Please reply to the two discussion
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Discussion #1
Allyson W
The differences in the different types of diabetes are that Type 1 diabetes, or juvenile diabetes is generally diagnosed in childhood and occurs because the pancreas produces little to no insulin, therefore leaving the patient dependent on insulin injections. Type 2 diabetes occurs when there is an impairment in the way the body uses sugar which can lead to too much sugar in the bloodstream elevating glucose levels. The pancreas struggles to keep up with the increase in glucose levels, and results in a chronic need for glucose monitoring and supplemental insulin injections (Mayo Clinic, 2021). Gestational diabetes is diagnosed in some pregnant women and happens because pregnancy has affected the way that the body uses sugar, and results in increased glucose levels. This can affect the baby’s health and requires supplemental insulin as needed (Mayo Clinic, 2017).
Gestational diabetes is first treated with glucose monitoring, exercise, and dietary changes, like low sugar and low carbohydrates diet. If these changes are not effective in managing elevated blood glucose levels, then insulin is introduced. Insulin is the drug of choice for gestational diabetes since it does not cross into the placenta (Kampmann et al, 2015). I was diagnosed with gestational diabetes and given an insulin pen. I monitored my glucose closely and had to use sliding scale insulin coverage for glucose levels over 150. When administering, I used the dial at the end of the pen and dialed to the ordered number of units. Then, I used a screw on needle to the pen. I then cleaned a site on my lower abdomen with alcohol and injected the needle with the correct dose of insulin by pressing the end down. It was super easy. I made dietary changes that included no sugar and counted carbohydrates and tried to keep them below 50 grams a day.
Short term effects of gestational diabetes are increased glucose levels and more weight gain from insulin treatment. Long term effects are more of a concern. Women diagnosed with gestational diabetes are more likely to be diagnosed with type 2 diabetes later in life. If blood glucose levels are under control, gestational diabetes does not have long term effects on the baby. Babies born from mothers with gestational diabetes may have increased birth weight, but that levels out as they continue to grow.
Discussion # 2
Kendra H
Type 1 & 2- Often diagnosed later in life such as middle adulthood but can occur at different ages whereas type 1 is often diagnosed in early childhood. Etiology is unknown however obesity and genetics and lifestyle factors such as poor diet and lack of physical activity play a major role unlike type 1 which is autoimmune. Fluctuations in blood sugar are often more stable in type 2 compared to type 1 which has wider variations influenced by medications, illness, exercise, and caloric intake. The treatment for type 2 can be noninsulin, insulin, or combination in conjunction with healthy diet, exercise, and weight management. Treatment for type 1 requires insulin therapy and strict dietary therapy (Rosenthal, & Burchum, 2021).
Gestational- Occurs during pregnancy due to increased cortisol production, hormone production that inhibits insulin, and free flow of glucose from fetus to mother. GD usually ends quickly after delivery of fetus. Blood glucose should be monitored about 7 times a day and insulin should be administered based on blood glucose level and carbohydrate intake that will be at that meal. The only oral medication that is safe in pregnancy is metformin, all other oral antidiabetic medications should be stopped, and insulin should be used (Rosenthal, & Burchum, 2021).
Juvenile- Often associated with type 1 diabetes but can also be type 2.
DM type 2
Drug: Metformin Oral, Class: Biguanide
Actions: Decreases glucose production by the liver, increases response to insulin. Absorbs in small intestines but not metabolized and is excreted by kidneys. If kidney function is altered metformin can build up and become toxin if excretion is impaired (Sanchez-Rangel, & Inzucchi, 2017).
Major Adverse Reactions: Nausea, Diarrhea, decreased appetite
Administration: Studies show controlled blood glucose levels with the use of Metformin (850mg BID) in conjunction with lifestyle modifications. Metformin can also be used with other oral medications or insulin (Sanchez-Rangel, & Inzucchi, 2017).
Metformin can lead to poor absorption of B12 which leads to neuropathy, supplemental B12 can help reduce the risk.
Short term risks for DM2 poor blood sugar levels and fluctuations until a therapeutic regimen is established leading to episodes of hypo- or hyperglycemia. Diabetic Ketoacidosis is not common in DM2 however I have seen many patients come to the hospital in DKA because they were never diagnosed with diabetes (Rosenthal, & Burchum, 2021).
Long term risks with DM2 are effects medications has on the body, poor wound healing, damage to smaller blood vessels causing neuropathy, and retinopathy, nephropathy. Also, cardiovascular disease, cerebrovascular disease, and peripheral vascular disease (Rosenthal, & Burchum, 2021).
Many patients that come in with wounds on our unit is related to uncontrolled DM2, neuropathy, and poor foot care
