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

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

Type 1 Diabetes

Type 1 diabetes generally develops during childhood or adolescence, however type 1 can develop during adulthood (Rosenthal & Burchum, 2018). Previously called insulin dependent or juvenile diabetes, type 1 diabetes is caused by an autoimmune reaction that destroys pancreatic beta cells, which are the cells responsible for insulin synthesis and release into bloodstream.

Type 2 Diabetes

Type 2 diabetes accounts for 90-95% of diagnosed diabetes cases and approximately 22 million Americans have this disease (Rosenthal & Burchum, 2018).  Type 2 diabetes is non-insulin dependent diabetes or also known as adult-onset diabetes mellitus.  Insulin is still produced for patients with Type 2, the secretion is no longer tightly coupled to plasma glucose, which makes the release of insulin delayed and peak output is subnormal. A patient will have fasting labs and also check a hemoglobin A1C.

Juvenile Diabetes

An autoimmune disease where the pancreas stops producing insulin. Also, known as type 1 diabetes or insulin dependent. This is not related to lifestyle or diet. Early signs to watch for, include thirst and urination.  If having symptoms, the provider will test blood levels.

Gestational Diabetes

Diabetes that appears during pregnancy and then subsides after delivery is gestational diabetes (Rosenthal & Burchum, 2018). You want to monitor blood glucose and make sure it is well controlled with diet and insulin if prescribed. Gestational diabetes usually shows up in the middle of pregnancy, and providers test between 24-28 weeks of pregnancy (CDC, n.d.).

The medication I chose is Metformin (Glucophage). Metformin is an oral agent that decreases glucose production by the liver and increases tissue response to insulin (Rosenthal & Burchum, 2018). Metformin is started once diagnosis of type 2 diabetes is made unless contraindicated.  Metformin is safe and has beneficial effects on A1C, weight management, and cardiovascular mortality (American Diabetes Association, 2018). Metformin can be used as monotherapy, unless A1C is greater than 9%, then consider dual therapy.  Keeping a healthy weight is important along with diet and lifestyle changes.

Drug Class: Biguanides          

Pharmacokinetics: Metformin is slowly absorbed from the small intestine and is not metabolized, but excreted unchanged by the kidneys (Rosenthal & Burchum, 2018). Metformin can accumulate to toxic levels.  Metformin can be used in patients with mild impairment in kidney function and in some patients with moderate kidney impairment (U.S. Food  & Drug, 2017).  Before started, obtain patients eGFR. Not recommended in patients with a eGFR <30.

Side effects: decreased appetite, nausea, and diarrhea.

Severe metabolic acidosis can occur with accumulation of Metformin and patients with significant renal impairment.  If a patient had any recent infection or illness they need to be aware to let the provider know and the medication might have to be stopped until feeling better.  Patients admitted in the hospital are usually stopped on their Metformin and resumed after discharge. Caution patients if drink alcohol, whether its acute or chronic, because alcohol potentiates the effects of Metformin on lactate metabolism.  Metformin can cause low blood sugar if patients do not eat enough, if they drink alcohol or if they take other medications that can lower blood sugar (U.S. Food & Drug, 2017).  Monitoring blood glucose levels are very important when  educating patients.

Sarah

References

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2018. Diabetes Care, 41(supplement 1), S73-S85. Retrieved from: https://care.diabetesjournals.org/content/diacare/41/Supplement_1/S73.full.pdf

Centers for Disease Control and Prevention. (n.d.). Gestational Diabetes and Pregnancy.Retrieved from: https://www.cdc.gov/pregnancy/diabetes-gestational.html

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

U.S. Food & Drug. (2017). FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. Retrieved from: https://www.fda.gov/drugs/drug- safety- and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain