Assignment On Diabetes
Assignment On Diabetes
Diabetes mellitus is a group of metabolic diseases that manifest with hyperglycemia caused by defects in insulin secretion, insulin action, or both. Type 1 diabetes results from autoimmune destruction of pancreatic B cells (ADA, 2020). Type 2 diabetes is a progressive disorder characterized by increasing insulin resistance and diminishing insulin secretory capacity. It is frequently associated with obesity (ADA, 2020). Gestational diabetes refers to any level of glucose intolerance with onset or first recognition during pregnancy (ADA, 2020). Juvenile diabetes occurs in children. It is characterized by the body’s inability to produce insulin secondary to autoimmune destruction of the beta cells in the pancreas.
Glipizide is an antidiabetic drug, under the class of sulfonylureas, used to treat Type 2 diabetes. Its main effect is to increase insulin secretion from pancreatic beta cells. It also reduces the rate of hepatic glucose production and increases insulin receptor sensitivity (Correa et al., 2020). The recommended starting dosage of Glipizide is 5 mg/d, with up to 15 mg/d given as a single dose. However, when higher daily dosages are required, they should be divided and given before meals. The maximum recommended total daily dose is 40 mg/d. For maximum effect in reducing postprandial hyperglycemia, it should be ingested 30 minutes before breakfast because absorption is delayed when the drug is taken with food. (Correa et al., 2020) It is contraindicated in patients with significant hepatic or renal impairment because of a high risk for hypoglycemia.
The short-term impact of type 2 diabetes includes hypoglycemia, which is associated with sulfonylurea medications and missing meals. A patient may develop hyperosmolar hyperglycemic nonketotic syndrome, characterized by very high blood glucose (Papatheodorou et al., 2018). The long-term impact includes complications such as nephropathy, diabetic retinopathy, diabetic neuropathy, and macrovascular disorders (Papatheodorou et al., 2018). The complications occur due to high glycemic levels, which damage small blood vessels causing microvascular complications and large vessels causing macrovascular complications.
American Diabetes Association. (2020). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes care, 43(Supplement 1), S14-S31. https://doi.org/10.2337/db16-0806
Correa, R., Rodriguez, B. S. Q., & Nappe, T. M. (2020). Glipizide. In StatPearls [Internet]. StatPearls Publishing.
Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of diabetes research, 2018, 3086167. https://doi.org/10.1155/2018/3086167
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The four categories of diabetes mellitus are type 1, type 2, gestational, and other specified types. Type 1 diabetes results from the destruction of pancreatic beta cells and requires daily dosing with insulin. This is caused by an autoimmune or idiopathic response. Type 2 is the most common form of diabetes and accounts for 90-95% of all diagnosed cases (Rosenthal & Burchum, 2021). Type 2 usually results from insulin resistance and inappropriate insulin secretion. At one point type 1 diabetes was termed juvenile- onset as it was thought to occur solely in young children. Type 1 is now known to develop in adulthood as well and type 2 is becoming more common in children. Although both type 1 and type 2 carry signs and symptoms, they differ in etiology, prevalence, treatments, and outcomes (Rosenthal & Burchum, 2021). In gestational diabetes, insulin requirements physiologically increase during pregnancy. The increase in insulin demand is due to increased maternal caloric intake, maternal weight gain, presence of the placental hormones such as placental growth hormone, and placental lactogen, as well as increased prolactin and growth hormone production (Lende & Rijhsinghani, 2020). As pregnancy advances, the pancreatic beta cell mass increases to keep up with the demand for increased insulin. Failure of the beta cell expansion with a relative inadequate rise in insulin secretion leads to gestational diabetes ( McMcance & Heuther, 2019).
Insulin is the preferred treatment for control of hyperglycemia in patients with gestational diabetes. Insulin is a large molecule and does not cross the placenta. In patients unable to take insulin, oral hypoglycemic agents can be considered. Metformin is preferred over glyburide due to the risk of possible fetal hypoglycemia associated with maternal administration of glyburide. Typically, the dose of oral medications is once or twice a day. Metformin and glyburide have been shown to cross the placenta and into the fetus. Oral medications have not been adequately studied for possible long-term effects on neonatal outcomes, and therefore they are not recommended as the first choice in treatment for persistent hyperglycemia in gestational diabetic patients (Lende & Rijhsinghani, 2020).
One complication of insulin treatment is hypoglycemia unawareness. Hypoglycemia occurs when insulin levels exceed insulin needs. The more a patient experiences hypoglycemia, they begin to have diminished symptoms over time (Rosenthal & Burchum, 2021). Frequent blood glucose monitoring minimizes the risk for this complication. When therapy is successful, both hyperglycemia and hyperglycemia are minimized and the patient is actively involved in their own therapy. To reach optimal glucose control, dosage must be closely matched with insulin needs (Rosenthal & Burchum, 2021).
Lende, M., & Rijhsinghani, A. (2020). Gestational Diabetes: Overview with Emphasis on Medical Management. International Journal of Environmental Research and Public Health, 17(24). https://doi-org.ezp.waldenulibrary.org/10.3390/ijerph17249573
McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Health Sciences.
Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier Health Sciences.