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.
colleague 1
Diabetes Mellitus (DM) is a metabolic disease of inadequate control of blood glucose levels. It is usually chronic and has no definite cure. Most treatment modalities are mainly to control hyperglycemia which triggers most complications of diabetes mellitus ranging from amputation of lower extremities blindness, infertility in both males and female, and so on. There are various forms of diabetes mellitus, they seem to have different pathophysiologic stages of development however, they share one common characteristics of hyperglycemia. As explained by Sapra and Bhandari (2021), the Islets of Langerhans in the Pancreas, has two main insulin producing endocrine cells namely Alpha cells that produces glucagon and beta-cells that produces insulin. Regulation for balance between the two cells, depends on the level of the circulating blood glucose. Higher levels of blood glucose cause the production of insulin which lowers the blood glucose by forcing them into the muscles whereas lower blood glucose levels cause the production of glucagon which converts glycogen into glucose. Alteration in the production and utilization of insulin and glucagon, raises to the diagnosis of diabetes mellitus which is characterized by hyperglycemia.
Type 1 Diabetes Mellitus: This type of diabetes results due to non-production of insulin by the Beta-cells of the Pancreas. It could be caused by autoimmune reaction where the body’s immune system attack itself. It is sometimes referred to as Childhood diabetes as the diagnosis of diabetes starts early in life.
Type 2 Diabetes Mellitus: This is usually referred to as adulthood diabetes as it starts later in life. It is sometimes called insulin resistant diabetes as there is production of insulin by the Beta-cells. However, in type 2 DM, the insulin produced is not adequately utilized by the cells of the body as they fail to recognize and utilize insulin, hence body cells become resistant in allowing glucose into the cells and muscles tissues of the body in the presence of insulin. Under normal physiology, cells of the body stores and utilizes blood glucose in the Presence of insulin. More so, Type 2 DM occurs when there is imbalance between insulin levels and insulin sensitivity causes low functional insulin with obesity as the main predisposing factor (Sapra and Bhandari, 2021).
Gestational Diabetes Mellitus: this is DM that occurs during pregnancy its cause is unknown but Human Leukocyte Antigen (HLA) causes excessive production of Proinsulin which induces Beta-cells stress that lowers the production of insulin. More so, increased production of progesterone, cortisol, prolactin, Human Placental Lactogen and Estrogen seems to affect beta-cells function and peripheral insulin sensitivity (Sapra and Bhandari, 2021). Murray and Reynolds (2020) added that gestational diabetes is usually caused by overweight and obesity found among some pregnant women.
Juvenile Diabetes Mellitus: this type of DM is also called type 1, adolescent, or insulin-dependent diabetes mellitus. There is usually autoimmune disorder leading to lower or no insulin production (Gold, 2020).
Gestational Diabetes Mellitus
For DM during pregnancy, most times insulin therapy has been initiated for the control of blood glucose since it does not cross placental site in controlling maternal increased blood glucose which could lead to fetal and maternal morbidity. However, insulin administration causes hypoglycemia more frequently and increased maternal weight hence these days use of Metformin has been widely used in place of insulin for gestational diabetes mellitus (Murray and Reynolds, 2020).
Metformin is an orally administered hypoglycemic agent that controls Blood glucose. It is a biguanide antihyperglycemic medication which lowers glucose production in the Liver, increases insulin sensitivity of body tissues and increases GDF15 which reduces appetite and caloric intake (Graham et al, 2017). Belongs to class: Non-sulfonylureas, Brand names: Glucophage XR, Fortamet, Glimetza, Riomete, etc.
Metformin is prepared from Galegine, a natural plant product which is a derivative of Isoprenyl derivative of Guanidine. Presents in tablets and liquid hence can be given orally and should not be used for children under 18years, adults with low Glomerular filtration rate <30ml/min, metabolic or severe keto acidosis and use of metformin should be on hold if undergoing for CT scan with IV contras (dye) (Sanjai, 2021).
Effects of Metformin to Gestational diabetes:
Metformin controls maternal blood glucose, limit gestational weight gain, fewer neonatal risk of hypoglycemia, respiratory distress, need for phototherapy, birth trauma, Apgar score <7 or prematurity of about 32% as compared to 32.2% in insulin therapy. Babies exposed to metformin tend to have lower or average birth weight as compared to insulin (Murray and Reynold, 2020).
Diet:
For control of blood glucose, it is imperative that diet, exercise and medication need to work hand and in hand. Use of DASH Diet (Dietary Approaches to Stop Hypertension) focus on lowering sodium and increasing potassium. This form of diet becomes apparent for DM as increased blood pressure tends to increase blood glucose. Following Mediterranean diet seems to lower blood glucose as this diet consist of vegetables, whole grains, beans, fruits, healthy fats, low sugar. Carbohydrates affects blood glucose level while unhealthy fats can contribute to cholesterol build-up which leads to obesity hence, the quantity and quality of food affects health of any individual.
Long term and short-term Effects of Gestational Diabetes Mellitus to both Mother and Fetus.
Gestational DM if not controlled can lead to maternal and fetal complications. Some examples of Short-term effect include: Macrosomia, Shoulder dystocia, birth trauma, hypoglycemia in immediate postpartum period. Some Long-term effects include: impaired fetal development, obesity, cardio metabolic risk noted at childhood and adulthood. Pre-eclampsia and risk of developing DM later in life are some long-term effects of gestational DM to the mother.
Conclusion
Diabetes mellitus seems to be a preventable endocrine disorder especially type 2 diabetes. While it is advised on adequate weight maintenance through exercise and healthy dieting can improve in controlling and maintaining normal blood glucose. It is also recommended that daily blood glucose monitoring with glucometer and two-three monthly Laboratory Hemoglobin AIC monitoring be implemented.
Colleague 2
Types of Diabetes
Diabetes signifies a group of metabolic diseases and has many different types. According to the American Diabetic Association, about 1.5 million Americans are diagnosed with diabetes Most often we are commonly exposed to these main two types are type one and type two diabetes. Gestational diabetes is another type of diabetes that we can be exposed to. Huether & McCance, (2017) explains that there are two types of diabetes that occur at a specific time in life. Juvenile diabetes or type 1 diabetes occurs during childhood and Gestational diabetes occurs during pregnancy especially with women who have glucose intolerance during pregnancy
Type 1 Diabetes, also known as juvenile diabetes, occurs when beta cells of the pancreas are damaged, resulting in a complete stop of insulin production. The pancreas does not have sufficient insulin reserve through which blood could be regulated. This results in a high amount of glucose in the blood. Patients characterized with type 1 DM are prone to ketoacidosis, minimal to no insulin secretion, and are insulin-dependent
With type II diabetes, the body’s muscle and fat cells tend to have less sensitivity to insulin action or the production of insulin by the pancreas are not sufficient to meet the body’s demands, or the body becomes resistant to insulin, leading to decreased beta-cell mass and function (Rosenthal & Burchum, 2018). This type 2 diabetes is common amongst grown adults, and it is a very common metabolic disease that is killing many people around the world. Gestational diabetes is a type of diabetes that appears during pregnancy and then subsides rapidly after delivery. Gestational diabetes is managed in much the same manner as any other diabetic pregnancy. Successful management of diabetes during pregnancy demands that proper glucose levels be maintained in both the mother and fetus; failure to do so may be teratogenic or may otherwise harm the fetus, (Rosenthal & Burchum, 2018).
Pharmacological Management of Type II Diabetes
With the rapid increase in the number of people having Type II diabetes worldwide, I will select this type 2 diabetes and provide one effective therapy for the management of this type of diabetes. The utilization of sulfonylureas is one of the most effective treatments for type 2 diabetes. This method fixes the imbalance in the metabolism of lipids, proteins, and carbohydrates by increasing the release of insulin from the pancreas. According to Rosenthal & Burchum, (2018), Sulfonylurea’s link to the beta-cell receptors, through which ATP depended on potassium channels are closed, and calcium channels are opened Moreover, the release of insulin is triggered through this rise in cytoplasmic calcium.
Hypoglycemia is the most significant side effect linked to the intake of sulfonylureas. Therefore, maintaining a healthy diet is extremely important, with food being consumed with its use. In young patients, alcohol abuse has also been linked with the occurrence of hypoglycemia (Rosenthal & Burchum, 2018). Patients should be educated on the effect of alcohol on the medication or considerably reduce their consumption of alcohol when taking this drug. Also, a regular healthy diet is necessary to maintain so that the effects of this drug could be maximized, and any serious side effects could be prevented. Renal function should be assessed as this medication is excreted by the kidneys
Short- and Long-Term Impact of Type II Diabetes on Patients
According to Rosenthal & Burchum, (2018), education is the main feature of diabetic therapy because there is a higher risk of developing microvascular and macro-vascular problems in diabetic patients. These include ophthalmic abnormalities, nephropathy, and heart disease. It is vital for patients with diabetes to be put on a healthy diet as well as encourage them to participate in regular exercise to help manage their blood glucose, especially those with type II diabetes. The kind of lifestyle of a patient influences the effectiveness of drug therapy. A patient’s blood glucose will not be correctly regulated if they continue to consume food containing high sugar or simple carbohydrates s rather than complex carbohydrate (American Diabetes Association, 2019). Moreover, patients should pay close attention to potential signs of hyperglycemia and hypoglycemia and immediately take proper intervention measures as directed by their physician.
Conclusion
A collaborative effort provided by the patient, healthcare providers, and the patient’s family members is an important tool for effectively managing diabetes. Lately, nutritionists are also increasingly involved in the management of diabetes. Regulation of diabetes should be done according to each patient so the quality of life of each patient is improved (American Diabetes Association, (2019).). Since there have been numerous research on diabetes without a proven cure, having a collaborative effort with our diabetic patients would greatly benefit them in managing their diabetes as well as improve their quality of life
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