Diabetes and Treatment
NURS - 6521N - 4
Diabetes and Treatment
Diabetes is a group of diseases that result from a defect in the body’s ability to maintain a homeostatic glucose level. The defect may be in insulin secretion, insulin action or both. Diabetes can be classified as Juvenile, Type 1, Type 2, or Gestational. Distinction between the different classifications is based on the circumstances present at time of the diagnosis. Defect in insulin secretion
Type 1 diabetes is an absolute deficiency in insulin secretion in the pancreatic islets. Type 1 diabetes can be confirmed by serological evidence of an autoimmune process and genetic markers. Type 1 is the results from a cellular-mediated autoimmune destruction of the β-cells of the pancreas. These patients are dependent on insulin to survive and have a high risk of being ketoacidosis when first diagnosed. Insulin resistance
Type 2 diabetes or noninsulin dependent diabetes has a gradual onset and patients may take years to identify common symptoms. Autoimmune destruction of β-cells does not occur. Insulin secretion is defective in these patients and insufficient to compensate for insulin resistance. These patients are usually obese or carry extra fat in the midsection of the body. Gestational diabetes
Gestational diabetes (GDM) is recognized as any glucose intolerance that is diagnosed initially during pregnancy. “The definition applies regardless of whether insulin or only diet modification is used for treatment or whether the condition persists after pregnancy.”("ADA," 2004, para. 26) If a patient is diagnosed with GDM the patient may not continue to be diabetic after delivery or may develop Type 2 diabetes immediately after delivery or later in life. Women who have had GDM have a 35% to 60% of developing diabetes in the next 10 to 20 years according to the National Diabetes Fact Sheet of 2011. Treatment for Gestational Diabetes
The first line treatment for GDM is nutritional therapy and education. It is not recommended for pregnant females to lose weight. The current recommendations of restricting carbohydrate intake to 35 to 40% of dietary calories, there is debate about restricting calorie intake, due to the effects of reduce calories on the fetus. The recommendation by the American Diabetes Association for patient’s that have a body mass index greater than 30 kg per m2 is to decrease the calorie intake by 30 to 33% of daily intake. If the patient is unable to maintain blood glucoses 105 mg per dL in the fasting state and 120 mg per dL two hours after meals then either insulin or oral medications are recommended. There has been no documented evidence that either form is better at maintaining normal plasma glucose. Patients must be educated on taking her blood glucose often, usually at least four to five times per day. Initial treatment for GDM with insulin maybe either via multiple daily injections or continuous subcutaneous insulin infusion. Regular and neutral protamine hagedorn (NPH) insulin, both of which are classified as pregnancy category B, have been the classic initial therapy. Recently, rapid-acting insulin aspart has been approved for use in pregnancy, and lispro is considered a treatment option for patients, 70/30 aspart mix and 75/25 lispro mix are pregnancy category B. For basal insulin, detemir is recommended during pregnancy but remains a pregnancy category C.(Jodon, 2011)
Short term effects of GDM
The short term effects of GDM are usually seen in the fetus. In the early weeks of pregnancy it is thought that uncontrolled hyperglycemia may cause birth defects that include neural tube defects, cardiac malformations, and early loss of pregnancy. In later weeks there is evidence that the maternal hyperglycemia crosses the placenta and causes “fetal hyperglycemia, compensatory fetal hyperinsulinemia, and consequently increased adipose deposition of nutrients, resulting in...
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Diagnosis and Classification of Diabetes Mellitus. (2004). Retrieved from dio:10.2337/diacare.27.2007.S5
Jodon, H. (2011). New Standards of Care for Gestational Diabetes. Retrieved from Clinicians Review: http://www.clinicianreviews.com/home/article/new-standards-of-care-for-gestational-diabetes/43f9e46f915c950c0d48257fbbe7bb52.html
McCance, K. L., & Huether, S. E. (2012). Understanding Pathophysiology (5th Custom Edition ed.). St. Louis, MO: Elsevier Mosby.
Turok, D., Ratcliffe, S., & Baxley, E. (2003, November 1). Management of Gestational Diabetes Mellitus. American Family Physician, 68(9), 1767-1773. Retrieved from http://www.aafp.org/afp/2003/1101/p1767.html
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