types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/To PrepareReview 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.BELOW IS THE QUESTION——————————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.BELOW IS THE REQUIRED READING——————————–Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Chapter 48, “Drugs for Diabetes Mellitus” (pp. 397-415)Chapter 49, “Drugs for Thyroid Disorders” (pp. 416-424)American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73-S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdfThis article provides guidance on pharmacologic approaches to glycemic treatment as it pertains to treating patients with diabetes. Reflect on the content of this article as you continue to examine potential drug treatments for patients with diabetes.please don’t forget to add 5 references not more than 5 years old with APA format 7th edition. Make sure to go through the rubic. CORE SKILL: treatment selection in diabetes is now driven by COMORBIDITY, not just by A1c. The old “metformin then add anything” algorithm is obsolete and reproducing it will cost you marks.
CLASSIFY FIRST: TYPE 1 (autoimmune beta-cell destruction — absolute insulin deficiency; requires insulin; risk of DKA); TYPE 2 (insulin RESISTANCE plus progressive beta-cell failure); GESTATIONAL; and know the mimics — LADA (latent autoimmune diabetes in adults, often misdiagnosed as type 2 in lean adults who fail oral agents rapidly) and MODY (monogenic, autosomal dominant, young, non-obese, strong family history). Misclassification is a real clinical error and naming these shows depth.
DIAGNOSIS: A1c ≥6.5%, fasting glucose ≥126, 2-hr OGTT ≥200, or random ≥200 with symptoms. Know the A1c CAVEATS — it is unreliable in hemoglobinopathies (sickle cell trait), anemia, recent transfusion, pregnancy, and CKD, because it depends on red cell lifespan. That caveat is exactly the sort of nuance that separates bands.
PHARMACOLOGY BY MECHANISM:
— METFORMIN: decreases hepatic gluconeogenesis and increases insulin sensitivity. First-line for most. Weight-neutral to modestly weight-reducing, no hypoglycemia as monotherapy. Adverse: GI upset (titrate slowly, take with food, XR formulation), B12 DEFICIENCY with long-term use (monitor — an underappreciated cause of neuropathy that gets misattributed to diabetes itself, which is a genuinely important clinical point), lactic acidosis (rare; contraindicated at eGFR <30, caution 30–45, hold before iodinated contrast).
— SGLT2 INHIBITORS (empagliflozin, dapagliflozin): block renal glucose reabsorption. THE MAJOR PARADIGM SHIFT — cardiovascular and RENAL outcome benefits independent of glucose lowering. Now indicated in heart failure (HFrEF AND HFpEF) and CKD regardless of diabetes status. Adverse: genital mycotic infections, urinary tract infections, volume depletion, EUGLYCEMIC DKA (a diagnostic trap — DKA with a normal or near-normal glucose), and rare Fournier's gangrene.
— GLP-1 RECEPTOR AGONISTS (semaglutide, liraglutide, dulaglutide) and dual GIP/GLP-1 (tirzepatide): incretin effect — glucose-dependent insulin secretion (so LOW hypoglycemia risk), delayed gastric emptying, appetite suppression. SUBSTANTIAL WEIGHT LOSS and proven cardiovascular benefit. Adverse: nausea/vomiting (titrate slowly), pancreatitis, gallbladder disease, and a BOXED WARNING for medullary thyroid carcinoma/MEN2 (rodent data) — contraindicated with that history.
— SULFONYLUREAS (glipizide, glyburide): stimulate insulin release independent of glucose → HYPOGLYCEMIA and WEIGHT GAIN. Cheap. Glyburide is particularly risky in the elderly (Beers).
— DPP-4 INHIBITORS: modest, weight-neutral, well tolerated; saxagliptin and heart failure signal.
— INSULIN: basal (glargine, detemir, degludec) vs. prandial (lispro, aspart); basal-bolus; correction factor and carb ratio; the DAWN PHENOMENON (early-morning counterregulatory hormone surge) vs. the SOMOGYI EFFECT (rebound hyperglycemia after nocturnal hypoglycemia) — the management is OPPOSITE (increase vs. decrease the evening basal), so distinguishing them by checking a 3 a.m. glucose is the classic teaching case.
GESTATIONAL: insulin is the standard; metformin and glyburide cross the placenta. Screen at 24–28 weeks; postpartum reassessment because of high subsequent T2DM risk.
GUIDELINE LOGIC TO STATE: if there is established ASCVD, heart failure, or CKD, an SGLT2i or GLP-1 RA is indicated FOR THAT INDICATION, independent of A1c. Individualize A1c targets — tighter in young healthy patients, looser (<8%) in the frail elderly with hypoglycemia risk or limited life expectancy. Address the SOCIAL determinants: insulin cost and rationing is a documented cause of DKA and death, and any realistic plan must address affordability.
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