Introduction to Diabetes

Diabetes is a metabolic disorder characterized by impaired glucose uptake by the cells and increased glucose production (Rosenthal & Burchum, 2021). Globally diabetes in the top 10 cause of death killing 1.6million people worldwide. According to CDC (2021) in the past 20 years the number of adults with diabetes has more than doubled to approximately 34.2 million adults making diabetes the number one leading cause of kidney failure, neuropathy, limb amputation and blindness. DM is classified into four types, Diabetes namely type 1 diabetes (insulin dependent) mellitus, type 2 (non-insulin dependent) diabetes mellitus, gestational diabetes mellitus and juvenile diabetes mellitus

Type 1 Diabetes Mellitus

Type 1 insulin dependent DM (IDDM) occurs in about 5% of individual and results from autoimmune pancreatic beta cell destruction resultant in an inability of the pancreas to make insulin. Insulin in an essential hormone for carbohydrate metabolism that turn carbohydrate into glucose which is the utilized by the body cells for energy The cause of the autoimmune response is unknown however genetics, environment and infections are speculated to play key roles (Reddy, 2018). Signs and symptoms of DMM1 include thirst, polydipsia, polyuria, and rapid weight loss. Ketoacidosis is a life-threatening complication of IDDM resulting from impaired glycolysis resulting in accumulation of ketones in the body. If not treated DKA can result in coma and death. The cornerstone of type 1 diabetes treatment is insulin therapy.

Type 2 Diabetes Mellitus

Type 2 non-insulin dependent DM (NIDDM) is the most prevalent form of diabetes accounting for greater than 90% of cases (Rosenthal & Burchum, 2021). It is characterized by the impaired insulin secretion, peripheral insulin resistance and increased glucose production by the liver. Initially, beta pancreatic cells can compensate for the hyperglycemic state by producing more insulin, however as the disease progresses and insulin resistance develops the beta cells are unable to compensate anymore causing diabetes with fasting hyperglycemia (Reddy, 2018). The etiology of NIDDM is unknown however risk factors include heredity and being overweight. Treatment of type 2 diabetes is a combination of proper diet, increase physical activities and oral and injectable antidiabetics. Metformin is the most used oral agent and insulin is utilized as disease progresses.

Gestational Diabetes

Gestational diabetes a serious most common medical complication that develops during pregnancy but resolves after the birth of the child. Risk factors include, advanced maternal age, family history, obesity and overweight, and ethnicity (McIntyre et al.,2019). High blood sugar levels result from antagonistic action of the placenta to insulin and a three time increase levels of cortisol which results in increase insulin requirement that the body cannot sufficiently provide. It crucial that GBM is constantly monitored to prevent long term complication such as maternal cardiovascular disease, type 2 diabetes and macrosomia and birth complications in the infant due to hyperinsulinism (Plows et al, 2018). In most part of the world GBM is controlled with diet and oral antidiabetics such as metformin or glyburide however, the current recommendations are diet and insulin.

Juvenile Diabetes

Juvenile Diabetes is diabetes occurring in children from infancy to childhood. Both type 1 and type 2 DM are prevalent in children however type 1 remains the most common form (Reddy,2018). Environmental factors and genetics again play a role as risk factors.

Insulin (Humalog)

The primary goal for diabetes management is to reduce high blood sugar levels and prevent complications. Insulin is the most common used medication for Type 1 and some type 2 diabetes. It is manufactured using recombinant DNA technology (Rosenthal & Burchum,2021). There are four types of insulin, Short acting, intermediate acting, long acting and ultra-long acting. Type 1 diabetics use both short acting insulin (Humalog or NovoLog) and long-acting insulin such as Lantus. Humalog onset of action is 15 to 30min with duration of 3-6hrs and is injected subcutaneously immediately before a meal, with increased carbohydrate intake and anticipated physical activity (Silver et al.,2018). The patient can use a syringe to draw the needed dose from a vial or use a filled pen with a needle to dial the exact dose. Site of injection should be rotated with each administration to prevent infection and included the upper arm, thighs, abdomen, and buttocks. After use, the vial or pen should be stored in a cool place away from extreme temperatures. Hypoglycemia is a life-threatening complication of insulin that occurs as result of imbalance between insulin needs and insulin levels (Rosenthal & Burchum, 2021). therefore, patient education is critical to ensure patients and families are aware of symptoms of hypoglycemia and the treatment needed.

Reference

Centers for Disease Control and Prevention (2021). Diabetes. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html

McIntyre, H. D., Catalano, P., Zhang, C., Desoye, G., Mathiesen, E. R., & Damm, P. (2019). Gestational diabetes mellitus. Nature reviews Disease primers, 5(1), 1-19. https://doi.org/10.1038/s41572-019-0098-8

Plows, J., Stanley, J., Baker, P., Reynolds, C., & Vickers, M. (2018). The Pathophysiology of Gestational Diabetes Mellitus. International Journal of Molecular Sciences, 19(11), 3342. doi:10.3390/ijms19113342

Reddy, E. S. R. (2017). A Basic Review on Diabetes Mellitus. Journal of Complementary and Alternative Medical Research, 1-15. DOI https://doi.org/10.9734/JOCAMR/2017/39478

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

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1 month ago

omar abdel razzaq 

RE: Diabetes and Drug Treatments

COLLAPSE

Thanks Onesis

according to American Diabetes Association (ADA), Diabetes is a demanding disease, so it can affect your life in many ways. Managing your diabetes can be stressful. The way you feel when your blood glucose levels are low or really high adds to the stress. On top of that, there are the worries that you might develop complications, and the burden of dealing with any complications you may already have. It is no wonder that many people feel that diabetes affects their quality of life.  Part of the answer is obvious: everyone wants to have the best possible quality of life. It just feels good to be satisfied and happy. But there is another reason, as well. Just as diabetes can affect your quality of life, your quality of life can affect your diabetes. When you are feeling good about your life in general and about your life with diabetes in particular, you have more energy to take good care of your diabetes. And when you take good care of yourself, you are likely to feel better day-to-day and to stay healthier in the long run. Feeling better and staying healthy give a further boost to your quality of life. So good quality of life activates a self-reinforcing positive cycle

( ADA, 2010).

several studies shows using of insulin in treatment of hyperkalemia, for instance  Even though insulin-mediated glucose uptake is impaired in uremia, the potassium-lowering effect of insulin is unaffected . This is thought to be due to the independent pathways for potassium and glucose transport across cell membrane . Insulin shifts potassium into cells by stimulating the activity of Na⁺-H⁺ antiporter on cell membrane, promoting the entry of sodium into cells, which leads to activation of the Na⁺-K⁺ ATPase, causing an electrogenic influx of potassium. IV insulin leads to a dose-dependent decline in serum potassium levels( Tingting &Anitha, 2014).

References

American Diabetes Association. (2019). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020251/

Tingting  Anitha Vijyan, Insulin for the treatment of hyperkalemia: a double-edged sword: ClinKidney. 2014 Jun; 7(3): 239–241.

doi: 10.1093/ckj/sfu049.  

response

Thank you for such an educative post. I’ve specifically benefited from the information on the effects of drugs used for type 1 diabetes because I also handled the same content. I agree with you that macro vascular complications of diabetes cause damage to vital organs such as the heart, the brain and the blood vessels. Microvascular complications of diabetes type 1 affect the eyes, small blood vessels and the nerves (Richard I. G. Holt, 2017).

Long term complications of the eye include conditions such as cataracts, retinopathy and blindness. Type 1 diabetes also affects the heart, blood vessels, skin, and the feet causing long term complications such as heart failure, atherosclerosis, loss of thermoregulatory skin function and diabetic foot amputation respectively. Short term complications of the eyes, foot, skin, kidney and the nerves include blurry vision, foot ulcers, sweating, extreme thirst and frequent urination and numbness respectively  (Lehne, 2004).

References

Lehne, R. A. (2004). Pharmacology for Nursing Care. Saunders.

Richard I. G. Holt, C. C. (2017). Textbook of Diabetes. John Wiley & Sons.