Week 5: Endocrine System Disorders and the Treatment of Diabetes
Instructions:
Respond to your colleague by who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.
**minimum of three (3) scholarly references are required for each reply cited within the body of the reply & at the end**
David Maniago
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As many of us know, diabetes is an endocrine disorder that affects millions of Americans. There are several types of diabetes, and it is vital to understand the differences in pathophysiology to distinguish between each type. In Type 1 Diabetes Mellitus (DM I), onset is usually early and gradual. On a physiological level, beta cells are defective or insufficient. Beta cells are located in the pancreas and are responsible for producing insulin. Therefore, in DM I, insulin levels are low. It is also important to note that DM I was formerly called juvenile-onset diabetes. However, this implies that it is strictly children who are affected in DM I. In Type II Diabetes (DM II), the affected people are usually over 40 years of age, but it is becoming more common in children. Hence, juvenile-onset is no longer the term used to describe DM I as it affects both primary forms of diabetes (Rosenthal & Burchum, p. 397, 2021). Lastly, gestational diabetes is a form of diabetes that occurs commonly during pregnancy and terminates at the end of gestation. In this type, hyperglycemia is caused by several factors. Mainly, insulin resistance is due to the placenta releasing hormones that inhibit insulin action. Second, the production of cortisol, a glucocorticoid, is increased during pregnancy. This contributes to hyperglycemia (McCance & Huether, 2019). It is essential to note that glucose passes freely between the mother and the fetus, so when glucose levels are high in the fetal circulation, the fetus will release more insulin.
Rosenthal & Burchum (2021) explain that the hallmark for blood glucose treatment in gestational diabetes requires regular monitoring of glucose levels. Glucose levels should be managed with diet (limiting fat intake, eating fruits and vegetables), physical exercise, weight control, and insulin subcutaneously. Metformin, an oral medication, can be used to treat glucose as well. Metformin is the only exception to PO agents. Any other oral medication must be discontinued during pregnancy. Metformin works by decreasing gluconeogenesis in the liver while increasing tissue sensitivity to insulin.
The primary goal of managing gestational diabetes is to prevent short-term consequences such as hyperglycemia (diabetes untreated) and hypoglycemia (too much insulin received or too little glucose). When left untreated, chronic hyperglycemia to the maternal side can lead to long-term effects, damaging the heart, kidneys, and neuropathy. It can also lead to diabetic ketoacidosis, a metabolic emergency that causes ketone buildup in the body, placing the body in an acidotic state. This is a life-threatening that must be managed aggressively. In the fetus, hyperglycemia can lead to congenital disabilities (Stanford Children’s Health, 2021).
Moreover, if insulin is taken subcutaneously, diligent monitoring of blood glucose levels is warranted. Hypoglycemia, characterized by glucose levels less than 70 mg/dL, brain damage can occur as there is not enough glucose to supply to the brain. The brain requires oxygen and glucose to function. Insufficient levels can lead to irreversible damage.
References
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
Rosenthal, L. D. & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). St. Louis, MO: Elsevier.
Stanford Children’s Health. (2021). Diabetes during pregnancy. Lucile Packard Children’s Hospital Stanford. https://www.stanfordchildrens.org/en/topic/default?id=diabetes-and-pregnancy-90-P02444
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