NURS 6521 DIABETES AND DRUG TREATMENTS

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.

References

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/cells10010191Links to an external site.

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 Links to an external site.

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.2020.02.002Links to an external site.

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/s41591-021-01502-7Links to an external site.

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Type 2 Diabetes Mellitus (T2DM), one of the most common metabolic disorders, is caused by a combination of two primary factors: defective insulin secretion by pancreatic β-cells and the inability of insulin-sensitive tissues to respond appropriately to insulin. Biguanide oral drugs action are to decrease glucose production by the liver, increases tissue response to insulin. for Type 2 DM treatments can start with lifestyle modifiable changes such as exercising and change of diet. There is a four-step approach, starting with Metformin oral meds. Continuing with Metformin and lifestyle changes, either a thiazolidinedione, or a DPP-4, a dipeptidyl peptidase. The next step would progress to a three-drug combination and last step should previous treatments fail to work after 3-6 months, it is suggested that a combination injectable regimen inclusive of insulin and a GLP-1 receptor agonist.” (Rosenthal & Burchum, p.400).

Metformin (Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet) extended and immediate release, IR tablets dosages range 500, 850, 1000mg, usual initial adult dosage is 850 mg daily or 500 mg twice daily

References

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

Galicia-Garcia U;Benito-Vicente A;Jebari S;Larrea-Sebal A;Siddiqi H;Uribe KB;Ostolaza H;Martín C; (n.d.). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences. Retrieved December 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/32872570/

I enjoyed reading your post. Diabetes can cause people to develop other comorbid diseases if it is not treated properly and taken of carefully. Diabetes can complicate the health of other body organs. Diabetes is a long-term (chronic) illness that affects how your body converts food into energy (CDC, 2022). Type 1, Type 2, and gestational diabetes are the three varieties. You mention in your post that type 2 diabetes has no known cure but can be prevented and managed with early, manageable care. People with type 2 diabetes are more susceptible to numerous short- and long-term problems, which frequently result in an early death (Olokoba et al., 2012). The first recommendation for individuals who have Type 2 diabetes is to maintain a healthy diet and exercise regularly. If it fails to work, the patient is then introduced to oral drugs, and when those do not however work, insulin is eventually used.

References

Centers for Disease Control and Prevention. (2022). What is Diabetes? Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html

Olokoba, A. B., Obateru, O. A., & Olokoba, L. B. (2012). Type 2 Diabetes Mellitus: A Review of Current Trends. Oman Medical Journal, 27(4), 269–273. Retrieved from https://doi.org/10.5001/omj.2012.68

Gestational diabetes is a type of diabetes that develops during pregnancy. It occurs when the body is not able to produce enough insulin, a hormone that helps regulate blood sugar levels, to meet the increased demands of pregnancy. This can lead to high blood sugar levels, which can have serious health consequences for both the mother and the baby.

There are several factors that can increase a woman’s risk of developing gestational diabetes, including:

Being overweight or obese before pregnancy: Being overweight or obese increases the risk of developing gestational diabetes because excess fat cells can interfere with the body’s ability to use insulin effectively.

Having a family history of diabetes: If a woman has a family history of diabetes, she may be more likely to develop gestational diabetes due to genetic factors that increase her risk of the condition.
1. Having previously had gestational diabetes: Women who have had gestational diabetes in a previous pregnancy are at an increased risk of developing the condition again in future pregnancies.
1. Being over the age of 25: The risk of developing gestational diabetes increases with age, so women who are over the age of 25 are more likely to develop the condition.
1. Having high blood pressure or other conditions that increase the risk of diabetes: Certain medical conditions, such as high blood pressure or polycystic ovary syndrome (PCOS), can increase a woman’s risk of developing gestational diabetes.

Complications associated with gestational diabetes include:

High blood sugar levels in the mother: High blood sugar levels during pregnancy can lead to complications such as preterm labor, high birth weight, and an increased risk of developing type 2 diabetes later in life.
- High blood sugar levels in the baby: High blood sugar levels in the baby can cause the baby to grow larger than normal, which may increase the risk of complications during delivery.
- Low blood sugar (hypoglycemia) in the baby after birth: After birth, the baby’s body may have difficulty adjusting to life outside the womb, which can lead to low blood sugar levels.
- Increased risk of complications during delivery: Gestational diabetes can increase the risk of complications during delivery, such as cesarean delivery.
- Increased risk of developing type 2 diabetes later in life: Both the mother and the baby are at an increased risk of developing type 2 diabetes later in life if the mother has gestational diabetes during pregnancy.

Gestational diabetes can be managed through a combination of diet, exercise, and medication, if necessary. It is important for women with gestational diabetes to closely monitor their blood sugar levels and work with their healthcare providers to manage their condition during pregnancy.

References:

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

Diabetes is a metabolic disorder that affects many people as they age. This condition occurs due to a lack of insulin secretion by pancreatic beta cells or insulin-sensitive tissues’ inability to react to the hormone properly (Galicia-Garcia et al., 2020). Glycosylated hemoglobin (HbA1C) values, fasting plasma blood sugar (FPG) levels, and 2-hour plasma blood sugar levels during oral glucose tolerance testing are used to diagnose Diabetes Mellitus in adults and children.

There are 3 types of diabetes, Type 1, Type 2, and gestational diabetes.

Diabetes Type 1, also known as juvenile diabetes affects during childhood between ages 4-14. Compared to healthy individuals, type 1 diabetics have decreased beta-cell function (DiMeglio et al., 2018). Symptoms of this condition include typical high blood sugar, weight loss, excessive urination, and thirst.

Diabetes Type 2, is the most common diabetes prevalent today. This type of diabetes occurs due to advanced age, a sedentary lifestyle, obesity, and a lack of a proper diet and healthy lifestyle. High blood sugar is a symptom of diabetes type 2 when the body is unable to create enough insulin, use enough insulin, or properly utilize glucose as an energy source. The prevalence of T2DM is influenced by a variety of genetic, metabolic, and environmental risk factors that interact with each other (Galicia-Garcia et al., 2020).

Gestational diabetes usually develops during pregnancy that does not already have diabetes. Managing this condition will result in healthy and safe pregnancy and a healthy baby. Increased rates of gestational diabetes mellitus (GDM) and related pregnancy and postnatal problems are a result of increased obesity (Lende & Rijhsinghani, 2020). Therefore, maintaining a healthy weight before pregnancy is crucial. Other factors that include gestational diabetes are advanced age, family history and ethnicity.

Metformin belongs to a drug class called biguanides. It is a drug of choice for diabetes type 2. This drug needs to start immediately upon diagnosing of diabetes to prevent further complications. Metformin tends to inhibit glucose production in the liver, and it also reduces glucose absorption in the gut. It is available in 500 mg, 850 mg, and 1000 mg tablets, some of which are Intermediate releases (IR) and others are extended-release tablets (ER). Because absorption takes time, IR tablets are usually given in doses of 500 mg twice daily, whereas ER tablets are given once daily in the evening. Patients with renal impairment can develop lactic acidosis when taking metformin; monitoring renal function and GFR is therefore vital. Patients with renal dysfunction must be aware of the signs and symptoms of lactic acidosis. Along with medication regimen, dietary restriction is just as important.

Diabetes is managed using a combination of treatments rather than just one. High-fat meals should be avoided, as the fast can often get stored as glucose. High-sugar foods such as sweets, candies, and cakes also lead to diabetes and need to be avoided to control glucose levels. Exercise also helps use up the stored glucose for energy, lowering blood sugar levels.

The short-term impact of diabetes type 2 is hypoglycemia and Hyperosmolar hyperglycemic nonketotic syndrome (HHNS). HHNS is a serious condition that results in high blood sugar levels. This causes frequent urination as the kidneys are working hard, leading to dehydration. Elevated heart rate, confusion, and fatigue are possible as well. The most common and frequently treatment-limiting side effect of diabetic treatment is iatrogenic hypoglycemia, which can result from glucose-lowering medication (Silbert et al., 2018). Not eating as much and being on a diabetic medication regimen also lead to hypoglycemia; hence, eating at certain times is crucial when taking insulin or medication. The long-term impact of diabetes leads to diabetic neuropathy, retinopathy, and cardiovascular disease. Though metformin effectively manages diabetes, long-term use can result in vitamin B12 deficiency. Hence, monitoring these deficiencies on a routine basis is important as well.

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018, June 16). Type 1 diabetes. Lancet (London, England). Retrieved December 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6661119/

Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., Ostolaza, H., & Martín, C. (2020, August 30). Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences. Retrieved December 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503727/

Lende, M., & Rijhsinghani, A. (2020, December 21). Gestational diabetes: Overview with emphasis on medical management. International journal of environmental research and public health. Retrieved December 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767324/

Silbert, R., Salcido-Montenegro, A., Rodriguez-Gutierrez, R., Katabi, A., & McCoy, R. G. (2018, June 21). Hypoglycemia among patients with type 2 diabetes: Epidemiology, Risk Factors, and prevention strategies. Current diabetes reports. Retrieved December 26, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117835/

I live with DM2 and modifying one’s way of life is an essential component in both the management of type 2 diabetes and the reduction of the likelihood of developing additional comorbidities. Consuming a diet that is both healthy and well-balanced is not only necessary for the management of type 2 diabetes, but it can also help lower the risk of developing other conditions. Consuming a diet high in fiber, fruits, vegetables, and grains that are whole may assist to maintain stable blood sugar levels and provide the body with critical nutrients, which are important for general health. In addition to this, it is essential to keep a healthy weight and cut back on foods that contain added sugars.

The management of type 2 diabetes also benefits greatly from consistent physical activity. Exercising can assist in lowering blood sugar levels while also assisting in the maintenance of a healthy body weight. Stopping smoking and reducing the amount of alcohol you drink are two other important steps you can take to lower your risk of developing additional conditions.

It is also possible to assist control type 2 diabetes and lower the chance of acquiring comorbidities by frequently checking one’s blood sugar levels, as well as by taking prescribed drugs in the correct manner. Patients who have their blood sugar checked on a regular basis are better able to detect and respond to any changes that may occur in their blood sugar levels. Patients and their healthcare providers may use this information to better alter patients’ medicines and make any lifestyle adjustments that may be required to maintain appropriate blood sugar levels.

In addition, it is essential to be knowledgeable about the signs and symptoms of any other illnesses that can be associated with type 2 diabetes. Infrequent urination, severe thirst, intense weariness, hazy vision, sluggish wound healing, and unexplained weight loss are some of the symptoms that may be present. It is critical to inform a healthcare physician as quickly as possible about any symptoms that may be cause for worry.

Patients and their healthcare providers should collaborate to establish treatment objectives and a management strategy for the patient’s condition. Patients diagnosed with type 2 diabetes can lower their risk of getting additional comorbidities by making certain adjustments to their lifestyle. Patients with type 2 diabetes may improve their ability to control the illness and lower their risk of getting other problems by adjusting their lifestyles that are more healthful, checking their blood sugar levels on a regular basis, and taking their medicines as directed.

References:

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

NURS 6521 DIABETES AND DRUG TREATMENTS