Introduction
Diabetes mellitus is a disease characterized by high blood sugar levels (hyperglycemia) due to insulin inadequacy or resistance. The high disease burden of diabetes is due to comorbidities and strain on financial resources. This paper aims to discuss diabetes mellitus with a special focus on type 2 diabetes.
Types of Diabetes
This first part of the paper centers on the discussion of four different kinds of diabetes:
Type 1 Diabetes
This is insulin dependent diabetes. Impaired immune mechanisms result in the complete or partial destruction of the pancreatic beta cells that produce insulin, and the result is type 1 diabetes. This diabetes occurs in normal-weight individuals, or individuals who are thin and losing weight. It is a less common type of diabetes, accounting for only 5% of diabetic cases (American Diabetes Association, 2015).
Type 2 Diabetes
In this case, the beta cells do not produce insulin in sufficient amounts. In addition, the cells are not able to take the little insulin produced by the body. The incidence of type 2 diabetes is directly proportional to age, and 90% of people with diabetes have type 2 diabetes.
Gestational Diabetes
This prevails during pregnancy and is due to the anti-insulin effects of cortisol, progesterone, and human placental lactogen (Arcangelo & Peterson, 2013). Treatment for this kind of diabetes is rather intense because it encompasses all aspects of therapy (exercise, diet and insulin). The essence is to protect the growing fetus from abnormal development.
Juvenile Diabetes
Juvenile diabetes was the term used previously for type 1 diabetes or insulin-dependent diabetes. The term juvenile diabetes might have come about due to its high prevalence in early years, mainly childhood (Saudek, Rubin & Donner, 2014).
Treatment
Type 1 diabetes requires immediate treatment. Type 2 diabetes, largely, requires weight management, and the use of medicine is not a priority. Among the many pharmacotherapies used in the treatment of type 2 diabetes, metformin has stood the test of time, and has remained as the most popular oral antidiabetic agent irrespective of emerging drug therapies. However, its mechanism of action has not been clearly understood. Lehne (2012) delineates that metformin indirectly improves the functionality of the beta cells by decreasing glucotoxicity. The advantage of metformin is that it has no effect on plasma insulin concentration even when administered in high doses.
Pharmacotherapy with metformin should begin with a low dosage while being slowly uptitrated, with the aim of alleviating GI side effects. Mohan and Unnikrishnan highlight the use of 2,000 mg metformin a day based on a dose-response study by Garber et al. (cited in Mohan and Unnikrishnan, 2014). In a study by the Diabetes Prevention Program, cited in Lehne (2012), lifestyle changes resulted in 58% reduced risk of developing type 2 diabetes among patients with impaired glucose tolerance. In comparison, there was a 31% reduced risk of progression to type 2 diabetes when using metformin alone. Challenges, for example, low compliance and socioeconomic constraints make it difficult to use diet alone in the management of type 2 diabetes. Hence, drug intervention is paramount. Metformin helps in weight loss, but it does not substitute diet. Metformin is administered alone, or together with a glitazone, sulfonylurea or exenatide.
Preparations, Dosage, and Administration
Metformin takes various forms: as immediate-release tablets of 500, 850 and 1000 mg, such as Glucophage. Secondly, it can be found as extended-release tablets of 500, 750, and 1000mg, such as Glucophage XR, Fortamet, and Glumetza. Thirdly, it can take the form of an oral solution (500mg/5ml), such as Riomet. Lastly, the drug is available in fixed-doses, used together with other type 2 diabetic drugs.
The initial dosage of immediate-release drugs and oral solution is 500mg, two times a day, or 850mg, once a day, with meals. The intake of extended-release tablets is once a day with the evening meal. The evening meal enhances absorption, which is attributed to slow GI transit time at night (Lehne, 2012).
Side effects of Metformin
Metformin reduces the absorption of vitamin B 12 and folic acid; thus, its use can result in deficiencies of these nutrients. Lack of vitamin B 12 progressively results in peripheral neuropathy. Metformin, just like other biguanides, thwarts the process of mitochondrial oxidation. The result is lactic acidosis, which is a cause for a high mortality rate. Lactic acidosis is common among patients with renal insufficiency.
Effects of Diabetes
Short-term effects of Diabetes
Hypoglycemia, which is due to excess insulin in the body, and hyperglycemia, which is due to insufficient insulin. Severe hypoglycemia progresses to ketoacidosis, which is a less common effect in type 2 diabetes (Lehne, 2012).
Long-term Effects
Type 2 diabetes leads to visual impairment and blindness, subsequently, affecting productivity. It also causes kidney failure and lower limb amputation due to slow wound healing. Diabetic people are fivefold likely to have cardiovascular disease compared to those without diabetes (Arcangelo & Peterson, 2013).
Dietary Interventions
Alongside exercise, the diet aids, effectively, in the management of type 2 diabetes. Most of the people with type 2 diabetes are overweight or obese; hence, their eating goals are blood sugar control, and weight loss (Ford-Martin & Baker, 2013). In the management of blood sugar, determining the quantities of carbohydrates is paramount through carbohydrate counting and dietary exchanges (Ford-Martin & Baker, 2013). In addition, consumption of certain types of foods helps to slow the absorption of the carbohydrates. According to Ford-Martin and Baker (2013), high-fat and high-protein diets help in delaying the absorption of carbohydrates. High fiber foods are equally effective in slowing carbohydrate absorption.
Conclusion
There are different types of diabetes, and each has a unique treatment plan. The focus of this paper was type 2 diabetes, which results from insulin resistance and inadequate insulin in the body. Type 2 diabetes can be easily managed by diet and exercise. However, insulin drugs containing metformin can be used as well for better results.
References
American Diabetes Association. (2015). Type 1 Diabetes. Web.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins. Web.
Ford-Martin, P., & Baker, J. (2013). The Everything Guide to Managing Type 2 Diabetes. Avon: Adams Media. Web.
Lehne, R. (2012). Pharmacology for Nursing Care (8th ed.). Philadelphia: Saunders. Web.
Mohan, V., & Unnikrishnan, R. (2014). World Clinics: Diabetology: Type 2 Diabetes Mellitus. New Delhi: Jaypee Brothers Medical Publishers Ltd. Web.
Saudek, C., Rubin, R., & Donner, T. (2014). The John Hopkins Guide to Diabetes: For Patients and families. Baltimore: Johns Hopkins University Press. Web.