Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

Note:Create a reply (that corresponds to the instructions above) for the two posts, 1 page each for both, with 2 or more references not less than 5years each, thanks.

POST 1 (from Classmate A.A)
Diabetes and Drug Treatments
Types of Diabetes

Diabetes is a metabolic disorder characterized by insulin resistance and impaired pancreatic ß-cell function. The types of diabetes include type I, type II and gestational. Type I diabetes has been referred to as “juvenile-onset” and “insulin dependent” diabetes (Rosenthal & Burchum, 2020). This type of diabetes usually develops during childhood with an abrupt onset. With this type of diabetes insulin levels start to decrease in the early stages and eventually drop to zero. These type of diabetics require insulin for the rest of their lives.

Type II diabetes has been referred to as “non-insulin dependent” and “adult onset” diabetes (Rosenthal & Burchum, 2020). This type of diabetes usually begins in middle adulthood and progression is gradual. These type of diabetics may need insulin or the may be able to treat with oral medication.

Gestational diabetes mellitus (GDM) is one of the most common conditions during pregnancy and affects about one in six births globally (Ali et al., 2020).GDM is the onset of hyperglycemia during pregnancy in women with no previous history of diabetes (Pooransari et al., 2020). GDM is problematic due to the ability of glucose to pass freely from the maternal circulation to the fetal circulation. These type of diabetics may either use insulin or oral medications. GDM is no longer present once the mother delivers, if the mother continues to show signs of diabetes, she should be tested for type II diabetes.

Drugs for Gestational Diabetes

Drugs that can be used for GDM include regular insulin, rapid acting insulin and oral medications, specifically Metformin. Metformin is taking orally and is absorbed in the small  intestines. Metformin is available in extended release and immediate release tablets and is usually taken at night. In studies Metformin had the same outcomes as insulin and is now becoming an acceptable alternative for women with GDM who do not want to give themselves injections.
Diet
Diet restrictions for GDM are much the same as they are for those with type I and II diabetes. Woment with GDM should restrict highly processed and carbohydrate dense foods, as well as beverages and food with high sugar content. Women with GDM should eat three meals a day with two or three snacks as eating a lot at one time can cause blood sugar levels to rise.

Effects of Gestational Diabetes

GDM effects both the mother and the neonate. Adverse effects for the mother include pregnancy-induced hypertension, preeclampsia, eclampsia, polyhydramnios and preterm labor (Pooransari et al., 2020). Adverse effects for the neonate include macrosomia, birth trauma, shoulder dystocia and hypoglycemia (Pooransari et al., 2020). Both mother and neonate are at an increased risk for developing type II diabetes after a pregnancy effected by GDM (Ali et al., 2020). Post meal glucose control for women with GDM has been shown to improve maternal and neonatal outcomes (Pooransari et al., 2020).

With GDM the practitioner has two patients being effected by diabetes. It is imperative that practitioners take the time to educate the mother properly for herself and for the baby. If the mother has a difficult time controlling her blood glucose levels the practitioner may want to refer her to a dietitian who can help with meal planning and education.
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References

Ali, N., Aldhaheri, A. S., Alneyadi, H. H., Alazeezi, M. H., Al Dhaheri, S. S., Loney, T., & Ahmed, L. A. (2020). Effect of gestational diabetes mellitus history on future pregnancy behaviors: The mutaba’ah study. International Journal of Environmental Research and Public Health, 18(1), 58. https://doi.org/10.3390/ijerph18010058
Pooransari, P., Ebrahimi, A., Mirzamoradi, M., & Ketabdar, M. (2020). A comparison of the efficacy of insulin aspart and regular insulin for managing gestational diabetes and their effects on delivery outcomes. Journal of Midwifery & Reproductive Health, 9(1), 2565–2572. https://doi.org/10.22038/jmrg.2020.49287.1613
Rosenthal DNP ACNP, Laura & Burchum DNSc APRN BC, Jacqueline. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assisstants (2nd ed.). Saunders.

POST 1 (from Classmate J.C)

Discussion: Diabetes and Drug Treatments

Understanding diabetes medications begins with understanding the different forms of diabetes.  Diabetes type 1, Diabetes type 2, and Gestational Diabetes. Regardless of the form of diabetes, treatment and management is a life-long task and requires determination and close communication with medical practitioners to ensure positive outcomes. Diabetes Mellitus (DM) is an endocrine disorder characterized by the body destroying pancreatic cells responsible for excreting insulin (Klandorf & Stark, 2021). Left untreated, chronic high blood sugars due to low insulin levels can cause renal, neurologic, cardiovascular, and other serious complications. Caused by both genetic and environmental factors, symptoms of DM include increased urine output, excessive thirst, dehydration, hypotension, fatigue, and blurred vision. Treatment for (DM) include lifestyle changes such as diet and exercise modifications and addition to a hypoglycemic agent. There are three types of DM, Diabetes type one, Diabetes type two, and gestational diabetes.

Type 1 Diabetes (Juvenile Diabetes)
Type 1 diabetes is typically initiated by an autoimmune response exacerbated by an acute infection. During this time, the body’s cells attack the pancreatic cells responsible for excreting insulin. For approximately 10 years, the body can maintain adequate amounts of insulin, but once 80% of beta cells are destroyed, the effects of type 1 diabetes are initiated(Klandorf & Stark, 2021). Typically presented in adolescence, type 1 diabetes is referred to as juvenile diabetes due to the age of onset. Although not everyone that experiences the infection related response in the pancreas develops diabetes type 1, it is commonly experienced in those of African or Asian descent.
            Treatment
Treatment for diabetes type 1 involves insulin replacement. In addition to insulin replacement, addition of an ACE inhibitor and ARB can reduce diabetic neuropathy and diabetic hypertension. Another form of treatment for patients is to manage cholesterol levels with a statin such as atorvastatin.

Type 2 Diabetes
Type 2 diabetes is the most prevalent form of diabetes and is related to obesity and lack of exercise. In these individuals, the cells become less sensitive to the insulin naturally excreted by the body and larger volumes are needed to elicit natural responses (Klandorf & Stark, 2021). Typically, individuals with type 2 diabetes are not aware of their diagnosis until damage to other body systems have already occurred such as nerve damage and atherosclerosis. There is a high genetic prevalence of type 2 diabetes.
Gestational Diabetes
Gestational diabetes is a form of diabetes that occurs during pregnancy in patients that previously did not carry a diabetes diagnosis. Women who experience gestational diabetes have a higher risk of developing diabetes after giving birth. Additionally, the children of women who have gestational diabetes are at high risk for developing diabetes as well.

       Treatment
Treatment for diabetes type two not only focuses on glycemic control but around exercise to promote glucose uptake by muscle. A combination of oral and injectable medications are used primarily using metformin as an oral intervention for glycemic control. Goals and treatment for diabetes type two must be based on duration of diabetes, life expectation, comorbidities, cardiovascular complications, and health awareness. After initiation of metformin which stimulates natural production of insulin, other medications such as a DPP-4 or SGLT, GLP-1, or thiazolidinedione. As needed, the patient would work with their clinician to add multiple medications to achieve to desired goal.

Insulin
Insulin is used to treat many patients with type 1 and most patients with type 2 diabetes. Insulin consists of two amino acid chains and is synthesized by the pancreas. The metabolic actions of insulin are anabolic and promote energy conservation. Under the influence of insulin, glucose is converted into glycogen, amino acids are turned in to proteins, and fatty acids and transitioned into triglycerides. There are two main forms of insulin manufactured for use. Human Insulin which directly mimics natural insulin and Human Insulin Analogs which work similarly to human insulin but release and work over different time frames (Rosenthal & Burchum, 2021).
          Short duration: rapid acting
Short duration, rapid acting insulins are administered in association with meals to control the postprandial rise in glucose (Rosenthal & Burchum, 2021). Insulins in this category vary in onset between 10 to 30 minutes and include medications such as lispro, aspart, and glulisine.
            Short duration: short acting
Regular insulin is unmodified human insulin and can be injected before meals to control postprandial rise in glucose and can also be injected subcutaneously via insulin pump to provide a continual basal dose of insulin (Rosenthal & Burchum, 2021). Types of regular insulin include Humulin R and Novolin R.
            Intermediate duration
Neutral protamine Hagedorn insulin suspension (NPH) (isophane insulin) combines insulin with protamine. By combining insulin with the larger protein, absorption is delayed, and the duration of action is extended (Rosenthal & Burchum, 2021). Short acting insulins will be needed for meal-time coverage. Also, since protamine is a foreign protein, there is chance for allergic reaction.
Long duration
Insulin glargine available as Lantus, Basaglar, and Levemir is a modified human insulin with a duration of action of up to 24 hours. This insulin is utilized daily for children and adults with type 1 diabetes and for adults with type 2 diabetes. Insulin glargine differs from normal human insulin by four amino acids which allows for it to slowly dissolve and release the insulin in small amounts.
            Ultralong duration
Insulin glargine (U-300), Toujeo, is three times concentration compared to a long duration insulin. The duration of action for a U-300 insulin can surpass 24 hours. Tresiba is an insulin degludec which is a human insulin with effects that persist for up to 42 hours (Rosenthal & Burchum, 2021).

Complications
Potential complications related to diabetes include hyperglycemic events and hypoglycemic events. Hypoglycemia is whenever blood glucose levels drop below 70mg/dL. A major cause of hypoglycemia is insulin overdose. Reduced intake of food, diarrhea, vomiting, excessive alcohol consumption, unusually intense exercise, and childbirth may all lead to hypoglycemia. Signs of hypoglycemia include tachycardia, palpitations, sweating, and nervousness (Lavis, 2019). Treatment of hypoglycemia must be immediate to prevent convulsions, coma, and eventually death.
Hyperglycemia is blood glucose greater than 130 mg/dL after fasting for 8 hours. However, a hyperglycemic event is a glucose greater than 400 mg/dL (Garg, et al., 20141). Signs of hyperglycemia include blurred vision, increased thirst, frequent urination, and headache.
Conclusion
Diabetes is a chronic condition that requires close monitoring and frequent follow-up with clinicians. A strict medication regimen and potential medication changes over the course of treatment may be required. It is the responsibility of practitioners to determine the appropriate route of administration, form of treatment, and care plans or patients diagnoses with diabetes.

References:

Klandorf, H., PhD, & Stark, S. W. . R. A. Dns. (2021). Diabetes mellitus. Magill’s Medical Guide (Online Edition).
Garg, R., Hudson, M., & Wexler, D. J. (2014). Hyperglycemia in the hospital setting. Jaypee.
Lavis, V. R., M. D. (2019). Hypoglycemia. Magill’s Medical Guide (Online Edition).
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for Advanced
Practice nurses and physician assistants. Elsevier.

Learning Resources

Required Readings (click to expand/reduce)

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397–415)
Chapter 49, “Drugs for Thyroid Disorders” (pp. 416–424)

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

This article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.

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