response 2 on Diabetes

Type 1 Diabetes

Pancreatic cells that are responsible for insulin production and release into the circulation begin to decrease early in Type 1 diabetes, this usually occurs in childhood or adolescence, with symptoms appearing quickly as the pancreas stops producing and insulin levels drop to zeros. (Rosenthal & Burchum, 2021). Further compounding the issue is cell destruction which is caused by an autoimmune reaction where the patient’s immune system mistakenly attacks his or her own cells. (Rosenthal & Burchum, 2021). Approximately 5% of the population live with this issue. (Rosenthal & Burchum, 2021). Diabetes complications can be avoided by following a comprehensive plan that focuses on glucose management and lowering cardiovascular risk factors. (Rosenthal & Burchum, 2021). Diet, self-monitoring of blood glucose (SMBG), physical exercise, and insulin replacement are all used to achieve glycemic control. (Rosenthal & Burchum, 2021).

Type 2 Diabetes

Type 2 diabetes is characterized by modest first symptoms that might allow diagnosis to be delayed for years and is more prevalent in adults, however, more children are being diagnosed with this type of diabetes. (Rosenthal & Burchum, 2021). Type 2 diabetes is generally caused by Insulin resistance and reduced insulin secretion. (Rosenthal & Burchum, 2021). Although pancreatic cells still make insulin, insulin release is delayed, and peak production is below normal. (Rosenthal & Burchum, 2021). Insulin levels are usually normal or slightly raised early in the illness. (Rosenthal & Burchum, 2021). Insulin resistance raises the demand for insulin to a level that pancreatic cells can’t produce and then the target tissues (liver, muscle, adipose tissue) develop insulin resistance which means the target cell tissue are not able to metabolize glucose available to them. (Rosenthal & Burchum, 2021). Increased insulin resistance, is associated with genetics, obesity, poor nutrition, and a sedentary lifestyle. (ADA, 2018).  Insulin resistance appears to be caused by an insulin decrease receptor numbers, binding, and responsiveness. (Rosenthal & Burchum, 2021). A thorough treatment strategy is required to avoid long-term problems since poor glycemic control will affect pancreatic cell function, resulting in lower insulin production and release, this causes the tissue cells struggle to overcome insulin resistance. (ADA, 2018). Glycemic management is built on a basis of lifestyle changes (diet and physical exercise) and medication therapy. (ADA, 2018).

Gestational Diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy and then goes away soon once the baby is born. (CDC, 2020). Pregnant women who acquire gestational diabetes are more likely to develop type 2 diabetes later in life. (CDC, 2020). Gestational diabetes is associated health risks such as hypertension, an increased birth weight or preterm birth for the developing baby. (Rosenthal & Burchum, 2021). In the vast majority of instances, there are no symptoms. (Rosenthal & Burchum, 2021). During pregnancy, a blood sugar test is performed to diagnose the condition. (Rosenthal & Burchum, 2021). Daily blood sugar testing, a balanced diet, exercise, and baby monitoring are all part of the treatment plan. (Rosenthal & Burchum, 2021). Medication is required if blood sugar levels are excessively high. If insulin is needed, gestational diabetes is treated in the same way as any other diabetic. (CDC, 2020).

Juvenile Diabetes

With the knowledge that the illness may strike anybody at any age, what was once known as juvenile diabetes is now known as type 1 diabetes. (Babu & Eisenbarth, 2012). The American Diabetes Association (ADA) classification distinguishes Type 1 diabetes into two types: type 1A (autoimmune) from type 1B (non-autoimmune). (Babu & Eisenbarth, 2012). The most common form of childhood onset diabetes is type 1A. (Babu & Eisenbarth, 2012). Type 1A diabetes is linked to a variety of autoimmune diseases, and most will have additional autoimmune symptoms, the most prevalent of which is thyroid autoimmunity. (Babu & Eisenbarth, 2012). Although more children are diagnosed with Type 1 diabetes, Type 2 diabetes is becoming more common in children (Rosenthal & Burchum, 2021).

Drug Used to Treat Diabetes – METFORMIN

Pharmacokinetics. Metformin is an oral Biguanide drug that increases tissue response to insulin and decreases glucose production in the liver, and slows absorption of glucose in the stomach. (Rosenthal & Burchum, 2021). Metformin does not promote insulin secretion from the pancreas, and therefore does not actively lower blood glucose levels, so posing little of hypoglycemia when taken alone. (Rosenthal & Burchum, 2021). It is prescribed for a person with Type 2 diabetes and can be prescribed for adults, children and adolescents, and during pregnancy. (Rosenthal & Burchum, 2021). Metformin can used as monotherapy in conjunction with diet and exercise to enhance blood sugar management or can be combined with other medication. (Rosenthal & Burchum, 2021). An off-label use for Metformin is for the treatment of polycystic ovarian syndrome (PCOS) off-label (PCOS), however is not recommended for Type 1 diabetics. (Rosenthal & Burchum, 2021).

Dosing and Precautions. Metformin is an oral medication only and is available in immediate or extended release. (Kwon et al, 2020). The initial dosing is usually 500mg once daily with dosage adjustments increased gradually. (Kwon et al, 2020). The maximum dosage is 2.5 grams a day, however adjunct therapy medications may be needed for doses of 2grams as GI symptoms may occur. (Kwon et al, 2020). 

Diabetes Management. According to the ADA Standards of Medical Care in Diabetes a four-step approach to diabetes management is recommended with metformin as the gold-standard for initial treatment of Type 2 diabetes when medication is required.(Rosenthal & Burchum, 2021). According to the ADA, after a patient is diagnosed with Type 2 diabetes and lifestyle modifications, such as diet and exercise to not fully control glycemic levels, then initiating lifestyle changes plus metformin is the recommended step one, progressive medication management along with lifestyle changes continue in steps 2-4. (Rosenthal & Burchum, 2021).    

Short/long term management. The first pharmacological option for treating type 2 diabetes is metformin. (Rosenthal & Burchum, 2021). However, due of the danger of lactic acidosis, this medication is not advised for people who have compromised renal function. (Kwon et al, 2020). Patients taking Metformin should have their renal and hepatic function monitored at least yearly for altered kidney function with dose adjustments as needed. (Kwon et al, 2020). Type 2 diabetes mellitus is a progressive disease, and many patients will need treatment with insulin, in addition to Metformin, during the course of the disease. (Kooy et al, 2020). In a study by Kooy et al, 2020, long term Metformin treatment prevented weight gain, improved glycemic control, and reduced insulin requirements. (Kwon et al, 2020).  

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