Regular insulin has an onset of action within 30 to 60 minutes, a peak effect at 2 to 3 hours, and a duration of 3 to 6 hours. Among women with gestational diabetes, 15% will require insulin. Human insulin is the least immunogenic (Smyth, 2017).

While there are controversial statistics regarding oral hypoglycemia medications, some healthcare providers use glyburide to treat when diet alone is insufficient. However, a significant number of these patients go on to require insulin to maintain optimal glycemic control. Another oral hypoglycemic agent that is using as a substitute for insulin is metformin. Compared to insulin, metformin has the same effect on the patients and does not affect the fetus, and it is becoming more of an alternative for women (Rosenthal & Burchum 2021).  Diabetes and Drug Treatments sample discussion essay. Exercise helps to improve glycemic control. The mechanism of this improvement is mainly secondary to increasing tissue sensitivity to insulin. Some patients find that exercising three or more times a week for at least 15 to 30 minutes is helpful to them (Smyth, 2017).

Short-Term vs. Long-Term Effect

Gestational pregnancy considers being short-term because 95% of women’s blood glucose normalizes after giving birth. The postpartum period recommends that the patient glucose tolerance screening be performed at 2 to 4 months after delivery to help detect the 3% to 5% of women who remain diabetic and require further treatment. The women need to follow up and get tested and monitor for type 2 diabetes.

For long-term monitoring, if the patient blood glucose is normal, she needs to be checked for diabetes every three years. However, if she has an  Impaired Glucose Tolerance test, she must be tested for diabetes every year. Finally, if the patient develops type 2 diabetes, she must work with her physician to develop a treatment to manage the patient properly. Diabetes and Drug Treatments sample discussion essay

 

Reference

Gilmartin, A. B. H., Ural, S. H., & Repke, J. T. (2018). Gestational diabetes mellitus. Reviews in obstetrics & gynecology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582643/.

Mayo Clinic. (2021, March 27). Type 1 diabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice

         nurses and physician assistants (2^nd ed.) Diabetes and Drug Treatments sample discussion essay

Smyth, T. (2017). Gestational Diabetes: Your Survival Guide to Diabetes in PregnancyGrant Paul Gestational Diabetes: Your Survival Guide to Diabetes in Pregnancy 128pp £9.99 Sheldon Press 9781847094414 1847094414. Nursing Standard, 31(21), 32–32. https://doi.org/10.7748/ns.31.21.32.s36

 

sample response 1

you provided great information on gestational diabetes. It is interesting to read that once a woman has had gestational diabetes, they have a higher risk of developing type 2 diabetes (Mayo Clinic, 2021) Diabetes and Drug Treatments sample discussion essay. Therefore, they require frequent blood glucose testing after delivery. The three factors that predispose women to diabetes in pregnancy are the placenta’s higher hormone production that antagonizes insulin’s actions. Second, the production of cortisol promotes hyperglycemia. Third, glucose can pass freely in the circulation, in which an increase in the mother will stimulate excessive secretion of insulin in the fetus (Rosenthal & Burchum, 2021, p. 398). Diabetes and Drug Treatments sample discussion essay These patients should be provided information to manage gestational diabetes by eating healthy foods and exercising regularly (Centers for Disease Control and Prevention [CDC], 2020). If the patient cannot maintain normal blood glucose by nutrition and exercise, medications should be used. Two pharmacological options are insulin and oral medication, such as metformin or glyburide. Insulin is the treatment of choice; however, both approaches are effective (Durnwald, 2021). Diabetes and Drug Treatments sample discussion essay.

 

References:

Centers for Disease Control and Prevention [CDC]. (2020). Gestational diabetes and pregnancy. Retrieved https://www.cdc.gov/pregnancy/diabetes-gestational.html

Durnwald, C. (2021). Gestational diabetes mellitus: Glycemic control and maternal prognosis. Retrieved from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis

Mayo Clinic. (2021). Gestational diabetes. Retrieved from https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 Diabetes and Drug Treatments sample discussion essay

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

 

 

sample response 2

great post. You explained in detail the types of diabetes that exist and focused on gestational diabetes. For gestational diabetes, it is likely to be short term while the women is pregnant. However, it can turn into long term and does require follow-up (Smyth, 2017). There can be severe long-term effects to uncontrolled diabetes regardless of the type. This can include delayed wound healing, kidney disease, stroke and in severe cases limb amputations (Bagchi & Nair, 2018). Although it is uncommon to experience these complications if gestational diabetes is in control, it is something to be mindful of to follow up with after pregnancy. Diabetes and Drug Treatments sample discussion essay

References

Bagchi, D., & Nair, S. (Eds.). (2018). Nutritional and therapeutic interventions for diabetes and metabolic syndrome. ProQuest Ebook Central https://ebookcentral.proquest.com

Smyth, T. (2017). Gestational Diabetes: Your Survival Guide to Diabetes in PregnancyGrant Paul Gestational Diabetes: Your Survival Guide to Diabetes in Pregnancy 128pp £9.99 Sheldon Press 9781847094414 1847094414. Nursing Standard, 31(21), 32–32. https://doi.org/10.7748/ns.31.21.32.s36 Diabetes and Drug Treatments sample discussion essay