P5#2

18 hours ago

Casey Hoffman 

Initial Post

COLLAPSE

Top of Form

Type 1 Diabetes Mellitus, Juvenile onset

In regard to DM I, it frequently occurs in childhood and affects both male and females equally. According to the authors Zaccardi, Webb, Yates, & Davies (2016), an estimated 5-15% of adults diagnosed with type 2 DM actually have type I DM or latent autoimmune diabetes of adults. Type 1 DM poses a greater genetic risk than type 2 DM. There are genetic influences that affect the triggering of islet autoimmunity and the progression of the disease process (Zaccardi, Webb, Yates, & Davies 2016). There is an overall higher prevalence of type 1 DM observed in relatives, which implies a genetic risk.  It should be made known that glucose levels are frequently elevated years before the diagnosis of DM type 1 (Zaccardi, Webb, Yates, & Davies 2016). Even within the normal range,  higher glucose levels are predictive of DM type 1 (Zaccardi, Webb, Yates, & Davies 2016). Glucose levels tend to have a wide fluctuation range during the progression to DM type 1. 

Type II Diabetes Mellitus

In regard to DM type II, there is a defective insulin secretion from the pancreas. Those suffering from DM type II are unable to increase insulin secretion to overcome insulin resistance (Tuomi, 2005). Patients suffering from DM type II can be either insulin resistant or insulin sensitive. In DM type II, the first-phase insulin secretion is significantly impaired or lost (Tuomi, 2005).  Patients suffering from DM type II will inevitably have complications from hyperglycemia due to their DM type II. As this disease progress, hyperglycemia becomes more severe and more difficult to treat. 

Gestational Diabetes 

In a normal pregnancy, the female patient must increase her insulin secretion by 200-250% (Kampmann, et.al., 2015).  Gestational diabetes mellitus, or GDM, occurs when a pregnant woman is not able to produce an adequate insulin response to compensate for this normal insulin resistance (Kampmann, et.al., 2015). GDM is prevalent in both lean and obese females. In obese women, however, the pathophysiology is characterized by pre-pregnancy induced insulin resistance being amplified by the already elevated pre-pregnant insulin resistance level (Kampmann, et. al., 2015). Insulin resistance is one of the 4 known factors that are prominent in metabolic syndrome. In women that are lean and become pregnant, there seems to be a defect in the first-phase insulin response that contributes to the development of GDM. 

Treatment of Diabetes II Mellitus and Dietary Considerations

In regard to the treatment of DM type II, the oral medication known as Metformin is the recommended first-line treatment, if there are no contraindications in the patient's medical history. Metformin falls in the drug class of biguanides, it can be used alone, in combination with a sulfonylurea, or insulin. Patients taking Metformin should be monitored for a decrease in their B12 level (Rosethal & Burcham, 2018).  Metformin should be taken with meals to reduce GI side effects. Metformin should be taken as prescribed including the appropriate dosage. If a dose is missed, the patient should take that dose as soon as possible, or if it is close to the next scheduled dose, the missed dose should be skipped and scheduled dose should be taken in order to get the patient back on schedule. 

When taking Metformin, patients should avoid foods high in fiber because Metformin levels have been found to decrease in those who have a diet high in fiber (Kampmann, et.al., 2015). Patients should also maintain a diet low in carbohydrates in order to gain better control of their overall blood glucose levels. 

Short and Long Term Effects of Type II Diabetes Mellitus 

Short term complications of DM type II include hypoglycemia and hyperosmolar hyperglycemic non-ketonic syndrome (HHNKS). Long term complications of DM type II include diabetic retinopathy, kidney disease, diabetic neuropathy, and macrovascular issues. Hypoglycemia may occur due to another medication such as aspirin or from alcohol consumption. HHNKS occurs when the blood glucose level is not controlled, which then causes a cascade of electrolyte imbalances. The long term effects of DM type II can be quite devastating, they include blindness, kidney failure, and decreased sensation/feeling in the extremities because of damage caused to the nerves. 

Kampmann, U., Madsen, L. R., Skajaa, G. O., Iversen, D. S., Moeller, N., & Ovesen, P. (2015).

Gestational diabetes: A clinical update. World journal of diabetes, 6(8), 1065-1072.

https://doi.org/10.4239/wjd.v6.i8.1065

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Tuomi, T. (2005). Type 1 and Type 2 Diabetes What Do They Have in Common? Diabetes, 54(2), 540-545.

Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type 2

diabetes mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084), 63-69.