NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments
Diabetes Mellitus
According to (Chance et al.,2019) Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (DM) is disorders of the endocrine system that affect how the body uses glucose. (Chance .,2019) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments. In 2015 in the United States, an estimated 30.3 million people (9.4%) had diabetes and 7.2 million were estimated to be undiagnosed. DM was the seventh leading cause of death in 2015. When we eat carbohydrate, our body turns it into a sugar call glucose and send it the bloodstream. Our pancreas releases insulin, a hormone that helps move glucose from the blood into cells, when is used for energy. When one has diabetes and does not get treatment the body does not use insulin as it should. Too much glucose stays in the blood, a condition calls high blood sugar-hyperglycemia. This can cause a health problem that may be serious or even life-threatening.
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There are various kinds of DM, for example, type 1 DM, type 2 DM, and gestational diabetes. The reason for this conversation is to analyze DM type 1, type 2, and gestational diabetes while investigating the medication medicines and dietary contemplations of gestational diabetes. NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments
Comparison of Diabetes Mellitus Type 1, Type 2, and Gestational Diabetes
DM type 1 is an autoimmune disease where the pancreas does not produce insulin (American Diabetes Association,2020) As described by the American Diabetes Association
DM type 1 is usually diagnosed in childhood but can occur at any age. DM type 2 is the most common endocrine disorder where the body is insulin resistant and is unable to produce enough insulin (Humprey et al.,2019). According to the same study DM type, 2 is usually referred to as adult-onset diabetes and the body does not produce enough insulin to meet the body’s need resulting in elevated glucose levels. The onset of type DM type 2 is usually adult but is also present with children and teens due to obesity. According to Rosenthal et al.,2018) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments.
The goal of treatment for gestational diabetes is to keep blood glucose levels at a normal level to ensure the health of mother and baby. The significant treatment plan is checking diet and implementing a low impact exercise plan out. The occasion that diet and exercise don’t bring down glucose levels, consistent treatment should be started either with insulin or oral experts NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments. Insulin was reliably the best quality degree of treatment for gestational diabetes, regardless it has been found to cause increased weight in pregnant women or cause hypoglycemia which has prompted the utilization of metformin Rosenthal et al.,2018).
Gestational Diabetes Treatment
According to Rosenthal et al.,2018) The goal of treatment for gestational diabetes is to keep blood glucose levels at a normal level to ensure the health of mother and baby. The significant treatment plan is checking diet and implementing a low impact exercise plan out. The occasion that diet and exercise don’t bring down glucose levels, consistent treatment should be started either with insulin or oral experts. Insulin was reliably the best quality degree of treatment for gestational diabetes, regardless it has been found to cause increase weight in pregnant women or cause hypoglycemia which has prompted the utilization of metformin (Rosenthal et al.,2018)
Metformin
The Metformin mechanism of action is to reduce glucose levels by activating adenosine monophosphate-activated protein (AMP) kinase. According to Rosenthal et al., 2018), metformin is absorbed slowly from the small intestine and not metabolized but rather excreted by kidneys. Metformin is available in immediate-release and extended-release forms and taken by mouth (Rosenthal et al., 2018). The immediate-release is initially dosed as 500mg twice daily with breakfast and dinner whereas the extended-release is dosed 500mg daily with dinner (Rosenthal et al., 2018). Metformin is the first drug of choice, It fully effective in lowering A-1C and low cost. NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments
Dietary Considerations
The goal of rewarding gestational diabetes is to keep up typical blood glucose by starting great sustenance (Shepherd et al., n.d ). The patient with gestational diabetes will be approached to quantify their blood glucose a few times each day an hour after eating so legitimate sustenance guarantees better results. American Diabetes Association. (2018). The patient should begin by decreasing carbohydrates intake is the first while eating a little snack and bites spread out all through to keep up typical glucose levels.
Short-Term and Long-term Effects of Gestational Diabetes
The short and long term impact of diabetes depends on patient understanding and adherence with diet, exercise, mindfulness, and above all medications. Input instruments are profoundly sensitized to metabolic changes inside the body. The goal of short-term management of glucose is to settle scenes of hypo/hyperglycemia which may happen during times of stress and illness. Interim the board with sliding scale insulin is notable in medical clinics and hospitals consequently. The long-term management of diabetes the board is to keep up control of hyperglycemia, improve the factors that support a healthier lifestyle and collaborated care re-enforcing healthier lifestyle of life and diet, and teamed up care adherence minizine damage. (American Diabetes Association. 2020) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments
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 http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf
American Diabetes Association. 2020. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl.
Humphreys A, Bravis V, Kaur A, et al. Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: an ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis. Diabetes Res Clin Pract 2019;155:107789
National Institutes of Health. (n. d.). National Institute of Diabetes and Digestive and Kidney Disorders. Endocrine diseases. Retrieved July 3, 2019, from
https://www.niddk.nih.gov/health-information/endocrine-diseases
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Shepherd, E., Gomersall, J. C., Tieu, J., Han, S., Crowther, C. A., Middleton, P., & Shepherd, E. (n.d.). Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews, 11.
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NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments response
Pregnant women should be screened at 24 to 28 weeks to detect gestational diabetes. If glucose is >140 mg/dL 1 hour after 50 g oral glucose, a 3-hour GTT is recommended. Addition of insulin if glucose is >90 mg/dL fasting or >120 mg/dL on two or more occasions in a 2-week period. Oral agents are generally avoided; however, Metformin has been used to treat pregnant women with pregestational diabetes, type 1 or type 2 that existed prior to conception. Sulfonylures should be avoided as well because they cross the placenta and can cause fetal hyperinsulinemia (Hollier & Hensley, 2018). It is important to identify women with gestational diabetes to minimize maternal and neonatal morbidity. Studies found that appropriate management of gestational diabetes resulted in reduction in preeclampsia, birth weight >4000 g, and shoulder dystocia. Women with gestational diabetes are at increased risk for developing type 2 diabetes, so follow-up is advised. They should be screened 6-12 weeks postpartum and continue surveillance throughout lifetime (UpToDate n.d.) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments.
There are two choices to pharmacologic treatments to control blood glucose: insulin or oral antihyperglycemic agents (metformin, glyburide). Insulin is the treatment of choice because strict control of blood glucose can be maintained, but oral agents can be used in certain circumstances. Insulin should be initiated when target glucose levels are exceeded despite nutritional therapy. The dose of insulin varies depending on the individual due to obesity, ethnic characteristics, and degree of hyperglycemia. In general, dosing of insulin ranges from 0.7 to 2 units per kg for glucose control (UpToDate n.d.) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments.
References:
Hollier, A., & Hensley, R. (2018). Clinical guidelines in primary care. Third edition. Lafayette, La: Advanced Practice Education Associates, Inc.
UpToDate. (n.d.). Retrieved from https://www.uptodate.com/contents/gestational-diabetes-mellitus-glycemic-control-and-maternal-prognosis?
NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments response 2
Gestational diabetes has become more common over the years in pregnancies. This can increase the risks individuals have during pregnancy as well as possibly lead to type 2 diabetes (T2D) later down the road. The placental hormones in the last two trimesters provoke insulin action. The beta-cell dysfunction during pregancy causes exaberations. There are studies that show that women that were on anti-psychotic medications prior to pregnancy had an increased risk for gestational diabetes. The anti-psychotics commonly identified are olanzapine or quetiapine (Newcomer & Nicol, 2018). NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments
Further studies have suggested that priobiotics may help reduce the risk for gestational diabetes. Probiotics are able to alter the gut microbiomes which can be responsible for inflammatory pathways and the metabolism of lipids and glucose. One study showed a sixty-percent decrease in gestational diabetes by taking the priobiotic beginning early in pregnancy. Encouraging patients to eat healthy while taking a probiotic daily can lessen their risks (Barret, Dekker, Conwell, & Barrett, n.d.) NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments.
References
Barrett, H. L., Dekker Nitert, M., Conwell, L. S., Callaway, L. K., & Barrett, H. L. (n.d.). Probiotics for preventing gestational diabetes. Cochrane Database of Systematic Reviews, 2. https://search-ebscohost-
com.ezp.waldenulibrary.org/login.aspx?direct=true&db=chh&AN=CD009951&site=eds-live&scope=site
Newcomer, J., & Nicol, G. (2018). Gestational diabetes risk during treatment with antipsychotic medications. American Journal of Psychiatry, 6, 498. https://doi-org.ezp.waldenulibrary.org/10.1176/appi.ajp.2018.1802021w NURS 6521 Week 5 Discussion: Diabetes and Drug Treatments