Types of Diabetes Type 1 diabetes, previously called juvenile diabetes or insuli
Types of Diabetes Type 1 diabetes, previously called juvenile diabetes or insulin-dependent diabetes can be developed at any age, it happens when the pancreas does not make enough insulin. The cause of type 1 diabetes is autoimmune in nature, where the body destroys beta cells made in the pancreas, which can happen months or even years before symptoms are present. In type 1 diabetes, diet and lifestyle do not play a role in causing the disease(What is Type 1 Diabetes, 2021) Type 2 diabetes often happens to individuals over age 45 but more children and teens are developing this disease due to diet and obesity. In Type 2 diabetes, individuals develop insulin resistance as the body’s cells stop responding in a normal way. Because of this, the pancreas works hard to produce more insulin, but over time cannot keep up so blood sugar rises and eventually leads to type 2 diabetes. While gestational diabetes appears in pregnancy and subsiding after delivery. It is managed in the same way as any diabetic pregnancy would be with diet and insulin(Burchum & Rosenthal, 2021) Type 2 diabetes Lifestyle modifications and drug therapy is required for glycemic control. Along with glycemic and lifestyle modifications, patients must also be assessed for comorbidities such as hypertension, nephropathy, dyslipidemia, and retinopathy, and obesity. Bariatric surgery is also considered for obesity management along with medication and behavior modification(Blaslov et al., 2018) Metformin is the most widely used oral medication, but when diabetes progresses and insulin in the body decreases, then patients with Type 2 diabetes need insulin therapy. The 4-step approach is used to treat type 2 diabetes: step 1involves lifestyle modification and metformin. In step 2 drug therapy includes lifestyle modification, Metformin, and a second drug such as thiazolidinedione, a dipeptidyl peptidase-4 inhibitor, a sodium-glucose cotransporter 2 inhibitor, a glucagon-like peptide-1 receptor agonist. If the patient does not achieve the goals of treatment on these medications, a sulfonylurea or basal insulin is considered. In Step 3, there is a three-drug combination which includes metformin. If three-drug therapy including insulin does not achieve glycemic control after 3-6 months, then the recommendation is combination therapy with injectable insulin and a GLP-1 receptor agonist(Burchum & Rosenthal, 2021) Insulin Preparations Insulin injectables are medications used to treat type 2 diabetes. Types of injectable insulin include rapid-acting, short-acting, immediate duration, long duration, and ultralong duration. They are injected subcutaneously before or after meals. One insulin used to treat type 2 diabetes is NPH insulin which has intermediate duration with the onset of 60 to 120 minutes (Humulin N, Novolin N), is injected subcutaneously twice daily at the same time each day. The patient should use gentle agitation when preparing this drug which is administered at mealtime to control blood sugar after meals, rather it is used between meals at night. Patients should be advised that NPH insulin should only be mixed with short-acting insulins; the short-acting insulin is drawn into the syringe first to avoid contaminating the short-acting insulin with NPH insulin. Hypoglycemia can occur with reduced food intake, vomiting, diarrhea, unusually intense exercise, childbirth, and excessive consumption of alcohol. Patients should also be aware that beta blockers can mask symptoms of hypoglycemia, hyperglycemic agents such as glucocorticoids can counteract insulin’s desired effects and hypoglycemic oral agents such as sulfonylureas can intensify hypoglycemia brought on by insulin(Burchum & Rosenthal, 2021) Short and long term consequences of type 2 diabetes Long-term effects of diabetes include heart disease, myocardial infarction, stroke, and higher mortality after CABG, when compared to those without type two diabetes(Bundhun et al., 2017) Type 2 diabetes increases the risk of heart failure, peripheral artery disease, diabetic retinopathy, and microvascular complications such as chronic kidney disease(Oieru et al., 2014) A Short term effect of type 2 diabetes is hypoglycemia which can be heightened by insulin and sulfonylureas(Freeland & Bigelow, 2017) References Blaslov, K., Naranđa, F. S., Kruljac, I., & Renar, I. P. (2018). Treatment approach to type 2 diabetes: Past, present, and future. World Journal of Diabetes, 9(12), 209–219. https://doi.org/10.4239/wjd.v9.i12.209 Bundhun, P. K., Bhurtu, A., & Yuan, J. (2017). Impact of type 2 diabetes mellitus on the long term mortality in patients who were treated by coronary artery bypass surgery. Medicine, 96(22). https://doi.org/10.1097/MD.0000000000007022 Burchum, J., & Rosenthal, L. (2021). Lehne's Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier, Inc. Freeland, B., & Bigelow, A. (2017). Type 2 Diabetes Care in the Elderly. The Journal for Nurse Practitioners, 13(3). https://doi.org/10.1016/j.nurpra.2016.08.010 Oieru, D. S., Vlad, I., Popa, A. R., & Zaharia, M. (2014). Long Term Complications of Diabetes - A Review. Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 21(4). https://doi.org/10.2478/rjdnmd-2014-0042 What is Type 1 Diabetes. (2021, March 25). CDC Centers for Disease Control. https://www.cdc.gov/diabetes/basics/what-is-type-1-diabetes.html

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