Medical Principles and Practice Discussion

Diabetes Types and Management Response

Thank you for your insightful discussion on the different types of diabetes, their management, and their short- and long-term implications in patients’ lives. The emphasis on lifestyle changes in managing type 2 diabetes has been recommended in various studies. In diabetic patients, the leading cause of chronic hyperglycemia is resistance to insulin action. As such, Borse et al. (2020) recommend lifestyle modification as an effective way to manage type 2 diabetes mainly because its etiology is attributed to the complex interaction of genetic and environmental factors. This includes modifications in physical activities, dietary habits, stress management, and improved sleeping patterns.  In addition to lifestyle modification, you mentioned the use of pharmacological interventions, particularly metformin, as the first-line medication for type 2 diabetes. Before initiating Metformin medication for diabetes patients, healthcare professionals must educate patients on the drug’s benefits, risks, and side effects. Medical Principles and Practice Discussion

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Diabetes Mellitus may have detrimental long-term impacts on health outcomes and overall quality of life.  According to Farmaki et al. (2021), type 2 diabetes may result in acute or chronic complications. In addition to those you mentioned in your post, other complications may include hyper-hypoglycemia, diabetic coma, diabetic foot, and cardiovascular diseases, including congestive heart failure, coronary disease, and arterial heart failure. Early identification of signs and symptoms can effectively initiate early intervention, ultimately reducing diabetes-associated complications and improving overall patient outcomes.

References

Borse, S. P., Chhipa, A. S., Sharma, V., Singh, D. P., & Nivsarkar, M. (2020). Management of type 2 diabetes: Current strategies, unfocussed aspects, challenges, and alternatives. Medical Principles and Practice, 30(2), 109–121. https://doi.org/10.1159/000511002

Farmaki, P., Damaskos, C., Garmpis, N., Garmpi, A., Savvanis, S., & Diamantis, E. (2021). Complications of the type 2 diabetes mellitus. Current Cardiology Reviews, 16(4), 249–251. https://doi.org/10.2174/1573403×1604201229115531 Medical Principles and Practice Discussion

When it comes to diabetes, there are several varieties that require explanation. Type I diabetes mellitus is generally referred to as juvenile diabetes because most of these individuals are present in childhood. Type I diabetes is primarily an autoimmune disorder where antibodies attack Beta cells of the pancreas, and it is generally a genetic condition (Khan et al., 2019). These are the cells responsible for producing insulin, and when the autoimmune process destroys more than 80-90 percent of these cells, there is insufficient insulin to support normal glucose metabolism. These patients generally require insulin replacement in terms of treatment, which comes in a variety of formulations that have different lengths of action (Khan et al., 2019). Type 2 diabetes mellitus is much more common than Type 1 diabetes, and it usually presents in adulthood. Its causes are multifactorial in nature and include genetic and environmental factors as well as lifestyle factors. In Type 2 diabetes, insulin resistance as well as reduced insulin secretion and erratic glucagon secretion affect normal glucose metabolism (Khan et al., 2019). Some Type 2 diabetics may require insulin therapy, but this tends to be later and for more severe cases. Many oral hypoglycemic meds and other medications are often effective for Type 2 diabetes (Khan et al., 2019). Finally, gestational diabetes refers to any women who develops glucose intolerance in pregnancy. Some intolerance to glucose occurs in all pregnant women, but those with gestational diabetes are unable to produce increased amounts of insulin to overcome this resistance (Khan et al., 2019). Medical Principles and Practice Discussion

Understanding the different types of diabetes, Type 2 diabetes mellitus is most common and deserves attention because of this. Lifestyle management is important in this group of patients. Optimal weight is encouraged as overweight and obesity are risks for Type 2 diabetes (Ahmad et al., 2022). In addition, dietary management is important and should include calorie count guidance and instructions on the types of carbohydrates to eat as well as portions of carbohydrates, fats, and protein in the diet. Dietary consultation is generally encouraged to assist with this education and guidance (Ahmad et al., 2022). Similarly, exercise and physical activity is encouraged not only for weight management but to reduce vascular side effects and to reduce the degree of insulin resistance (Ahmad et al., 2022). The first-line medication for the majority of Type 2 diabetics is Metformin, which is a biguanide. Metformin has many mechanisms of action including the ability to inhibit hepatic gluconeogenesis, which lowers baseline and post-prandial glucose levels. Metformin also reduces intestinal absorption of glucose and other sugars, and it increases sensitivity to insulin at a cellular level (Glossman & Lutz, 2019). It is usually initiated at 500mg po BID. Side effects can include diarrhea, nausea, vomiting, and dyspepsia. Adverse events can include lactic acidosis, hypoglycemia, and reduced vitamin B12 levels (Glossman & Lutz, 2019). Medical Principles and Practice Discussion

In considering short and long-term impacts of diabetes, early symptoms that herald the diagnosis can include polyuria, excessive thirst, weight loss, blurry vision, paresthesia, and dizziness. Having the diagnosis made can also have psychological effects such as anxiety and depression (Ahmad et al., 2022). Long-term complications related to diabetes often involve micro and macro-vascular problems. Small vessel complications can lead to retinal disease, neuropathy, and renal disease. It can also affect the skin with skin ulcerations (Khan et al., 2019). Large vessel atherosclerosis and problems can also occur leading to a higher stroke and heart attack risk (Khan et al., 2019). Over time, it is not uncommon to require higher dosing of medications or the addition of secondary agents. This is why long-term lifestyle and dietary management are important (Ahmad et al., 2022). Medical Principles and Practice Discussion