Discussion Responses: Diabetes and Drug Treatments

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 selected (I chose T1DM), 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.

 

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 (I chose T1DM). Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Provide 2 references for each colleague\’s response.

 

Scenario 1:

Diabetes and Drug Treatments

Diabetes is a chronic condition affecting many people globally. The American Diabetes Association outlines various categories of diabetes including type 1 diabetes also know as juvenile diabetes, gestational diabetes, type 2 diabetes, and neonatal and maturity-onset diabetes. Type 1 diabetes refers to a disease where the pancreas is unable to secret insulin because the β-cells of the pancreas that produce insulin are mistakenly attacked by the body’s immune system. It is commonly referred to as an auto-immune condition. Type 2 diabetes affects many people and refers to where the body cannot use insulin effectively. Individuals with this condition have insulin resistance. Gestational diabetes refers to a type of diabetes that is first recognized during pregnancy and is commonly diagnosed during the second or third trimester of pregnancy. Other forms of diabetes include maturity-onset diabetes of the young described by a condition where insulin secretion is impaired but insulin action is not affected (American Diabetes Association, 2015).

Treatment and Management of Type 2 Diabetes

In most cases, the management and treatment of type 2 diabetes comprise education, medication, and lifestyle modifications (Wexler, 2019). The suggested medication to manage type 2 diabetes is metformin, which is suggested because of its glycemic efficacy and because it does not result in weight gain. Additionally, it is cost-effective and well tolerated by many individuals. Wexler (2019) suggested that the beginning dose of metformin should be 500mg once daily, which can then titrated upwards up to a total dose of 2000mg daily. The medication is taken with food, either breakfast, evening meal or both. Other important considerations include avoiding sugar-sweetened foods and beverages and regular monitoring of calorie intake. Exercise is also important and individuals should engage in regular exercise activities of mild to moderate-intensity for 30-60 minutes a day (Wexler, 2019).

Type 2 diabetes can cause many complications. A common short-term complication is hypoglycemia that can easily develop if the individual takes diabetes medication without sufficient calorie intake. The long-term effects include eye, kidney, cardiovascular and nerve complications. When the blood glucose remains out of range for long periods, it can cause retinopathy and/or cataracts that leads to loss of vision. It can also cause impairment in kidney functioning, diabetic neuropathy, poor wound healing, and opportunistic infections. Persistent high blood glucose due to diabetes is also associated with higher risk of heart diseases such as myocardial infarction, coronary heart disease, and atherosclerosis (Amutha & Mohan, 2016; Knight, Nigam, & Andrade, 2017).

 

 

Scenerio 2:

 

Differences between the Types of Diabetes

The term diabetes mellitus comes from the Greek word for fountain and the Latin word for honey. Long in the past, diabetes was diagnosed by the sweet smell of urine and by its sweet taste also (Rosenthal & Burchum, 2021).

Diabetes Mellitus (DM ) is a metabolic condition that involves improperly elevated levels of blood glucose. There are many types of DM, including type 1,(Juvenile diabetes) type 2, maturity-initiated young diabetes (MODY), gestational diabetes, neonatal diabetes, and secondary causes of endocrinopathy, steroid use, etc. Type 1 Diabetes Mellitus ( T1DM) and Type 2 Diabetes Mellitus ( T2DM) are the major subtypes of DM that are classically derived from deficient insulin secretion (T1DM) and/or action (T2DM). In children or teenagers, T1DM exists, while T2DM is suspected to affect middle-aged and older adults with prolonged hyperglycemia because of poor lifestyle and dietary choices. The pathogenesis of T1DM and T2DM is dramatically different, with different etiologies, presentations, and treatments for each form. Type 1 diabetes mellitus  was previously known as insulin dependent diabetes mellitus or juvenile diabetes.

        The loss of beta cells in the pancreas, usually secondary to the autoimmune destruction of beta cells, characterizes T1DM. The effect is the absolute death of the beta cells, and insulin is absent or exceedingly low as an effect. (Sapra & Bhandari, 2020). T1DM is common among Asians and Africans. T2DM entails a more insidious onset where the difference between insulin levels and insulin sensitivity triggers a functional insulin deficit. Insulin resistance is multifactorial, but it typically occurs as a result of obesity and aging. (Sapra & Bhandari, 2020).  T2DM is common among American Indians and Alaska Natives.

        T2DM involves a more complex interplay between genetics and lifestyle. There is clear evidence suggesting that T2DM is has a stronger hereditary profile as compared to T1DM. The majority of patients with the disease have at least one parent with T2DM. (Rosenthal & Burchum, 2021).

        MODY is a heterogeneous disorder identified by non-insulin-dependent diabetes diagnosed at a young age (usually under 25 years). It carries an autosomal dominant transmission and does not involve autoantibodies as in T1DM. (Sapra & Bhandari, 2020). The genetics of this disease are still unclear as some patients have mutations but never develop the disease, and others will develop clinical symptoms of MODY but have no identifiable mutation. (Sapra & Bhandari, 2020).

       Gestational diabetes is essentially diabetes that manifests during pregnancy. It is still unknown why it develops; however, some speculate that HLA antigens may play a role, specifically HLA DR2, 3, and 4. Excessive proinsulin is also thought to play a role in gestational diabetes, and some suggest that proinsulin may induce beta-cell stress. (Sapra & Bhandari, 2020). Others believe that high concentrations of hormones such as progesterone, cortisol, prolactin, human placental lactogen, and estrogen may affect beta-cell function and peripheral insulin sensitivity. (Rosenthal & Burchum, 2021).   The contributing factors for gestational diabetes include obese women who are pregnant, pregnant women who are older than 25 years old, and pregnant women who fall under the ethnic groups with high prevalence rates for diabetes and having a family history of diabetes mellitus.

 

Drug for T2DM and Diet consideration related to treatment

The drug that I selected is Metformin which is used to treat type 2 diabetes mellitus. Metformin hydrochloride, a biguanide, is the most common oral glucose-lowering drug. It is the first line of choice and mechanism of action to reduce blood glucose levels by increasing insulin sensitivity, slowing intestinal glucose absorption, increasing glucose transport power, and stimulating intracellular glycogen synthesis. Metformin is a hydrochloride salt that is taken orally in tablet form. Its formulations are immediate-release (IR) and extended-release (XR).  The extended-release is administered once daily with meals mostly in the evening, it is not to be chewed or crushed. The immediate-release is to release 1-2 hours of administration.  The dose of Metformin is individualized, there is no fixed-dose. (Sanchez-Rangel & Inzucchi, 2017).

          Diet and exercise are recommended with type 2 diabetes mellitus and when taking Metformin.  Individuals are advised to eat low-fat protein and low carbohydrates. They are to avoid foods high in sugar and refined carbohydrates (white bread, rice, pasta). Instead, individuals are encouraged to eat more complex carbohydrates such as brown rice, whole grain bread, lean proteins, fish as well as non-starchy vegetables (broccoli).  Ginko should be avoided as it results in persistently elevated blood glucose.

Long-Term and short-term impact of Type 2 Diabetes mellitus including drug treatment:

          Short-term complications of type 2 diabetes include hypoglycemia (extremely low blood glucose) and hyperosmolar hyperglycemic nonketotic syndrome (HHNS), which is very elevated blood glucose levels. Long-term complications of type 2 include diabetic retinopathy, kidney failure (nephropathy), diabetic neuropathy, and macrovascular issues. (Sanchez-Rangel & Inzucchi, 2017).

     Metformin should be avoided in individuals who are alcoholics, heart, kidney, and liver issues.  The short-term effect of using Metformin are gastrointestinal symptoms of nausea, vomiting, upset stomach, low ph levels, dizziness, anorexia, and hypoglycemia (Sanchez-Rangel & Inzucchi, 2017). Long-term use of Metformin is Liver and kidney damages, malaise, body pain, tiredness, malabsorption of vitamin B12 deficiency, and lactic acidosis which is rare (Sanchez-Inzucchi, 2017).  Metformin is not recommended during pregnancy due to maternal and fetal complications. Metformin is to be taken with meals to reduce side effects.