response 1 on Diabetes

Diabetes mellitus is one of the most deadly diseases that affects differenr age group .It is a disorder in the body metabolism which is characterized by altered glucose conversion into energy for cell use, defects in insulin secretion or increase insulin resistance (Antonioli et al., 2015).It is diagnosed by determining the glycosylated hemoglobin (HbA1C) levels, fasting plasma blood sugar (FBG) levels or random blood sugar level. The A1c levels is the most accurate measure to diagnose diabetes (Huether & McCance, 2017) .About 23 million people in the United States have been diagnosed with diabetes, and 5% to 10% of those cases are juvenile (type 1). This is about one in 250 people; of those, about three-quarters are diagnosed with juvenile diabetes during childhood or young adulthood (“Juvenile Diabetes Signs, Symptoms, Causes, Treatments and More”, 2021). The most common age for a juvenile diabetes diagnosis is between 10 and 16, possibly because puberty triggers an increase in hormone production and these hormones, including estrogen and testosterone, can affect blood sugar levels (“Juvenile Diabetes Signs, Symptoms, Causes, Treatments and More”, 2021)


Different types of Diabetes

Type 1 diabetes mellitus or juvenile

Type 1 diabetes mellitus or juvenile are mostly seen in childhood before age 10years old. It is associated with high blood sugar, excessive thirst and urination, weight loss resulting from an autoimmune dysfunction activating the CD4, CD8 T cells and the macrophages infiltrating the pancreas leading to chronic inflammation, pancreatic B-cell dysfunction, destruction and death (Antonioni et al., 2015). Genetic predisposition increases the risk of close relatives to a T1DM patient as a result of gene polymorphisms, while environmental exposure can initiate an immune response to genetically susceptible individuals killing the insulin-producing B-cells in the pancreas (Levitsky & Misra, 2019).


Type 2 diabetes mellitus (T2DM)

Type 2 diabetes mellitus (T2DM) is associated with genetically predisposed individuals due to advancing age, inactivity, and obesity leading to   high levels of blood sugar due to the body’s inability to produce insulin, use sufficient insulin, or glucose for energy with signs and symptoms of fatigue, weight gain, slow healing wounds, frequent infections, visual changes, and altered sensation (Ooi et al., 2021)16). Other factors are chronic-low grade inflammation, immune system activation, and infiltration in the pancreas results in B-cell dysfunction and progressively increased insulin resistance (Antonioli et al., 2015).


Gestational diabetes mellitus

Gestational diabetes mellitus is a type of high blood sugar that occurs during the onset or first detected during pregnancy. According to the American Diabetes Association (ADA) ,women with gestational diabetes may have had undiagnosed pre-existing diabetes, so the ADA recommends these group of patients  should receive a  T1DM or T2DM diagnosis instead of gestational diabetes (Heather & McCance, 2017).


Metformin Administration in Type 2 Diabetes

Metformin is the first line of therapy for type 2 diabetes   unless contraindicated because it hinders the liver’s glucose production and increases muscle tissue insulin sensitivity (Blair, 2016).  This medication   comes in two oral preparations: a) initial adult dose for the immediate-release tablet is 500 mg orally once or twice daily or 850 mg daily. To prevent GI upset, metformin should be taken with a meal should be administered with a meal. The dosage is increase gradually every seven days to minimize adverse GI effects .The  initial adult dose for the extended-release Metformin is 500 mg to 1 gram once daily with the evening meal and gradual dose titration to minimize adverse GI effects (UpToDate, n.d.). Contraindications to Metformin use are hypersensitivity to Metformin or any of its components, patients with eGFR < 30 mL/minute as it can result in lactic acidosis, acute, or chronic metabolic acidosis, and death (UpToDate, n.d.).


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

Short-term impact of T2DM  

Short-term impact of T2DM are : a) hypoglycemia in individuals taking secretagogues such as sulfonylurea agents or exogenous insulin that requires immediate glucose replacement by mouth or intravenously; b) hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), which  is less common but may  result in high mortality rate particularly in the elderly who have comorbidities such as infections, cardiovascular, or renal disease that  is characterized by very high blood sugar level resulting in severe dehydration, electrolyte imbalance, and neurologic impairment (Huether & McCance, 2017).


The long-term effect of T2DM

The long-term effect of T2DM include: microvascular complications which are damages to small blood vessels leading to renal failure, retinopathy leading to blindness, and neuropathy leading to impotence and foot disorders; and macrovascular complications are damage to larger blood vessels leading to cardiovascular diseases (Ooi et al., 2021)

Monitoring recommendation for Metformin

Checking vitamin B12 levels every two to three years especially in individuals with peripheral neuropathy or anemia because long-term metformin use may lead to vitamin B12 deficiency; b) initial and yearly hematologic and renal function studies. Other monitoring recommendations include: Bi-annual urine glucose, fasting blood sugar, and hemoglobin A1C in patients with stable glucose control and every four months for individuals not meeting glycemic control (UpToDate, n.d.).



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