NURS 6521 Wk 5 Types of Diabetes Mellitus
The four classifications of diabetes include type 1, formally known as insulin-dependent diabetes, type 2 formally known as non-insulin-dependent diabetes, gestational, and diabetes secondary to diseases of the pancreas and hormonal abnormalities. Type 1 diabetes is an autoimmune disorder where beta cells of the pancreas are damaged, resulting in the inability to secrete insulin (Arcangelo, Peterson, NURS 6521 Wk 5 Types of Diabetes Mellitus Wilbur & Reinhold 2017). When the pancreas does not produce insulin, blood glucose levels are elevated. It is also recognized as juvenile diabetes because it is primarily typically diagnosed in children, teens, and young adults. When the pancreas produces less insulin than the body required or the muscles and adipose cells becomes less responsive to the actions of insulin, it is known as type 2 diabetes. In some pregnant women, progesterone, cortisol, and human placental lactogen produce anti-insulin effects causing intolerance to glucose known as gestational diabetes. It usually resolves after the delivery but increases the risk for type 2 diabetes later in life (Arcangelo, Peterson, Wilbur & Reinhold 2017).
Gestational Diabetes
Diet and activity modifications are the first treatment options for the management of gestational diabetes mellitus (GDM). It is recommended to limit carbohydrate intake to 33% to 40% of calories and 30 minutes of aerobic exercise and resistance training most days of the week to improve glycemic control. Monitoring maternal weight gain is also essential in reducing the risk of fetal macrosomia (Garrison, 2015).NURS 6521 Wk 5 Types of Diabetes Mellitus
Treatment
In pregnant patients, there are two pharmacologic options which include insulin and selected oral antihyperglycemic agents. Oral medication is usually started first; however, when blood levels remain elevated despite diet modifications, increased physical activity, and the use of oral medications, insulin is required. Studies show that between 15 and 40% will need insulin after the use of oral medications initially. Rapid, intermediate, and long-acting insulins are safe to use in pregnancy because it does not cross the placenta. When initiating insulin therapy, one approach is to calculate a total dose of 0.7 to 1 unit per kilogram. Glargine (Lantus) and detemir (Levemir) are long-acting insulin options that are given as a single dose at half of the total daily requirement. The other half is administered in three divided doses at mealtimes with rapid-acting insulins, including lispro (Humalog) or aspart (Novolog) (Garrison, 2015).
Educating patients on the proper preparation, administration, and injection techniques of insulin are vital with this therapy. Lantus is given subcutaneously once daily at the same time every day. It is administered in the abdominal area, thigh, or deltoid and injection sites should be rotated within the same region to reduce the risk of lipodystrophy. Rapid-acting insulin should be administered 15 minutes before eating a meal into the abdominal wall, upper arm, or thigh. Injections should be ½ inch from the previous injection site. Patients should prepare injection only when they are ready to give it, and patients need to inspect the insulin for any visible particles as the solution should be clear and colorless (“Insulin Regular,” n.d.).NURS 6521 Wk 5 Types of Diabetes Mellitus
Short/Long Term Effects
GDM can contribute adverse short term and long-term health effects on the woman and fetus. Short term effects for the mother include increased risks for pre-eclampsia, pre-term labor, induced labor, and the need for intervention at birth. GDM can adversely influence intrauterine development that can result in spontaneous abortions, congenital anomalies, respiratory distress syndrome, neonatal hypoglycemia, and jaundice (Keygan, 2013).
The long-term effects on women include a higher risk of recurring GDW with following pregnancies and a greater risk of developing type 2 diabetes after pregnancy. According to Keygan (2013), women are six times more likely to develop type 2 diabetes than women who have a normoglycemic pregnancy, 17% will develop it within ten years, and 50% within thirty years. Babies exposed to maternal diabetes may have increased risk of impaired glucose intolerance, obesity, and type 2 diabetes in early adulthood (Keygan, 2013). NURS 6521 Wk 5 Types of Diabetes Mellitus