Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did.

Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

 

 

Main Post Mi: 

Types of diabetes and pathology

“The International Diabetes Federation (IDF) 2021 report recorded approximately 537 million individuals who are living with diabetes mellitus (DM) in worldwide” (Ngoatle & Mothiba, 2022, p. 1). Diabetes is a disorder of carbohydrate metabolism, impaired glucose uptake by cells due to the absence of insulin (DM type 1) or insufficient insulin release (DM type 2) from the pancreas’ beta cells (Rosenthal & Burchum, 2021). Without insulin, the body cannot open the door of cells; glucose stays in the bloodstream and the urine; cells are hungry, and tissues are drowning in the sugar pool. When the body cannot use glucose for energy, it tries to obtain energy by using other resources; protein or fat. It drives another body’s metabolic failure, such as diabetic ketoacidosis (DKA) coma, due to the byproduct of ketones piled on the body during the process of breaking down fat and protein, which is a critical health condition. There are also many diabetic inducing pathological complications; diabetic neuropathy, diabetic nephropathy, cardiovascular disease, peripheral vascular disease (DM foot), glaucoma, etc. Patients diagnosed with DM type 1, insulin production failure as an autoimmune response, require life-long insulin injection either via subcutaneous route or insulin pump, called IDDM (Insulin Dependent DM). Type 1 diabetes is called ‘juvenile diabetes’ because most IDDM patients are diagnosed in childhood and adolescence. Type 2 diabetes is called NIDDM (Non-Insulin Dependent DM, 90% of all diabetes, adulthood onset), which needs oral antidiabetic agents to decrease body cells’ resistance to the action of insulin or injectable synthetic hormones (synthetic amylin and incretin mimetics) for insufficient insulin production (Speed Pharmacology, 2017). There is another type of diabetes; gestational diabetes occurs only during the pregnancy due to the pregnancy hormonal change and insulin resistance to using, but it is more likely that both mothers and babies will develop type 2 diabetes later (Gestational diabetes, 2017). The mechanism of insulin action is to initiate its action by binding to a glycoprotein receptor on the surface of the cell, thus making a signal to let glucose enter inside the cell so that glucose is used for ATP synthesize and stored as glycogen in the river, and body can maintain the normal glucose level in blood and urine.

Intensive insulin treatments for IDDM (Type 1 DM)

Intensive insulin treatment is designed for people with IDDM to maintain their blood glucose level as near as the normal range by consistent glucose level monitoring and active insulin injection (UpToDate, n.d.). It is called tight control treatment because it requires lifelong insulin adjustment to minimize hyperglycemic complications. Patients check their sugar levels at least four times a day. Several injectable insulins (or continuous insulin pumping) are administered subcutaneously depending on the blood sugar and privately scheduled insulin dose charts. Insulin should be administered not orally (insulin is a tiny nano-size polypeptide molecule, being dissolved right away by the GI digestive enzymes) but into subcutaneous tissue from which insulin travels into the bloodstream for its desirable action speed with its own peak time and duration. Scientists designed four types of insulin; rapid, short, intermediate, and long-acting insulin, by modifying its structures to bind with biological molecules to be absorbed right away (rapid-acting insulin; onset 15 minutes after, peak time after 30 minutes, and duration for about 5 hours) or stay longer in the tissue (short-acting insulins; peak at 2 hours & duration 8 hours/ Intermediate-acting insulin; peak at 6 hours & duration 18 hours/ long-acting insulin; no peak & steady acting release for 24 hours) (Speed Pharmacology, 2017). Followings are the generic names of insulin in each category: rapid-acting insulins are lispro, aspart, and glurisine; short-acting insulin is Humulin R; intermediate-acting insulins are NPH and lispro protamine; long-acting insulins are glargine, detemir, and degludec (UpToDate, n.d.).

Short-term and long-term goals of Type 1 Diabetics

The long-term goal for people with IDDM is to adjust their lives to live healthy with diabetes for a lifetime. Consistency and active self-care treatment skills are essential for this goal. The short-term goal is to obtain diabetic knowledge and skills for insulin self-injection and understanding of the effects of insulin on body. “Optimizing diabetic knowledge and awareness among people will yield better health outcomes for communities. Increased diabetic knowledge is crucial for clients to enhance their lifestyle habits and improve medication adherence, resulting in better health benefits and delayed long-term complications. Diabetes mellitus education is essential not only to the client but also to their families to adjust and manage the required lifestyle modification and offering psychological and dietary support” (Ngoatle & Mothiba, 2022, p. 1). Well-managed insulin treatments will reduce the risk of hyperglycemic tissue damages, allowing people to maintain longevity with a healthy lifestyle, including exercise and diet control, which is another way to control the body sugar level. Nurses and nurse practitioners should set the education tools for ideal diabetic control, including side effects, how to fight hyperglycemic & hypoglycemic crises, the risk of insulin overdose, and the importance care competence and consistency.

 

 

 

 

 

 

References

Gestational diabetes. (2017, May 1). National Institute of Diabetes and Digestive and Kidney Diseases. https://niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/gestational

Ngoatle, C., & Mothiba, T. M. (2022). How Is It to Live with Diabetes Mellitus? The Voices of the Diabetes Mellitus Clients. International Journal of Environmental Research and Public Health, 19(15). https://doi.org/10.3390/ijerph19159638

 

 

Main Post: Rose

 

Diabetes is a condition characterized by a sustained increase in blood glucose levels beyond what is considered normal. The normal range for fasting and random blood sugar levels is 3.9 – 5.5 mmol/l and less than 7.8mmol/l respectively. Elevated blood sugar levels, referred to as hyperglycemia, may lead to early signs of diabetes in the patient such as excessive thirst, increased frequency of urination, and increased hunger pangs (Chaudhary & Tyagi, 2018). The signs must be accompanied by a blood sugar level test that points to an increase beyond the normal reference values. Increased blood sugar levels outside the normal range (> 7.8mmol/l) may be caused by such factors as insufficient insulin in the body, increased resistance to insulin by cells, and consumption of high-calorie and high-fat foods by the patient (DiMeglio et al., 2018). Diabetes mellitus is categorized into three main types.

Type 1 diabetes, also known as juvenile or early onset insulin-dependent diabetes, is caused by damage to the pancreatic beta cells that are responsible for insulin production. The damage to beta cells may occur due to an autoimmune attack (Gandhi & Mooradian, 2021). The production of insulin becomes insufficient to control blood sugar levels.  Children and young people are the most affected group. Type 1 diabetes is managed by insulin injection, diet, and exercise. Type 2 diabetes, referred to as non-insulin dependent diabetes, is caused by insulin resistance (Chaudhary & Tyagi, 2018). The uptake of glucose into cells is insulin-dependent. Resistance to insulin causes the accumulation of glucose in the interstitial space rising the blood sugar. Insufficient production of insulin by the pancreatic cells has also been implicated in type 2 diabetes. Type 2 diabetes mostly affects people above 40 years. Management of type 2 diabetes is done by medicines such as Metformin which improve insulin secretion and sensitivity. In cases where insulin secretion is reduced significantly, insulin injections can be considered to augment blood sugar control. Exercise and dietary modifications are recommended for type 2 diabetes. Lastly, gestational diabetes refers to the hyperglycemia experienced in pregnancy. The high blood sugar levels result from insulin resistance caused by a surge in hormones and fat tissue. Gestational diabetes usually resolves postpartum. In some cases, the blood sugar levels are kept in check using Metformin and Insulin injection.

For this discussion post, I chose to discuss the management of type 1 diabetes that is mainly through Insulin therapy. Measured doses are administered by subcutaneous injection around the abdomen and thighs (Gandhi & Mooradian, 2021). Rotation of injection sites is done to prevent lipohypertrophy. The evening dose is usually one-third of the total dose given in a day. Insulin is stored at low temperatures (2-8 degrees Celsius) in the fridge. The required dose is drawn into a graduated syringe and injected.  The patient is advised to eat foods low in fat and calories such as whole grains, vegetables, and fruits. Exercise and regular meal times are also encouraged. The short-term effects of insulin use in type 1 diabetes may include pain at the injection site, swelling, and itching (Gandhi & Mooradian, 2021). The long-term effects due to chronic hyperglycemia and insulin use are weight gain, lipohypertrophy, chronic infections, impaired vision, and peripheral vascular disease.

 

 

 

References

Chaudhary, N., & Tyagi, N. (2018). Diabetes mellitus: An Overview. International Journal of

            Research and Development in Pharmacy & Life Sciences, 7(4), 3030-3033.

 

 

 

Rubric

 

 

First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.