Diabetes mellitus is a common disease process found amongst all ages. 34.2 million people in The United States have diabetes (Diabetes Research Institute Foundation, 2020). Diabetes is an endocrine disorder that causes hyperglycemia.  The three main types of this disease are Type 1 diabetes, Type 2 diabetes, and Gestational diabetes. Depending on the type of diabetes diagnosed, it can be temporary or a chronic lifelong condition. Both temporary and chronic diagnoses of diabetes can be successfully managed with diet, exercise, and medications to ensure a high quality of life.

Type 1 diabetes is when the pancreas produces very little or no insulin. According to Lohmann (2020), “Type 1 diabetes is due to a progressive loss of B cell insulin secretion” (p.8). The exact cause of this disease is unknown. This type of insulin used to be known as juvenile diabetes because it usually develops during childhood. However, it is no longer referred to as juvenile diabetes anymore. This is due to the increase in childhood obesity, which has caused type 2 diabetes diagnoses to increase significantly in children (Medline Plus, 2020).  This type of diabetes can also develop as an adult. This is a permanent condition that is treated by controlling blood glucose with insulin and a healthy diet and lifestyle.

Type 2 diabetes is the most common form of diabetes. Lohman (2020) stated, “Type 2 diabetes is due to the progressive loss of B cell insulin secretion frequency on the background of insulin resistance” (p.8). Genetics and environmental factors such as sedentary lifestyle, obesity, and poor diet have contributed to this disease process (Rosenthal & Burchum, 2018).  It is most commonly diagnosed as an adult, but as stated previously, the incidence of children with type 2 diabetes is on the rise. This is a chronic form of diabetes but can be managed with or without medication. Maintaining a healthy weight, practicing a healthy lifestyle, and eating a healthy diet is crucial for the appropriate management of this disease.

Gestational diabetes is diabetes that appears in the second or third trimester of pregnancy in a woman who did not have diabetes before becoming pregnant. This happens because of hormones secreted by the placenta and increased estrogen, progesterone, cortisol levels during pregnancy contribute to the hyperglycemia and insulin resistance in this disease (Alfadhili, 2015). The cause of this disease is unknown, but there are certain risk factors that place women more at risk of developing this type of diabetes. These risk factors include obesity, increased maternal age, polycystic ovarian syndrome, family history of diabetes, and race (Alfadhili, 2015). As quickly as this diabetes shows up during pregnancy, it almost instantly disappears after birth. However, a woman diagnosed with gestational diabetes is 50% more likely to develop type 2 diabetes later in life (Alfadhili, 2015).

Gestational diabetes can usually be managed with a healthy diet and exercise. However, sometimes medication is needed for proper glucose control. Insulin, in most cases, is preferred. The type of insulin required is based on the patient’s specific blood glucose elevation. For example, If the patient’s fasting blood glucose is elevated, a long-acting insulin such as NPH should be prescribed at bedtime. If the patient’s blood glucose is elevated after meals, regular insulin, or rapid-acting insulin should be prescribed prior to meals. Close monitoring of patient’s blood glucose levels both prior to the start of medication and after the start of medication is crucial for proper glucose control. An adverse effect of insulin use is hypoglycemia. The patient should be educated on signs and symptoms of hypoglycemia, as well as treatment. The importance of a balanced diet of healthy meals and snacks should also be stressed to assist with the management of this diabetes.

If this type of diabetes, if not properly managed, can cause adverse effects in both the mother and fetus. If blood glucose is not controlled, the fetus can grow larger than average. This can cause the mother to undergo a cesarean section for the safe delivery of the child. The child can experience hypoglycemia after birth because of being used to the elevated blood glucose environment of the mother. Along with the complications of delivering a large baby, the mother can also experience preeclampsia. This hypertensive emergency can be a life-threatening event for both the baby and the mother. The baby could be born prematurely, and the mother could suffer from a seizure or a stroke (CDC, 2020). This is why close glycemic control should be maintained throughout the entire pregnancy.

References

Alfadhili, E. (2015). Gestational diabetes mellitus. Saudi Medical Journal, 36(4), 399-406. http://dx.doi.org/10.15537/smj.2015.4.10307

CDC. (2020). Gestational diabetes and pregnancy. Retrieved March 25, 2020, from https://www.cdc.gov/pregnancy/diabetes-gestational.html

Diabetes Research Institute Foundation. (2020). Diabetes Statistics. Retrieved March 25, 2020, from https://www.diabetesresearch.org/diabetes-statistics

Lohmann, T. (2020, January). Clinical and diagnostic considerations for diabetes mellitus. MLO: Medical Laboratory Observer, 52(1), 8-13. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=141656562&site=eds-live&scope=site

Medline Plus. (2020). Diabetes in children and teens. Retrieved March 25, 2020, from https://medlineplus.gov/diabetesinchildrenandteens.html

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

response

Thank you for an informative post on the different types of diabetes and insulin to treat gestational diabetes! I agree with you that it is crucial to treat gestational diabetes to prevent short-term and long-term complications in both the mother and the fetus. Lifestyle modification, self-education, and blood glucose monitoring are the initial steps to achieve normal glucose control in women with gestational diabetes; however, when glycemic control is not achieved, pharmacologic therapy must be initiated to prevent maternal and fetal complications (Anonymous, 2018).

Traditional pharmacologic treatment for gestational diabetes is insulin because it does not cross the placenta due to its molecular size and has a high safety profile for the fetus; however, in situations of high failure rate in insulin administration compliance, oral antidiabetics can be prescribed (Bergel, Hadar, Toledano, & Hod, 2016). Metformin, a biguanide, is commonly prescribed despite its ability to cross the placental barrier because several studies provided data that it is not teratogenic and has no adverse effects on the infant’s weight, fetal motor activity, has less severe neonatal hypoglycemia, and less maternal weight gain (Bergel et al., 2016). Balsells et al. (as cited by Bergel et al., 2016) conducted a meta-analysis on metformin in comparison with insulin and found out that women on the metformin group gained less weight, has lower risk of maternal hypertension, but with a higher rate of pre-term births; nevertheless, metformin is still recommended as an alternative to insulin when patients refuse insulin administration (Anonymous, 2018).

References

Anonymous. (2018). Treat gestational diabetes with insulin and/or oral antidiabetic agents when lifestyle changes are not effective. Drugs & Therapy Perspectives; Auckland, 34(6), 253–257. http://dx.doi.org.ezp.waldenulibrary.org/10.1007/s40267-018-0501-7

Bergel, R., Hadar, E., Toledano, Y., & Hod, M. (2016). Pharmacological management of gestational diabetes mellitus. Current Diabetes Reports; Philadelphia, 16(11), 1–9. http://dx.doi.org.ezp.waldenulibrary.org/10.1007/s11892-016-0802-y

Discussion: Diabetes and Drug Treatments

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

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 you selected, 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.

By Day 3 of Week 5

Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.

By Day 6 of Week 5

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. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Differences between Types of Diabetes

Type I diabetes (early onset) occurs due to an autoimmune response that causes beta cell destruction and often leads to complete insulin resistance. Type I diabetes occurs more often in whites then in nonwhite populations. Type II diabetes (late onset) occurs due to a combination of genetic disposition, environmental factors and is increased in those who are obese. Type II diabetes ranges from mostly insulin resistance with insulin deficiency to secretory defects with insulin resistance. Type II diabetes occurs more commonly in blacks compared to whites.  Gestational diabetes occurs in pregnant women who have yet to be diagnosed with diabetes and is a result of glucose intolerance that occurs during pregnancy. Juvenile diabetes (Maturity Onset Diabetes of Youth) occurs as a result of autosomal mutations that affects enzymes that are involved in beta cell functioning that affects insulin action (Huether & McCane, 2017, p. 478).

Sulfonylureas & Type II Diabetes

Sulfonylureas is a class of medications that can be used in the treatment of Type II Diabetes. These medications work by binding to receptor sites on beta cells that causes ATP dependent potassium channels to close-when these channels reopen it stimulates increased cytoplasmic calcium to be released with in turn stimulates the release of insulin. This medication class is most effective in those that have had Type II Diabetes less than five years, have no history of previous insulin use, have good glycemic control and who use less then 40 units of insulin per day. Sulfonylureas are to be used in caution in pregnant women and can not be used in children or those that are breastfeeding. Glyburide is a second-generation Sulfonylureas. Dosage of glyburide should start at the lowest dose of 2.5mg and be steadily increased every two weeks until desired glycemic control is obtained. The medication has an onset of 1.5 hours and last 18-24 hours  and is most effective if it is taken 30 minutes before meals (Arcangelo, Peterson, Wilbur & Reinhold, 2017, p. 788).

Oral diabetic agents such as sulfonylureas are not used for long term therapy management. Using oral diabetics in the beginning of treatment can assist the patient in prolonging treatment with insulin and therefore increasing patient quality of life. Oral agents for Diabetes will eventually lose its effectiveness which will eventually result in the need for insulin treatment. According to Sola et. al (2015), “Sulfonylureas act directly on β-cells, leading to progressive dysfunction and worsening of insulin secretion. Thus, despite better glycemic control in the short term, diabetes could worsen in the long term. The clinical result of this phenomenon is known as “secondary failure”, and it represents the inevitable fate of all oral hypoglycemic agents, especially older sulfonylureas (Sola et. al, 2015).

Taking sulfonylureas has the potential to make patients more sensitive to sunlight. Patients need to use caution while taking this class of medication and ensure that they are using sunscreen. Provider’s need to take caution when prescribing this class of medication as a lot of other medications can affect the effectiveness of this medication-either increasing or decreasing the effectiveness. For example, ciprofloxacin, gemfibrozil and tricyclic antidepressants can increase the effectiveness of sulfonylureas whereas, beta blockers, calcium channel blockers and corticosteroids can decrease the effectiveness. No dietary considerations are noted with the use of sulfonylureas however patients with Type II Diabetes should still be educated regarding the importance of following a diabetic diet.

Short term effects of Type II DM include fluctuating blood sugar levels which results in hyperglycemia and hypoglycemia signs and symptoms. Long term effects of Type II Diabetes include retinopathy, atherosclerosis, neuropathy and nephropathy  (Type II DIabetes, 2020).  Short term and long-term effects of medication administration with the use of sulfonylureas includes weight gain and decreased effectiveness of the medication over time.

 

Arcangelo, V. P. (2005). Pharmacotherapeutics for Advanced Practice. Philadelphia: Lippincott Williams & Wilkins.

Huether, S. &. (2017). Understanding Pathophyisology. St. Louis: Elsevier.

Sola, D. R. (2015). Sulfonylureas and their use in clinical practice. Archives of Medical Science, 840-848.

Type II DIabetes. (2020, March 24th ). Retrieved from Harvard Health Publishing: https://www.health.harvard.edu/a_to_z/type-2-diabetes-mellitus-a-to-z