Read a selection of your colleagues’ responses BELOW and respond to two of your colleagues POST BELOW. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

PEER 1 RESPONSE

Diabetes and Drug Treatments
Types of Diabetes
Diabetes type 1 can also be referred to as insulin-dependent diabetes. Initially it was referred to as juvenile-onset diabetes because, in most cases it often begun among children. Diabetes type 1 is an auto-immune disorder that causes a person’s immune system to attack and destroy cells responsible for insulin production in the pancreas (Kahanovitz, Sluss & Russell, 2017). People with type 2 diabetes can produce their own insulin but their bodies do not use the insulin very well (Wu, Ding, Tanaka & Zhang, 2014). Their bodies do not effectively use insulin as is required. Additionally, symptoms in type 1 diabetes appear more quickly compared to the type 2 symptoms, which manifest gradually. Gestational diabetes on the other hand is characterized by the temporary presence of high blood sugar, and only occurs during pregnancy. Medical specialists have attributed this kind of diabetes to hormonal changes.
Treatment for Diabetes Type 1
Diabetes Type 1 is mainly treated with insulin. People with diabetes type 1 are required to check their blood glucose regularly to make choices on the amount of food, exercise, and insulin they should take. A home glucose monitor is used to monitor the blood glucose and Insulin is administered with a syringe whenever the glucose levels are low. Patients are also encouraged to take a diet that includes carbohydrates, vegetables, legumes, low-fat milk and to stay away from sweetened beverages.
Short- and Long-Term Impacts of Type 1 Diabetics
Short term complications of type 1 diabetes include diabetic foot ulcers, hypoglycemia, hyperglycemia, peripheral artery disease and ketoacidosis. On the other hand, long term implications include heart disease, stroke, and diabetic diseases of the kidney, nerves, and the eyes. Ac According to previous research studies, prolonged use of insulin increases the risk of hypoglycemia, and mortality risk. It also exposes patients to the risk of specific cancers (Lebovitz, 2011).

References

Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 diabetes–a clinical perspective. Point of care, 16(1), 37.
Lebovitz, H. E. (2011). Insulin: potential negative consequences of early routine use in patients with type 2 diabetes. Diabetes Care, 34(Supplement 2), S225-S230.
Wu, Y., Ding, Y., Tanaka, Y., & Zhang, W. (2014). Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. International journal of medical sciences, 11(11),1185.

PEER 2 RESPONSE
According to McCance and Huether (2019), Diabetes is the seventh leading cause of death and an estimated 30.3 million people have diabetes in 2015. Diabetes is a metabolic disease that causes a decrease of insulin either through a lack of production or resistance. Affecting many Americans today, diabetes can be associated with genetics, lifestyle habits and environmental factors. The four categories of diabetes include; Type 1 diabetes mellitus, type 2 diabetes mellitus, juvenile diabetes and gestational diabetes.

Type 1 DM- Type 1 DM is an autoimmune disease that triggers a destruction of pancreatic beta cells. These patients are often diagnosed in childhood and is usually genetically exposed to the disease. A patient diagnosed with type 1 DM cannot produce insulin, resulting in a very high and common risk for developing ketoacidosis. The treatment for these patients must include daily insulin by injection.

Type 2 DM- Diabetes type two affects 9.3% of American adults and is highest diagnosed in American Indians and Alaska Natives (McCance and Huether, 2019). DM type two is a metabolic condition that causes insulin resistance. These patients produce insulin however, due to environmental and lifestyle behaviors including obesity, these patient’s insulin become resistant to sugars requiring short term and long term glycemic control with insulin and non-insulin medications.

Juvenile DM- Juvenile diabetes occurs in persons younger than 25 years old and has an autosomal dominant inheritance. These patients are children who genetically lack beta-cell antibodies. Treatment includes non-insulin management.

Gestational Diabetes is the development of diabetes type 2 during gestation and is almost immediately resolved once the baby is born. These mothers are suggested to be screened for diabetes at the first prenatal visit to avoid misdiagnosis with type 2 DM. It is essential to educate these patients on monitoring and reducing carbohydrates and sugary foods in preventing short term and long term complications from gestational DM.

Rosenthal and Burchum (2019) recommends Metformin (Glucophage) 500mg po twice daily to treat gestational DM. A study conducted by Kampmann et al (2015), determined that gestational DM prevention and treatment techniques should include exercise, weight loss and a healthy diet before, during and after pregnancy.

Short-term effects on a patient with gestational DM includes complications for the patient and their baby. The effects of gestational DM during pregnancy according to Kampmann et al (2015), includes high risk for gestational hypertension and preeclampsia. Furthermore, the study found that 23.7% of woman with gestational DM had a direct relationship to cesarean section rate and newborns born with macrosomia.

The long-term effect of gestational DM on a woman includes a risk for developing type 2 DM later in life. Kampmann et al (2015) confirms this risk as evident by their study that concluded 40% of women with diet-modified gestational DM developed DM 10 years after pregnancy. Women should maintain a healthy weight before, during and after a pregnancy, to maintain glycemic control in-order to prevent short and long term gestational DM complications.

References
Kampmann, U. (2015). Gestational diabetes: A clinical update. World Journal of Diabetes, 6(8), 1065. https://doi.org/10.4239/wjd.v6.i8.1065
McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease in adults and children. Elsevier Health Sciences.
Rosenthal, L., & Burchum, J. (2017). Lehne’s Pharmacotherapeutics for advanced practice nurses and physician assistants – E-book. Elsevier Health Sciences.