diabetes mellitus childhood or adolescence. Symptom onset is relatively abrupt. Primary defect in Type 1 diabetes is destruction of pancreatic cells (Rosenthal, L.D. & Burchum, J.R., 2021). The inadequate production of insulin leads to an increase in blood sugar levels.
Type 2 diabetes mellitus symptoms usually result from a combination of insulin resistance and impaired insulin secretion. Insulin is still produced in Type 2 diabetes; however, the release of insulin is delayed (Rosenthal, L.D. & Burchum, J.R., 2021). The body does not respond to the insulin, the glucose in the blood stream cannot be pushed into cells for energy. This results in fatigue and elevated blood sugar levels.
Gestational diabetes is diagnosed during pregnancy. Just like other types of diabetes, this form affects how cells use glucose. Women who are diagnosed with gestational diabetes are at high risk of developing DM type 2 later in life.
Juvenile diabetes previously called Type 1 diabetes is when the pancreas does not make insulin. Without insulin too much glucose stays in the blood. Elevation of blood sugar is seen in young children usually around the age of 6 with juvenile diabetes (Rosenthal, L.D. & Burchum, J.R., 2021).
Type 2 diabetes is more prevalent than other types of diabetes. Treatment is centered around dietary modifications, exercise and medication (Rosenthal, L.D. & Burchum, J.R., 2021). Biguanides are the first line of treatment for type 2 diabetes, they work by reducing the production of glucose that occurs during digestion (Understanding Metformin for Diabetes, n.d.) For example Metformin decreases glucose production by the liver and increases tissue response to insulin. Metformin is typically started immediately after diagnosis; it is taken by mouth usually 1-3 times daily with meals. Drink plenty of fluids while taking this medication and it should be used at the same time each day (Metformin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing – Webmd, n.d.).
Other dietary modifications are eating low carbohydrate foods, avoiding fast foods, concentrated sugars, and alcohol (Rosenthal, L.D. & Burchum, J.R., 2021). Short-term effects of treatment can include sudden drops in blood sugar levels and long-term effects include neuropathy, retinopathy, risk of cardiovascular diseases, stroke and loss of kidney function (Rosenthal, L.D. & Burchum, J.R., 2021).
Metformin oral: Uses, side effects, interactions, pictures, warnings & dosing – webmd. (n.d.). https://www.webmd.com/drugs/2/drug-11285-7061/metformin-oral/metformin-oral/details
Rosenthal, L.D. & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
Understanding metformin for diabetes. (n.d.). Verywell Health. https://www.verywellhealth.com/biguanides-diabetes-medications-1087355
Top of Form
Type 1 Diabetes
Defines as an autoimmune disorder that is present at birth and destruction of the insulin-producing beta cells in the islets of Langerhans. The patient will produce little to no insulin. Insulin is the hormone that comes from the pancreas. The pancreas has a responsibility to secrete insulin into the bloodstream. Insulin circulates, allowing sugar to enter your cells. Insulin lowers the amount of sugar in your blood stream and drops your blood sugar level.
Type 2 Diabetes
Developed over time requires a need to evaluate the patient’s micro and macrovascular complications. This treatment normally requires the patient to consider a strict diet with exercise and insulin management.
Diabetes that occurs during pregnancy but can last for life too. A screening is provided for pregnant woman at 24-28 weeks of gestation in order to test for diabetes. Prenatal care of patients with gestational diabetes focus on managing the conditions symptoms. These women are at risk for having an infant with congenital malformations because the disorder is organogenesis.
Type one diabetes is the most common chronic disease in children, caused by insulin deficiency resulting in destruction of insulin-producing pancreatic beta cells. Children are more at risk for developing type two diabetes if they are overweight, obese, Native American, or Pacific Islanders.
Type 2 diabetes initial therapy:
The main goal for the patient with type 2 diabetes is achieving and maintain a target glucose with minimal adverse effects. The first thing that would be considered is the patients first presentation such as symptoms, comorbiditites, A1C level. The next step would be to talk to the patient about their goals for the treatment and what they might prefer after hearing their options.
One medication that would be appropriate for a type 2 diabetic is Metformin. Metformin is used for newly diagnosed patients that are asymptomatic. Starting out at 500 mg once daily with the evening meal and once the patient is able to tolerate that a second dose of 500 mg can be added to breakfast. The max dose for this medication would be 2000 mg per day. Sometimes type 2 diabetes can lead to using Insulin therapy.
With type 2 diabetics monitoring the A1C at least twice a year would be sufficient for these patients to continue to monitor how well their diabetes is being controlled through the year and if the provider needs to adjust the regimen at all.
Dietary goals for these patients are very important. Weight maintenance and consistency in day-to-day carbohydrate intake at meals and snacks but also having a well-balanced nutritional content. Decreasing the consumption of sugar would be a very important factor for these patients.
Initial management of hyperglycemia in adults with type 2 diabetes mellitus. (n.d.). Retrieved March 30, 2021, from https://www.uptodate.com/contents/initial-management-of-hyperglycemia-in-adults-with-type-2-diabetes-mellitus?search=type+2+diabetes&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H118731970
Diabetes in Children and Teens. (2021, March 25). Diabetes in Children and Teens. https://medlineplus.gov/diabetesinchildrenandteens.html