Diabetes

For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.

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Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/

To Prepare
Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

Post a brief explanation of 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 proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.Diabetes And Drug Treatments Essay

*No plagiarism, do not change dates on references**
Explain the differences between 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 proper preparation and administration of this drug. Include dietary considerations related to treatment.
Explain the short-term and long-term impact of this diabetes on patients including effects of drugs treatments.
***Paper must have introduction and summary

Public health emphasizes the importance of prevention and proactively taking care of one’s body. As people grow older, they must follow certain guidelines to ensure that they age healthily and successfully. One of the biggest concerns facing the aging population is chronic diseases. Chronic diseases are long term diseases that have a slow progression. Once chronic diseases pass “certain symptomatic or diagnostic thresholds,” they become a permanent aspect of an individual’s life because “medical and personal regimens can sometimes control but can rarely cure them” (Albert and Freeman 105). One chronic condition that is a cause of concern is diabetes. causes of death in the over 65 population but…show more content…
Those who are diabetic may also be in risk of blindness (diabetic retinopathy) and nerve damage (diabetic neuropathy). Diabetic neuropathy can lead to numbness in hands and feet, foot ulcers, and eventual limb amputation (World Health Organization). Taking preventive steps can help to avoid many of the complications of diabetes. Several nationwide programs and incentives were administered in the last couple of decades to promote awareness of diabetes and hopefully help prevent millions of Americans from developing diabetes. Health Agencies, such as World Health Organization (WHO) and Center of Disease Control and Prevention (CDC), have developed objectives to tackle diabetes. Some of these objectives include conducting surveillance and obtaining diabetes data to identify trends in the population, spreading awareness about the condition, and developing programs that will enhance diabetes care and ensure the longevity of the patients. Various programs have been developed but while some excel, others fail to benefit the lives of the patient. One type of public health program approach that has been utilized recently with diabetes is aggressive care. With aggressive care, there are strict guidelines to keep diabetes in check. The goal of the intensive treatment is to lower the blood glucose level by administering glucose checks by pricking fingers multiple times a day Diabetes And Drug Treatments Essay

The main aim of diabetes treatment is to return blood sugar to a safe threshold and reduce the risk of complications while helping a person with diabetes to resume daily function.

In this article, we look at the treatments for types 1 and 2 diabetes, as well as the importance of insulin.

People can manage some cases of type 2 diabetes with lifestyle adjustments, so we also examine the steps a person can take in the early stages of diabetes to reverse its progression.

Medications
The main medication for managing type 1 diabetes is insulin.

Insulin
Taking insulin at the right times of day can improve quality of life for a person with diabetes.
People with type 1 diabetes must take insulin, as the pancreas of a person with type 1 does not produce the hormone. Supplementary insulin helps the cells in the body to absorb glucose and use energy.

A person with type 1 diabetes will need to receive insulin at several points throughout the day. Some doses of insulin will occur before or after a meal. With type 2 diabetes, insulin is not always necessary.Diabetes And Drug Treatments Essay

However, a doctor may recommend taking it at certain times, such as while pregnant or during an extended hospital admission.

Self-monitoring can help an individual decide when to take insulin.

Insulin has several different delivery methods. The most common methods include the following.

Insulin pump: This delivers small, continuous doses of insulin throughout the day.

Needle and syringe: An individual draws insulin fluid from a bottle and injects a shot. The most effective location is on the stomach, but a person can also administer a shot into the upper arm, the buttocks, or the thigh.

Some people need several shots to return blood glucose to an ideal level. Others might only require one shot.

Pen: Some insulin pens are disposable, while others offer space for a replaceable insulin cartridge. They are costlier than needles but easier to use and resemble a pen with a needle instead of a nib.

Less commonly, people might use the following to administer insulin:

Inhaler: Some types of insulin can be breathed in as a powder from an inhaler device. Inhaled insulin can reach the blood faster than other types. However, it is only suitable for adults who have type 1 or type 2 diabetes.

Jet injector: This method delivers a fine, high-pressure spray into the skin instead of a needle injection.Diabetes And Drug Treatments Essay

Injection port: This contains a short tube that the person who needs insulin slots just beneath the skin. They would then inject insulin into the port with a pen or needle and syringe and fit a replacement every few days. An injection port gets around having to puncture the skin every day.

Medications for type 2 diabetes
A person with type 1 diabetes will always need insulin.

However, alongside lifestyle measures, such as a balanced, low-sugar diet and regular exercise, a person with type 2 diabetes might need to manage blood sugar in other ways.

Metformin is a key medication for type 2 that people take in pill form or as a liquid. It helps reduce blood sugar and make insulin more effective, as well as assisting weight loss, which can also reduce the effects of diabetes.

Other oral medications can also help reduce blood glucose in people with type 2 diabetes, such as:

alpha-glucosidase inhibitors, such as acarbose and miglitol, which slow the breakdown of starches into glucose after a meal and slows down the increase in blood sugar levels
biguanides, including metformin, which reduce the production of glucose in the liver and make muscle tissue more sensitive to insulin to improve the absorption of glucose
bile acid sequestrants (BASs), which reduce cholesterol and blood sugar and are safe for people who also have liver problems, as they do not enter the bloodstream
DPP-4 inhibitors, such as alogliptin, linagliptin, and saxagliptin, which help improve the binding of glucose to the blood without causing low blood sugar
meglitinides, such as nateglinide and repaglinide, which stimulate the release of insulin but might cause low blood sugar Diabetes And Drug Treatments Essay
SGLT2 inhibitors, such as canagliflozin and dapagliflozin, which help block the reabsorption of glucose in the kidneys, resulting in sugars leaving the body in the urine
sulfonylureas, including glimepiride, glipizide, and chlorpropamide which stimulate the release of insulin in the pancreas
thiazolidinediones, or TZDs, such as rosiglitazone and pioglitazone, which improve the function of insulin in the fat and muscle and slow glucose production in the liver
GLP-1 agonists-including albiglutide, dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide can help with weight loss and some decrease cardiovascular events
Some medications reduce blood sugar too much and cause hypoglycemia, or low blood sugar, if a person takes them outside of mealtimes. Speak to a doctor and assess the risk of this and other side effects when receiving a prescription.

A doctor may prescribe a combination of these medications if only taking one at a time is not having the desired effect on blood glucose. Not all of these drugs interact with each other, as they impact on different functions in the body.

Certain medications require an injection, such as GLP-1 receptor agonists, which reduce the glucose output of the liver and increase insulin production.Diabetes And Drug Treatments Essay

A person must also inject amylin analog, which a doctor would prescribe for use alongside meals to slow the movement of food through the gut and control glucose levels after eating.

Type 1 Diabetes Mellitus
The global burden of diabetes is significant. The World Health organization (WHO) estimates that 346 million people have diabetes worldwide, with a mortality rate of 10% recorded for 2004 (WHO, 2011). However, there are wide variations in the prevalence and mortality rate of diabetes among countries. Over 80% of all deaths from the complications of diabetes occur in underdeveloped and transitioning countries and this rate is projected to double by 2030 (WHO, 2011). The countries with the largest number of people with diabetes are India (50.8 million), China (43.2 million), and the United States (26.8 million). In contrast, Australia had 700,000 people diagnosed with diabetes in 2004-2005 (WHO, 2011). However, although the prevalence of diabetes in Australia is not as high as in other countries, diabetes represents a great burden to the healthcare system of Australia, especially in the treatment of indigenous people, where the death rate has be shown to be as high as 12 times that in the non-indigenous diabetic population (AIHW, 2008). In addition, the death rate from renal complications in indigenous people was found to be 19 times higher than in the general diabetic population, and deaths from other complications such as coronary heart disease, stroke, peripheral artery disease, and ulcers in the lower extremities were 7% higher (AIHW, 2008). There are also race and ethnic differences in the prevalence of diabetes in the US, ranging from 7.1% for non-Hispanic whites, t 11.8% for Hispanics, and 12.6% for non-Hispanic blacks (WHO, 2011).Diabetes And Drug Treatments Essay

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Causes, Rate, and Risk Factors of Diabetes
During the process of digestion food is broken down into glucose, simple sugar. Glucose is then removed from the blood by insulin, a hormone made by the pancreas, and taken into the cells. Hyperglycemia, or high blood sugar levels, occurs when the pancreas cannot produce enough insulin to remove glucose from the blood or because the cells are not able to use the insulin (Centers for Disease Control (CDC), 2011). People with hyperglycemia can develop serious medical conditions should the disease progresses without medication (CDC, 2011).

There are different types of diabetes, which are classified according to their causes and risk factors. Type 1 diabetes is a chronic condition where the pancreas cannot make insulin to remove glucose from the blood and the patient develops hyperglycemia. With type 2 diabetes, the pancreas is either not making enough insulin or the cells lack the ability to use insulin.

Type 1diabetes, or diabetes mellitus, used to be referred to as child onset diabetes since the majority of patients diagnosed with type 1 diabetes were children and adolescents, although people can develop type 1 diabetes at any age (A.D.A.M.). The global incidence of childhood type 1 diabetes mellitus (T1DM) is increasing; although, as in all other forms of diabetes, there are wide variations among the different countries (Taplin et al., 2005). Some attribute the increase to environmental factors while others attribute it to genetic factors. The high-risk human leukocyte antigen (HLA) class II DRB1 gene has been shown to be commonly expressed in people with type 1 diabetes. However, a study by Fourlanos et al. (2008) has shown that the impact of the environment on lower-risk HLA class II genes can raise the incidence of type 1 diabetes in children who previously would not have developed type 1 diabetes. Another study found a correlation between maternal history of Type 1 and Type2 diabetes and later onset of Type 1 diabetes (Holstein et al., 2012). The study also found that people with type 1 diabetes have lower fertility rates.Diabetes And Drug Treatments Essay

Standards of Care for Children and Adolescents with Type 1 Diabetes
There is no known cause and no cure for Type 1 diabetes but the disease can be managed with diet, regular exercise, maintaining a normal body weight, and medication (CDC, 2011). Type 1 diabetes is diagnosed when a patient presents with a history of symptoms of diabetes, such as excessive urination, thirst and hunger, weight loss, and when laboratory tests confirm hyperglycemia, glycosuria, ketonemia, and ketonuria (Silverstein, 2005). In the absence of these symptoms, hyperglycemia alone does not indicate diabetes; however, when a patient who is otherwise healthy presents with high blood sugar levels, other tests are generally conducted to confirm or rule out diabetes. One of these tests is the hemoglobin A1C blood test; when this test shows levels higher than 6.5%, that means that the patient has diabetes. Another test is the oral glucose tolerance test; diabetes is confirmed if sugar levels are greater than 200 mg/dL after 2 hours. Type 1 diabetes is diagnosed in 10%–15% of people with diabetes and a great majority of these patients are children or adolescents.Diabetes And Drug Treatments Essay

Short-term Care
The first step in the management of child or adolescent diabetes is to have the patient evaluated by a multidisciplinary team consisting of a pediatric endocrinologist, nurse educator, nutritionist, and psychologist (Silverstein et al., 2005). As the child advances through the various stages of childhood and adolescence the team has to make adjustments to the treatment protocol to correspond with developmental changes. Around 30% of children with type 1 diabetes suffer from diabetic ketoacidosis (DKA), a life-threatening condition that needs immediate attention.

Medication is a critical component in the management of type 1 diabetes as the body cannot produce any insulin. There is also a strong educational component in the control his disease; therefore, a critical first step in the care of diabetes is patient education (Silverstein et al., 2005). This is particularly important as there is no cure for the disease and self-management is at the core of treatment. Parents with diabetic children must adapt and learn the skills necessary to help their children live with the disease and as they learn these skills they must also pass this knowledge on to their children (Holstein et al., 2012).Diabetes And Drug Treatments Essay

Long-term Care
Type 2 diabetes can be prevented through proper nutrition and regular exercise; however, there is no way to prevent or cure type 1 diabetes (A.D.A.M., CDC, 2011). Patients with either form of diabetes should wear an identification bracelet that identifies the wearer as a person with diabetes. This is especially true for school-age pediatric patients who are often away from their parents. The ability of children to manage diabetes on their own varies according to their motor development, cognitive ability, and maturity and increases with time. Parenting of children with type 1 diabetes can be stressful because the disease has to be monitored closely to ensure metabolic control and to prevent drops in blood-sugar levels. This is especially true in the oversight of infants who have no way of communicating or responding to the danger signals of the disease (Grey et al., 2011). Therefore, it follows that parents of children diagnosed with diabetes carry a large burden of care that often leads chronic stress and depression; and unfortunately, there are few interventions available to help parents cope with the challenges of caring for a diabetic child. It is critical to address this issue because the ability to cope with the stress of treating diabetes in a child can impact the management of the disease as well as the wellbeing of the entire family unit; and the ability to teach the child, when mature enough, to self-manage the disease. Studies have shown that parental depression correlates with poor metabolic control and low quality of life (QOL) of parent and child (Grey et al, 2011). One way to ameliorate this problem is to adopt a flexible and intensive approach to the management of insulin that would not only improve metabolic control but also result in dietary freedom. This approach has been made possible by the advent of new medications in the form of insulin analogues, although their use requires personalized and extensive parental education. As the child matures and the parent adjusts to the disease the diabetes care management team should develop a plan that meets the needs, hopes, and lifestyle of the young patient and the parents.Diabetes And Drug Treatments Essay

Diseases associated with diabetes
Diabetes is a serious disease that reduces QOL and has serious complications.
More than half of the patients diagnosed with diabetes suffer from other disabilities and 25% of these disabilities were a direct cause of diabetes (AIHW, 2008). Diseases associated with diabetes include diseases of the kidney, various cardiovascular and neurological diseases, eye problems, and stroke (A.D.A.M.). Cardiovascular disease and stroke account for half the mortality rate of people with diabetes. Impaired circulation and neuropathy in the lower limbs raise the risk of foot ulcers that sometimes lead to limb amputation. Poor circulation can lead to damage of the small blood vessels feeding the retina and diabetic retinopathy, which may eventually lead to blindness in 2%, and severe visual defects in 10%, of people with diabetes. There is also significant correlation between diabetes and renal failure and 10-20% of people with diabetes die due to kidney complications. Neurological damage is also common among people with diabetes and this can lead to pain and loss of sensation and function in the hands and feet. Finally, the overall risk of mortality among diabetics is over twice that of people in the general population.Diabetes And Drug Treatments Essay

Endothelial function plays a critical role in the progression of diabetes and is not just limited to the anatomy of the blood vessels but also involves their function. The blood vessels are responsible for the delivery of inflammatory cells and cytokines, and other regulatory substances to the various cells; thus, impaired anatomy translates into impaired function and vascular disease (Gallego, Wiltshire & Donaghue, 2007). Endothelial dysfunction leads to microalbuminuria, which signals the beginning of diabetic nephropathy. There are many factors that lead to impaired endothelia function in patients with type 1diabetes including high blood-sugar levels, low insulin levels, and elevated LDL cholesterol levels. High blood-sugar levels acts either directly, or indirectly via the activation of regulatory pathways, to compromise the function of blood vessels; while insulin can act directly by increasing the blood flow (Gallego, Wiltshire & Donaghue, 2007). Therefore, since endothelial dysfunction precedes diabetes-induced complications, it is critical to assess endothelial function even when there is no evidence of any such complications. The factors affecting endothelial function vary for young and older adults. In younger adults there is a correlation between LDL cholesterol levels and endothelial dysfunction, whereas in older adults the correlation is between microalbuminuria and flow-mediated dilatation (FMD). Once the factor that is causing impaired endothelial function has been isolated, the issue may be addressed with therapy; for example, FMD can be treated with nutritional supplements like folate of vitamin B6, LDL cholesterol can be controlled with statins, and high blood-sugar levels can be managed with insulin.Diabetes And Drug Treatments Essay

There is scientific evidence that control of modifiable risk factors such as blood sugar levels, cholesterol levels and blood pressure can lower the risk of complications due to diabetes. Proper nutrition can help control hyperglycemia, lower cholesterol and keep blood pressure within normal levels. To accomplish this it is critical to have a strong medical support system, especially as patients with type 1 diabetes transition from child hood to adulthood. Perry et al. (2011) found that young adults with type 1 diabetes were not receiving proper diabetes services in rural areas of New South Wales, Australia; they reported that the patient either had not access to diabetic care, or the care offered was inadequate and not age specific. There was a wide gap in the level of care and in the services the patients with diabetes received in childhood and in adulthood; patients felt they had been abandoned by the healthcare system, citing fragmentation of care, lack of coordinated care, and minimal support. This gap in the healthcare system in rural Australia may account for the higher prevalence of diabetes, complications from diabetes, and death among diabetic people in the lower socioeconomic groups, which is nearly double the rate in diabetic people in the higher socioeconomic groups (AIHW, 2008).Diabetes And Drug Treatments Essay

Living with diabetes is stressful at best; once diagnosed with the disease the patient knows that permanent life-style adjustments are to be made in order to live with the disease. However, if the disease is caught early, the patient cooperates with the diabetes management team and learns about the disease, the impact on quality of life can be minimized. The quality of care of a child with type 1 diabetes depends on the ability of the parent to adapt to the challenges of caring for the disease. The primary end of this study is to evaluate factors that affect parental care of type 1 diabetes mellitus. Diabetes And Drug Treatments Essay

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