In this week’s discussion, we are to reflect on differences between types of diabetes. Then, we are to select one type of diabetes to focus on and consider one type of drug used to treat the type of diabetes we selected including proper preparation and administration of this drug.

In this week’s discussion, we are to reflect on differences between types of diabetes. Then, we are to select one type of diabetes to focus on and consider one type of drug used to treat the type of diabetes we selected including proper preparation and administration of this drug.

In this week’s discussion, we are to reflect on differences between types of diabetes. Then, we are to select one type of diabetes to focus on and consider one type of drug used to treat the type of diabetes we selected including proper preparation and administration of this drug.  Then we are to reflect on dietary considerations related to treatment.  Finally, we are to think about the short-term and long-term impact of the diabetes selected, including effects of drug treatments.  Type I diabetes (or juvenile diabetes) is the most common pediatric disease and is usually diagnosed from infancy to the late 30’s (McCance & Huether, 2019). There are two types:  Autoimmune and Nonautoimmune.  In this type of diabetes, a beta cells in the pancreas are destroyed.  Symptoms for diagnosis are polydipsia,  polyuria, polyphagia, weight loss, and hyperglycemia, and intermittent DKA.  The patient is insulin dependent.

Type II diabetes usually affects those people over 40.  Insulin resistance and obesity is associated with type II diabetes.  The pancreas cannot use the insulin produced properly, and there is a reduction in beta cell mass and function (McCance & Huether, 2019).  The cells become resistant to insulin, making an excess of insulin than is necessary to keep blood glucose levels within a normal range.  The symptoms are obesity, dyslipidemia, and hypertension.  The patient experiences polyuria and polydipsia.  There are also recurrent infections, genital pruritus, visual changes, paresthesia, fatigue, and acanthosis nigricans.   The patient is not usually insulin dependent, but may require insulin.

Gestational diabetes occurs during pregnancy.  There is insulin resistance and inadequate insulin secretion.  It is most likely to occur in women who are obese, 25-years-old, have a family history of diabetes, have a history of gestational diabetes, or are of Native American, Asian, or black (these ethnic groups have a higher incidence rate of gestational diabetes (McCance & Huether).

For this discussion I am focusing on type II diabetes mellitus.  Those with this type of diabetes have a mortality rate twice that of the general population.  Complications from this type of diabetes are myocardial infarction, stroke, nephropathy, retinopathy, and peripheral arterial disease and neuropathy resulting in amputation (Laursen et. al., 2017).  One of the drugs used to treat this type of diabetes is in a class of drugs called biguanide named Metformin.  This drug decreases glucose production by the liver, reduces glucose absorption in the gut, and sensitizes insulin receptors in fat and skeletal muscle.  Metformin is slowly absorbed from the small intestine, and is excreted unchanged by the kidneys.  If there is renal impairment, it can produce toxic levels (Rosenthal  & Burchum, 2021).  It can be used alone, or with insulin.  Importantly,  it can be used for patients who skip meals because it does not lower blood glucose.  It can be taken during pregnancy. 

Common side effects are decreased appetite, nausea, and diarrhea.  Metformin decreases absorption of vitamin B12 and folic acid, thus causing vitamin B and folic acid deficiencies.  It does not cause weight gain.  It is important to eat healthy meals while taking Metformin, and not skip meals.  Metformin can cause lactic acidosis.   Initial dosing is immediate release 850-1000 mg daily or extended release 500 mg nightly.

References

Laursen, D., Christenssen, K., Christensen, U., & Frolich, A. (2017). Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnare (HeiQ). BMC Research Notes 10(213).  https://doi10.1186/s13104-017-2536-6