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 diabetes you selected on patients, including the 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.

Please use a Heading for each major part of the assignment!

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Solution

Diabetes and Drug Treatments

            The prevalence of diabetes mellitus (DM) has increased dramatically worldwide, becoming a major global public health concern. According to Lin et al. (2020), diabetes mellitus is among the major causes of reduced life expectancy and high mortality rate. This disorder is associated with various factors, including changes in glucose conversion, insulin secretion defects, or a rise in insulin resistance (Antonioli et al., 2016). Both children and adults are at risk of developing diabetes mellitus (DM). In the two patient populations, DM is mainly diagnosed by measuring glycosylated hemoglobin (HbA1C). However, other tests utilized in DM include the levels of fasting plasma blood sugar (FPG), random blood sugar level, or oral glucose tolerance testing that involves using 2-hour plasma blood sugar levels (Huether & McCance, 2017). This discussion presents differences between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), gestational, and juvenile diabetes. The paper will also cover a drug used in treating T2DM. Finally, it will include diseases’ short and long-term impacts on the patient.

Diabetes Types

Type 1 diabetes mellitus (T1DM)

T1DM is the first common type of diabetes, which is diagnosed in children below 10 years. The onset of T1DM is characterized by high blood sugar, excessive urination, excessive thirst, and unintentional weight loss due to autoimmune dysfunction, which activates various cells, including the CD4, T cell, CD8, and macrophages. The activation of these cells then infiltrates the pancreas resulting in chronic inflammation and destruction, dysfunction, and death of pancreatic B-cell in the body (Antonioli et al., 2016). Additionally, genetics and environmental exposure increase the risk of developing T1DM (Levitsky & Misra, 2019).

Type 2 diabetes mellitus (T2DM)

Genetically predisposed people mostly develop this condition. It is triggered by various factors, including age, obesity, and physical inactivity due to increased blood sugar levels. Additionally, T2DM is triggered by the inability of the body to generate insulin, convert glucose into energy, or use adequate insulin. This condition is characterized by excessive weight gain, fatigue, frequent infections, slow healing wounds, and visual problems (Blair, 2016). B-cell dysfunction occurs due to immune system activation, inflammation, and infiltration in the pancreas (Antonioli et al., 2016).

Gestational Diabetes Mellitus

High blood sugar levels characterize this condition during pregnancy. Nonetheless, this condition is common in expectant mothers with undiagnosed pre-existing diabetes (Heather & McCance, 2017).

Use of Metformin in Managing Type 2 Diabetes

Metformin is considered the first line of treatment for T2DM since it inhibits the liver from producing glucose and raises insulin sensitivity in the muscle (Blair, 2016). The initial dose for adults is an immediate-release tablet, 500 mg taken once or twice daily orally. This drug is taken with a meal to lower gastrointestinal (GI) upset. The dosage is then titrated upwards gradually within 7 days to prevent adverse GI effects. Secondly, the initial adult dosage is increased from Metformin is 1g taken once daily, particularly during the evening meal. It is associated with some contraindications, including hypersensitivity to Metformin. Additionally, it leads to lactic acidosis and chronic or acute metabolic acidosis in diabetes patients with eGFR < 30 mL/minute.

Type 2 Diabetes Short-Term and Long-Term Effects and Impact of Drug Treatment

Short-term effects of T2DM include hyperosmolar hyperglycemic nonketotic syndrome (HHNKS) and hypoglycemia. Although HHNKS rarely occurs in diabetes patients, it is attributed to a high mortality rate, especially in geriatrics with comorbidities, including cardiovascular, infections, or renal disease (Huether & McCance, 2017). On the other hand, T2DM is associated with microvascular and macrovascular complications in the long term. The microvascular complications involve the damage of small blood vessels resulting in renal failure, blindness due to retinopathy, and foot disorders, and impotence due to neuropathy. Macrovascular complications involve damage to larger blood vessels resulting in cardiovascular diseases (Blair, 2016).

Patients using Metformin should be monitored for Vitamin B12 levels, particularly in patients with anemia or peripheral neuropathy, since Vitamin B12 deficiency occurs following long-term Metformin use. Additionally, renal function and hematologic studies should be conducted initially and annually.

References

Antonioli, L., Blandizzi, C., Csoka, B., Pacher, P., & Hasko, G. (2016). Adenosine signaling in diabetes mellitus—Pathophysiology and therapeutic considerations. Nature Reviews Endocrinology, 11(4), 228-236.

Blair, M. (2016). Diabetes mellitus review. Urologic Nursing, 1, 27. https://doi.org/10.7257/1053-816X.2016.36.1.27

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby

Levitsky, L.L., & Misra, M. (2019, June 27). Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. In A.G. Hoppin (Ed.), UpToDate. https://www.uptodate.com/

Lin, X., Xu, Y., Pan, X., Xu, J., Ding, Y., Sun, X., … & Shan, P. F. (2020). Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Scientific reports, 10(1), 1-11.