NURS6521N – Advanced Pharmacology Essay

NURS6521N – Advanced Pharmacology Essay

NURS6521N – Advanced Pharmacology Essay

Discussion Response

Hello colleague. This is an insightful discussion on the different types of diabetes. I agree that Type 1 Diabetes mostly occurs during childhood, although it can occur at any age due to autoimmune response, genetics, and environmental factors. The discussion has enlightened me that Juvenile diabetes is similar to Type 1 diabetes, but it occurs in children, teenagers, and young adults. Besides, I have learned that gestational diabetes is associated with maternal obesity, a sedentary lifestyle, and advanced maternal age. Consequently, it is vital that lifestyle modifications, including dietary changes and regular physical activity, are incorporated in pregnant women at risk of or with gestational diabetes (Venkatesh & Landon, 2021).

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In addition to your discussion, I have learned from further research that gestational diabetes is defined as any level of glucose intolerance with onset or first recognition during pregnancy (ADA, 2020). Furthermore, type 2 diabetes is associated with a short-term impact of hypoglycemia caused by sulfonylurea drugs and missing meals. Besides, a patient can develop hyperosmolar hyperglycemic nonketotic syndrome (HHNS), marked by very high blood glucose (Papatheodorou et al., 2018). The long-term impact of type 2 diabetes includes complications such as diabetic retinopathy, nephropathy, diabetic neuropathy, and macrovascular disorders. The complications are associated with high glycemic levels, damaging the small blood vessels resulting in microvascular complications. High glycemic levels also damage large blood vessels contributing to macrovascular complications.

References

American Diabetes Association. (2020). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes care, 43(Supplement 1), S14-S31. https://doi.org/10.2337/db16-0806

Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of Diabetes 2017. Journal of diabetes research, 2018, 3086167. https://doi.org/10.1155/2018/3086167

Venkatesh, K. K., & Landon, M. D. (2021). Diagnosis and management of gestational diabetes: What every OB/GYN needs to know to manage this complication. Contemporary OB/GYN, 66(5), 9-15

 

Diabetes is a carbohydrate metabolism disease the impacts many Americans and can lead to complications if not well managed (Rosenthal & Burchum, 2021). Therefore, I will differentiate between the types of diabetes and discuss the impact and drug treatment of gestational diabetes.

Types of Diabetes

Type 1 Diabetes (DM) develops during childhood or young adulthood but can occur at any age. Various factors may cause Type 1 DM, such as autoimmune response, genetics, and environmental factors. Viral exposures may also contribute to the development of this disease (Mayo Clinic, 2021). These triggers cause the immune system to destroy insulin-producing cells, known as beta cells, of the pancreas. Therefore, the pancreas produces little to no insulin preventing glucose from entering the cells for energy resulting in an accumulation of glucose in the bloodstream. Treatment for Type 1 DM is injectable insulin because stomach acid destroys oral medications before absorption in the blood (Centers for Disease Prevention and Control [CDC], 2021). Juvenile diabetes is the same as Type 1 DM but develops in children, teenagers, or young adults (Mayo Clinic, 2021). These individuals are insulin-dependent, but the use of this term is not favored as more children are developing Type 2 DM, and insulin use is becoming more common for treatment (Rosenthal & Burchum, 2021). Type 2 DM occurs when the pancreas produces more insulin because the cells do not respond appropriately. The increased workload of the pancreas leads to increased blood glucose levels and insulin resistance because the pancreas becomes overworked and cannot keep up with insulin demand. Treatment for Type 2 DM can vary depending on how well an individual can manage blood glucose levels. For example, some may benefit from a healthy diet and physical exercise. However, some may require oral diabetic medications and or insulin. Gestational DM occurs during pregnancy due to hormonal changes and weight gain. The cells become resistant to insulin because of the inappropriate production of insulin. Treatment involves diet and exercise but may add Metformin or insulin as needed (CDC, 2021).

Gestational Diabetes Impact

Gestational diabetes (GDM) is becoming more prevalent in the United States due to increased maternal obesity, sedentary lifestyle, and advanced maternal age (Venkatesh & Landon, 2021). It can impact both the mother and fetus. Common fetal complications from GDM are: being large for gestational age (LGA), hypoglycemia, delayed lung development, shoulder dystocia, hypoxia, macrosomia, and increased risk of admission to the neonatal intensive care unit. Maternal short-term complications include Caesarean delivery, preeclampsia, and labor induction. Due to possible macrosomic or LGA infant, the mother may experience uterine rupture or perineal lacerations. Pregnancy hormones impact beta-cells and insulin secretion, and as the pregnancy progresses, the mother becomes less responsive to insulin. The mother is more susceptible to developing metabolic dysfunction, such as Type 2 DM, later and developing GDM with future pregnancies (Brown et al., 2017). Long-term consequences of Type 2 DM include “heart disease, renal failure, blindness, neuropathy, amputations, impotence, and stroke” (Rosenthal & Burchum, 2021, p. 397). However, GDM usually disappears after delivery of the infant resulting in discontinuation of treatment.

Treatment

Initial treatment for GDM is lifestyle modifications, such as dietary changes and regular physical activity (Rosenthal & Burchum, 2021). Venkatesh and Landon (2021) state that mothers with GDM should consume three meals and snacks per day for a calorie consumption equaling 2000 to 2400 per day. Diet should consist of 40-50% complex high fiber carbohydrates, 30-40% fat, and 20% protein. Insulin may be added for those who did not respond to lifestyle modifications and is preferred over oral antidiabetic medications because insulin does not cross the placenta (Venkatesh & Landon, 2021). Treatment can include Neutral protamine Hagedorn (NPH) insulin. As intermediate duration insulin, NPH solubility reduces due to the conjugation of regular insulin with protamine. Therefore, the delayed absorption results in a delayed onset and extended duration. NPH is subcutaneously injected two to three times daily for glycemic control between meals and nighttime. It does not control postprandial hyperglycemia. If postprandial glycemic control is needed, NPH and short-acting insulins are suitable for mixing. However, some adverse reactions of NPH include allergic reactions to the protein and hypoglycemia (Rosenthal & Burchum, 2021). Patients can develop sore fingers from monitoring blood glucose levels and tenderness around injection sites.

Conclusion

Gestational DM is increasing in prevalence, and treatment options are changing due to poor glycemic control. Treatment should initially involve less invasive methods, such as diet control and physical activity. However, studies have shown that insulin is an additional treatment option with beneficial effects on maternal and fetal health. Various types of insulin are available for individual needs in managing glycemic episodes. Therefore, patients with gestational DM should monitor their glucose levels to determine whether or not the treatment is effective.

References

Brown, J., Alwan, N. A., West, J., Brown, S., McKinlay, C. J. D., Farrar, D., & Crowther, C. A. (2017). Lifestyle interventions for the treatment of women with gestational diabetes. COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 5, CD011970. https://doi.org/10.1002/14651858.CD011970.pub2

Centers for Disease Control and Prevention. (2021). Diabetes. https://www.cdc.gov/diabetes/basics/index.html

Mayo Clinic. (2021). Type 1 diabetes. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011

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

Venkatesh, K. K., & Landon, M. D. (2021). Diagnosis and management of gestational diabetes: What every OB/GYN needs to know to manage this complication. Contemporary OB/GYN, 66(5), 9-15