Advanced Pharmacology

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. ( McCance & Huether 2019).  Per The American Diabetic Association (ADA) each year 1.5 million Americans are diagnosed with diabetes.  There are different types of diabetes in this paper we will differentiate between the various types and focus on type 2 diabetes.

Comparison of different types of diabetes including drug treatment

Type 1 Diabetes: caused by Beta-cell destruction leading to absolute insulin deficiency ( pancreas stops producing insulin) . This is the most common form of diabetes. Patients with type 1 diabetes are insulin-dependent.  About 75% of them develop before the age of 30.  Patients are prone to diabetic ketoacidosis.  Type 1 diabetes is secondary to other diseases such as pancreatitis, it is also said to be caused by genetic predisposition and environmental factors. It is most common in people of African and Asian descent.  Clinical manifestations of type 1 diabetes include Polydipsia, polyuria, polyphagia, weight loss, and fatigue.  Patients with type 1 diabetes take different types of insulin. Rapid-acting (Lispro ), short-acting ( regular insulin ) intermediate-acting ( NPH), long-acting (glargine).

Type 2 Diabetes; is caused by the progressive loss of b-cell insulin secretion frequency on the background of insulin resistance ( insulin becomes resistant, may be produced but does not do its job).  Patients with type 2 diabetes are usually not insulin dependent but might be insulin requiring depending on the severity of hyperglycemia.  Not ketosis-prone but may form ketones under stress. obesity in the abdominal region.  Mostly occurs in those 40years of age and above . has a strong genetic predisposition and is often associated with dyslipidemia and hypertension. Prevalence is highest among American Indians and Alaska Natives and lowest among non-Hispanic whites.  Clinical manifestations of type 2 diabetes are nonspecific but the most common ones are; recurrent infections ( boils and carbuncles, skin infections, and prolonged wound healing ), genital pruritus, visual changes, paresthesias, fatigue, and Acanthosis nigricans ( brown to black pigmentation in body folds associated with insulin resistance ).  Treatment of diabetes type two involves lifestyle modifications like weight loss which results in improved insulin sensitivity, and glucose tolerance, and preserves beta-cell function.  In cases where diet and exercise yield unsatisfactory results, first line of drugs for type 2 diabetes is Sulfonylurea, and in some cases insulin is added if the oral hypoglycemic agents do not work. they are nine classes of oral hypoglycemic agents with metformin being the drug of choice.

Gestational Diabetes Mellitus ( GDM);  Any degree of glucose intolerance with onset or first recognition of symptoms during pregnancy.  Caused by insulin resistance combined with inadequate insulin secretion in relation to hyperglycemia. occurs in obese women mostly older than 25years of age, and who have a family history of diabetes. prevalent in women in certain ethnic groups, Hispanic, Native American, Asian, and black. The metabolic stress of pregnancy may uncover a genetic tendency for type 2 diabetes mellitus.  The ADA recommends that pregnant women with risk factors be screened at their first prenatal visit, those without a risk factor should be screened with an oral glucose tolerance test at 24 -28 weeks gestation. Treatment will depend on the level of hyperglycemia. monitoring calorie intake and lifestyle modification and glucose monitoring are important.

Juvenile Diabetes; Is a Chronic condition in which the pancreas produces little or no insulin. It typically appears in adolescents and is characterized by polyuria, polydipsia, polyphagia, fatigue, and hunger. Treatment includes monitoring blood sugar levels, exercise, and diet modification. The same treatment for diabetes type 1 applies to juvenile diabetes.

TYPE 2 DIABETES MELLITUS

A genetic-environmental interaction appears to be responsible for type 2DM. The most well-recognized risk factors are age, obesity, hypertension, physical inactivity, and family history. They are 9 classes of oral glycemic agents that are the first line of drugs for the treatment of type 2DM.

METFORMIN ; is a Biguanide that works by decreasing hepatic glucose production and increasing insulin sensitivity and peripheral glucose uptake.  Metformin is well absorbed from the GI tract and distributed via the bloodstream throughout the body. Metformin provides more opportunities for the cells to bind sufficiently with insulin, initiating the process of glucose metabolism.  Hypoglycemia can occur if metformin is taken with cimetidine, nifedipine, procainamide, ranitidine, and vancomycin. Metformin is administered in type diabetics where diet and exercise have failed to reduce blood sugar levels. oral tablet of 500mg once a day is administered with evening meals initially, the provider titrates the dosage depending on blood sugar control. The maximum dose per day is 2000mg.

DIETARY CONSIDERATIONS

 The goal of treatment with type 2 diabetes is the restoration of near-euglycemia and correction of related metabolic disorders. Diet is an important factor in controlling type 2 diabetes. A  diabetic diet is a healthy -eating plan that is naturally rich in nutrients and low in fat and calories, this includes fruits, vegetables, and whole grains. When extra calories and fat are consumed, your body creates an undesirable rise in blood glucose.  Healthy meals should be eaten at regular times a day.  choose healthy carbohydrates, fiber-rich foods, fish, and good fats. avoid foods high in saturated fat , trans fat, cholesterol and sodium

Long-term and short-term effects of type 2diabetes on patients.

Complications of type 2 diabetes can either be acute or chronic ..

Acute; include hypoglycemia  and Hyperosmolar hyperglycemic nonketotic syndrome (HHNKS)

Chronic; Diabetic retinopathy, diabetic neuropathy, Acute kidney injury ( AKI) , macrovascular problems.

References

Benson, E. B., & Alfors, S. N. (2007). Prescription drug advertising and promotion: Learnings from recent food and drug administration warning letters. Drug Information Journal, 41(3), 281–289. https://doi.org/10.1177/009286150704100301

Bissonnette, D. J. (2019). A diabetic nation: An American Tragedy (1st ed.). Kendall Hunt Publishing.

McCANCE, K., & HUETHER, S. E. (2019). Pathophysiology. The Biologic Basis for Disease in Adults and children (8th ed.). ELSEVIER.

Sharma, A., & Agrawal, A. (2014). Association of dyslipidemia with diabetic complications (1st ed.). LAP LAMBERT Academic Publishing.