Pharm-Diabetes Paper Assignment

Pharm-Diabetes Paper Assignment

To complete: Write a minimum 4–page paper (excluding cover page and references) that addresses the following: Explain the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including the proper preparation and administration of this drug. Analyze and discuss the dietary considerations related to treatment. Explain the short- and long-term effects of this type of diabetes on patients including the effects of drug treatments. Include four or more appropriate scholarly sources from the last five years throughout the paper. Pharm-Diabetes Paper Assignment

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Diabetes: Different Types, Dietary Considerations, Drug Treatment, and Complications

Differences in Types of Diabetes

Diabetes is broadly divided into two types, diabetes mellitus and diabetes Insipidus. Pharm-Diabetes Paper Assignment

Diabetes Mellitus (DM)

It is characterised by uncontrolled high levels of blood sugar, resulting from insufficient insulin production or lack of insulin action. But both reasons can also occur at the same time. DM is divided into several different categories as follows (Hammer & McPhee, 2014, p. 525-533):

Type I Diabetes Mellitus (Juvenile Diabetes)

This DM is diagnosed in childhood. It is insulin dependent and is strongly linked to genetic variation. It is characterised by a lack of endogenous insulin (produced by the body). The patient produces autoantibodies that destroy the beta cells of the pancreatic islets of Langerhans that produce insulin.

Type II Diabetes Mellitus

This type of DM is not dependent on insulin. It is mostly diagnosed in adults and is strongly linked to lifestyle factors like obesity and lack of physical activity. These factors, like obesity, cause insulin resistance and decreased insulin secretion by the beta cells.

Gestational Diabetes Mellitus

Gestational DM occurs in pregnancy, usually in the second half of it. It is precipitated by the high levels of circulating hormones at this time. These hormones include cortisol, progesterone, prolactin, and chorionic somatomammotropin (Hammer & McPhee, 2014, p. 527). The hormones antagonise the actions of insulin, producing diabetes (hyperglycemia). Gestational DM resolves with delivery, but can recur with subsequent pregnancies.

Diabetes Insipidus (DI)

This type of diabetes differs from diabetes mellitus in that it has got nothing to do with the hormone insulin and hyperglycemia. It is characterised by low levels of antidiuretic hormone (ADH), produced by the posterior pituitary gland (Hammer & McPhee, 2014, p. 562-564). In DI the kidneys are unable to reabsorb water and hence there is frequent urination (polyuria) accompanied by frequent ingestion of water (polydipsia). Pharm-Diabetes Paper Assignment

Insulin: Use in the Treatment and Management of Type I Diabetes Mellitus

Type I DM is dependent on insulin therapy for control. Insulin is a tiny protein molecule in humans with a molecular weight of 5808 (Katzung, 2018, p. 747). The insulin given during treatment is exogenous insulin (not produced by the body). It is produced by recombinant DNA (deoxyribonucleic acid) technology. There are different formulations that can be short-acting, long-acting, or rapid-acting.  These formulations can be given individually or be combined following standard guidelines and operating procedures (there are those that may not be mixed, and some mixtures may require immediate use).

Preparation

The correct patient and the correct insulin (by label) are identified by two nurses (one reads while the other confirms). The patient is informed and consent for administration obtained. The administering nurse washes hands and then chooses the correct insulin syringe marked with the correct calibration of units (confirmed by second nurse). She then withdraws air equivalent to the dose into the syringe and injects this into the insulin vial. This prevents creation of a vacuum. The drug is then withdrawn and the right dose withdrawn confirmed by a second nurse before administration. A gentle tap on the syringe removes the air bubbles in the withdrawn drug.

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Administration

The injection site is cleaned and disinfected. This is usually the anterolateral thigh area, the upper arm, buttock area, or the abdomen. The injection is then given subcutaneously, at 90°. In the case of children or thin patients, the degree of the needle on injection may be reduced to 45°. Aspiration is not necessary (withdrawing to see if there is blood). Pharm-Diabetes Paper Assignment

Dietary Considerations Relative to Treatment in Type I DM

Patients with this type of diabetes are usually advised to consume high levels of whole foods like whole grain, fruits, vegetables, and high fibre diets (Jain, 2014, p. 174). The patient or their carer have to be taught meal planning techniques, timing of meals, and the amount of food consumed. For instance, a patient on a split-mix regime will have to divide 70% of their total daily carbohydrate intake into three major meals. The remaining 30% is split into three between-meals snacks (Jain, 2014, p. 174). For the children who have been put on “basal bolus regime,”

a major portion of the carbohydrates should be consumed as part of the three or four meals which are covered by the bolus insulin shots. Between-meal snacks are not essential. If the child or adolescent wishes to have snacks, these should have no more than 10–15 g of carbohydrates. (Jain, 2014, p. 174).

Effects of Type I Diabetes Mellitus on Patients

            According to the American Diabetes Association (ADA), quoted in Guljas et al. (2014); “Maintaining glycemic control is essential in diabetes management to prevent future complications” (p. 198).

Short-term Effects (Acute Complications) (Hammer & McPhee, 2014, p. 530-533)

1. Hyperglycaemia: this is abnormally high levels of blood sugar in the blood. It can occur if the patient misses a dose of insulin or if they do not stick to dietary advice and consume excess carbohydrates.
2. Diabetic ketoacidosis (DKA): when fatty acids are converted to ketone bodies in the liver. Occurs when compliance to treatment is poor and may lead to coma.
3. Hypoglycaemia: low levels of blood sugar which may occur due to an overdose of insulin, or exercise, or fasting states. Can lead to life-threatening coma. Pharm-Diabetes Paper Assignment

Long-term Effects (Chronic Complications) (Hammer & McPhee, 2014, p. 536-539)

1. Retinopathy: these are changes in the vasculature of the eyes causing blindness.
2. Nephropathy: the long-standing glycosuria and other microvascular changes eventually destroy the kidneys leading to end-stage renal disease (ESRD).
3. Neuropathy: the microvascular changes that occur over time damage the nerves resulting to a variety of symptoms including loss of sensation.
4. Macrovascular disease: these caused by major changes in the blood vessels. The result is conditions like coronary artery disease and cerebrovascular disease.
5. Others: these include frequent infections, foot ulcers, and risk of fractures. All these are due to the long-term changes in the blood vessels, hence compromised blood supply to vital tissues.

Effects of Insulin Treatment in Type I Diabetes Mellitus

The long-term treatment with insulin also has its adverse effects on the patient with type I DM. Weight gain typically occurs at the beginning of treatment, as the body adjusts to the medication. However, hypoglycaemia is an ever-present risk if the insulin dose is inadvertently surpassed. Other adverse effects of treatment with insulin include headaches, depression, and anxiety. Pharm-Diabetes Paper Assignment

References

Guljas, R., Ahmed, A., Chang, K., & Whitlock, A. (2014). Impact of Telemedicine in Managing Type 1Diabetes Among School-age Children and Adolescents: An Integrative Review. Journal of Pediatric Nursing , 29, 198–204. http://dx.doi.org/10.1016/j.pedn.2013.10.013

Hammer, D.G., & McPhee, S.J. (Eds). (2014). Pathophysiology of disease: An introduction to clinical medicine, 7^th ed. New York, NY: McGraw-Hill Education.

Jain, V. (2014). Management of Type 1 Diabetes in Children and Adolescents. Indian Journal of Pediatrics, 81(2), 170–177. DOI 10.1007/s12098-013-1196-3

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14^th ed. New York, NY:McGraw-Hill Education. Pharm-Diabetes Paper Assignment