Need assistance responding to my colleagues’ post

Need assistance responding to my colleagues’ post on diabetes. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. COLLEAGES POST BELOW: Types of Diabetes Mellitus According to Rosenthal and Burchum (2021), there are two types of diabetes mellitus (DM) named as Type 1 and Type 2; however, there are several subtypes within these determined by the onset characteristics. Type 1 diabetes is an abrupt onset of autoimmune processes negatively affecting pancreatic processes in secreting insulin (Rosenthal & Burchum, 2021). Therefore, those with Type 1 DM are `insulin-dependent ” as pancreatic beta cells, cells that synthesize and secrete insulin, are destroyed (Rosenthal & Burchum, 2021). Juvenile diabetes falls under the Type 1 DM category as onset is abrupt mostly during childhood, including adolescents; however , this may still develop during adulthood (Rosenthal & Burchum, 2021). Type 2 DM is the most common form of DM and occurs in all ages, mostly obtained in middle-aged patients and at a gradual onset (Rosenthal & Burchum, 2021). Unlike Type 1 DM, Type 2 DM pancreatic beta cells do function and can secrete and synthesize insulin; however, insulin resistance and impaired secretion of insulin is present due to the continued exposure of high blood sugar, also known as hyperglycemia (Rosenthal & Burchum, 2021). Pancreatic beta cells are unable to keep up with the high demands of insulin secretion and as a result of overworked cells, insulin production and secretion is diminished and therefore the tissues within the body become insulin resistant (Rosenthal & Burchum, 2021). Gestational diabetes occurs during pregnancy as the placenta produces hormones that block insulin’s actions and increase the blood sugar in the body (Rosenthal & Burchum, 2021). During the gestational diabetes process, the high blood sugar content can be passed through the placenta to the fetus causing the fetus’s body to secrete excessive amounts of insulin leading to adverse effects (Rosenthal & Burchum, 2021). Gestational diabetes subsides after delivery as the underlying cause, the placenta, is delivered as well with the fetus (Rosenthal & Burchum, 2021). For those with Type 1 DM, require the need for daily doses of exogenous insulin in order to survive due to their inability to secrete insulin and are more susceptible to ketoacidosis than those with Type 2 DM (Rosenthal & Burchum, 2021). According to the CDC (2021), ketoacidosis is a disease process that requires the liver to “break down fat to produce fuel” producing content such as ketones due to the body’s inability to produce enough insulin to break down glucose for fuel. Some common causes for diabetic ketoacidosis include those missing exogenous insulin subcutaneous injections and those who become ill by other means (CDC, 2021). When diabetics are ill, their body requires more fuel to fight off illness, the illness may suppress their thirst or appetite causing the person to be unable to manage their blood sugar levels (CDC, 2021). Diabetic Ketoacidosis is a medical emergency as the patients will need to be treated with fluids to dilute the excess of blood sugar, replenish electrolytes, receive ongoing insulin administration, and administer medications for underlying causes such as illnesses (CDC, 2021). Pharmacological Management of Diabetes Mellitus The American Diabetes Association (ADA) (2018) reports daily subcutaneous injections of insulin, for those with Type 1 DM. Surgical interventions may be provided by transplanting the pancreas and islet to manage glucose levels; however, these surgical interventions require immunosuppressants to prevent rejection of the transplants and recurring autoimmune processes on the islet cells (ADA, 2018). Therefore, daily subcutaneous injections of insulin are of the most common interventions in managing Type 1 DM (ADA, 2018). There are over six types of modified insulin with different time-effect relationships known as rapid acting, short acting, intermediate duration, long duration, and ultralong durations (Rosenthal & Burchum, 2021). Rapid acting insulins such as lispro, aspart and glulisine are provided before meals to manage the increase of blood sugar post meals as it has rapid onset of 10-30 minutes and therefore should be highly stressed to the patients that these injections should be taken if they are confidently going to eat right after administration (Rosenthal & Burchum, 2021). Short acting insulin such as regular insulin provides an onset of 30-60 minutes and is prescribed before meals to manage the increase of blood sugar and can be infused through insulin pumps in managing basal glycemic control (Rosenthal & Burchum, 2021). Intermediate duration insulins such as neutral protamine Hagedorn (NPH) is a delayed onset and duration type of insulin not to be used before meals in managing postprandial hyperglycemia, but to be administered in between meals and at night, up to 2-3 times daily (Rosenthal & Burchum, 2021). NPH insulin is the only type of insulin that can be mixed with short acting insulin, regular insulin (Rosenthal & Burchum, 2021). Long duration insulins such as glargine and detemir have a prolonged duration up to 24 hours and can be prescribed as a one to two times daily subcutaneous injection for both Type 1 and Type 2 DM in managing glycemic index and should not be used to prevent postprandial hyperglycemia (Rosenthal & Burchum, 2021). Lastly, ultra long duration insulin such as glargine (U-300) and degludec have prolonged duration of actions of more than 24 hours and is suggested for those “who do not realize a full 24 hours of effect with the U-100” version of glargine (Rosenthal & Burchum, 2021). Many of the insulins are given subcutaneously but should emergency need to be warranted, such as diabetic ketoacidosis, it can be given intravenously with rapid and short acting insulins (Rosenthal & Burchum, 2021). The ADA (2018) recommends the use of metformin as the initial pharmacological intervention for those with Type 2 DM, without other contraindications or complications. Metformin may also be prescribed for those with gestational diabetes and polycystic ovary syndrome (Rosenthal & Burchum, 2021). Metformin is the preferred initial intervention in managing Type 2 diabetes as it prevents the liver from producing glucose, prevents the gut from absorbing glucose, increases sensitivity of insulin receptors in skeletal and fat tissues which then increase the reuptake of glucose (Rosenthal & Burchum, 2021). Dietary considerations are more lenient and therefore can still be administered to those who are more likely to skip meals as it does not actively lower blood sugar (Rosenthal & Burchum, 2021). Therefore, Metformin is usually prescribed in those at the beginning of their diagnosis who were unable to follow or respond to dietary and physical activity intervention (Rosenthal & Burchum, 2021). Metformin can also be used as a preventative measure for those at high risk for Type 2 DM but should be highly stressed to patients that it does not substitute the need for dietary and exercise interventions (Rosenthal and Burchum, 2021). For both Type 1 and Type 2 DM, long-term complications are created as the body is gradually damaged by the increased blood sugar content in the circulatory system (MedlinePlus, 2020). Complications include retinopathy, suppressed immune system, cardiovascular disease, neuropathy, gastrointestinal upsets, and nephropathy (MedlinePlus, 2020). Short-term complications such as hyperglycemia and hypoglycemia require immediate interventions in regulating the blood glucose levels with insulin or glucose content, depending on levels of blood glucose (CDC, 2021). However, as disease processes gradually occur other pharmacological interventions are required to manage the signs and symptoms of long-term complications (CDC, 2021). Therefore, preventative measures, non-pharmacological, and pharmacological interventions are required in managing both long-term and short-term complications of DM.

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