01 Oct Diabetes Overview Diabetes Type 1 American Diabeti
Diabetes Overview Diabetes Type 1 American Diabetic Association (2012), reports that 1.25 million patients are affected, and 40,000 will be newly diagnosed. Diabetes Type 1 most commonly affects people under 30. Diabetes type 1 is either idiopathic or autoimmune and means the body does not produce enough insulin. Symptoms and signs present as polyuria, polydipsia, weight loss with elevated serum glucose, and ketoacidosis. Treatment consists of insulin therapy, diet, and exercise management. Insulin is given for diabetes type 1 and many with type II. Insulin dosages are for type 1 0.5 to 0.6 units/kg/day and type II 0.2 to 0.6 units/kg/day (Rosenthal, 2018, p. 497). Insulin is administered as a long-acting basal dose twice a day and short-acting after meals to adjust to meals and exercise. In the hospital, diabetic type 1 patients receive long-acting insulin like Lantus twice a day and Humalog at meals in the form of a sliding scale to supplement serum glucose monitoring. Humalog insulin and Lantus are refrigerated until opened, and then is it is usable for 30 days unrefrigerated. Prefilled syringes are stored in the refrigerator. Lantus is a cloudy compound and is given subcutaneously. Humalog insulin is clear and given separately from Lantus subcutaneous. The subcutaneous areas are the back of upper arms, upper thighs, and lower stomach. Humalog is short-acting and should be given 5 to 10 minutes within eating. Certain patients qualify for the insulin pump; the pump monitors blood glucose, and basal doses are scheduled and bolus to accommodate meals and activity. The pump’s advantage is unavoidable needle sticks for monitoring and administering medication. Insulin pen technology is advanced with dedicated smart pens offering smartphone applications for recording insulin dose and time, bolus calculation, and data sharing (Beck, R., Bergenstal, R., Laffel, L., & Pickup, L., 2019, p. 1266). Inhaled medications, such as Afrezza, provide good glycemic control and have not shown pulmonary function issues (Rosenthal, 2018, p. 496). Diabetes Type II Diabetes II (non-insulin dependent.) is genetic or environmental related and is the result of the body’s inability to use insulin properly and insulin resistance. Type II diabetes has a small risk of causing ketoacidosis. Type II diabetes is rapidly increasing in children due to obesity, physical inactivity, and family history. Treatment Is diet and exercise management, and weight loss of 5-10% body weight resolves the disease in 85% of diagnosed patients. Despite possible control with diet and exercise, new treatment models include drug therapy of metformin and sulfonylureas (e.g., glipizide) (Rosenthal, 2018, p. 488). The oral medication is given until the body produces less insulin over time, and eventually, insulin therapy is given. Gestational Diabetes Gestational diabetes presents while the patient is pregnant and resolves after delivery. Close monitoring during pregnancy, insulin is adjusted and dosed by a sliding scale dosing. Diligence with the mother and provider to obtain glycemic control to protect the fetus. If gestational diabetes continues after delivery, a new assessment and treatment plan will be developed for diabetes type 1 or type II. Patients that have diabetes II will convert from metformin to insulin for management while pregnant. Insulin is given before meals and at bedtime to obtain close blood glucose monitoring and correct insulin dosing. Childhood Diabetes Juvenile diabetes is renamed to childhood obtained diabetes type 1 and the increased risk of contracting diabetes type II. Unfortunately, diabetes I is the most common chronic pediatric disease. The disease peaks at twelve years old but does not appear before nine months old. Young patients are treated with long-acting and short-acting insulin with careful monitoring of serum glucose, diet management, and exercise. Education and monitoring in defiant or non-compliant young patients are challenging to maintain glucose control. Metformin Metformin is the drug addressed in this discussion. At NWTH, Texas Tech Physicians are participating in residency programs and provide assessments, care, and medication therapy for mental health patients at the Pavilion with the hospital. The process of diagnosis and treating diabetes II is mirrored in the text for this course. Metformin prevents glucose production in the liver, very slightly reduces glucose absorption, and it sensitizes insulin receptors in target tissues (fat and skeletal muscle) and increases glucose uptake to whatever insulin is available (Rosenthal, 2018, p. 500). Also, metformin is excreted by the kidneys unchanged and becomes toxic if renal insufficiency is present. Metformin is initiated with elevated A1C, serum glucose, and no history of exercise and diet management. The patient’s beginning diabetic medication therapy is reluctant because the labs are on the low end of perimeters. Education and instruction provide a rationale for initiating medication therapy early to prevent long term effects. Metformin is given twice a day orally, before breakfast and after the evening meal. It is rare to cause hypoglycemia. However, metformin inhibits the absorption of B12. Also, metformin increases lactic acid,, especially in patients renal insufficiency, liver disease, severe disease, drink excess alcohol, in medical shock, and history of hypoxemia. If discovered metformin caused the toxicity, hemodialysis is used to remove the metformin from the patient’s system. Early diabetes II intervention with metformin prevents microvascular complications, such as retinal damage. Tighter glycemic control prevents cardiovascular complications in young adults. In Rosenthal (2018), the Data from the Diabetes Prevention Program (DPP), a large study indicated metformin could delay development of type 2 diabetes in high-risk individuals by lifestyle changes and reducing body weight by 7% through moderate exercise, treated with 850mg of metformin or placebo (p.500). The result is that 31% avoided developing diabetes type 2. Exercise, dietary changes, and weight loss (5-7%) reduced risk by 58% (Rosenthal, 2018, p. 500). Conclusion Diabetes mellitus type I and type 2, gestational, and childhood disease is challenging for providers because education occurs every encounter. Non-compliant patients are at increased risk of complications and hospitalizations. Strong foundational knowledge of the disease, insulin therapy, and oral therapy combined with diet management, exercise, and glucose management assists providers in diagnosing, developing medication therapy, and outcomes. Also, accessing resources and support assist in educating patients and families. References American Diabetes Association (2012). Retrieved from https://www.diabetes.org/diabetes Beck, R. W., Bergenstal, R. M., Laffel, L. M., & Pickup, J. C. (2019). Advances in technology for management of type 1 diabetes. The Lancet, (10205). https://doi- org.ezp.waldenulibrary.org /10.1016/S0140-6736(19)31142-0 Else, T., & Hammer, G. (2019). Disorders of the hypothalamus & pituitary gland. In Hammer, G., & McPhee, S. (Eds.). Pathophysiology of Disease: An Introduction to Clinical Medicine (8thed.). (pp. 583-608). China: McGraw-Hill Education Rosenthal, L., (2018). Drugs for diabetes mellitus. In Rosenthal, L., & Burchum, J. (Eds.). Lehne’s Pharmacotherapeutics for Nurse Practitioners and Physician Assistants. (pp. 488-509). China: Elsevier please response
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