Instructions - Read a selection of your colleagues’ responses and respond to at least two of your colleagues ( see below the two colleagues post ) who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Post 1 please focus on gestational diabetes in the response Post 2 Post 1 focus in diabetes type 1 treatment in the response APA style 3 citations in each response Diabetes and Drug Treatments Introduction Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (McCance & Huether 2019). The symptoms of diabetes result from a deficiency of insulin or cellular resistance to insulin's actions. Type 1 diabetes According to McCance & Huether (2019), type 1 diabetes mellitus (DM) is the most common pediatric chronic disease and affects 0.17% of US children, and the incidence is increasing. Rosenthal & Burchum (2021) notes that in autoimmune-mediated DM, environmental-genetic factors are thought to trigger cell-mediated destruction of pancreatic beta cells. Generally, type 1 diabetes develops during childhood or adolescence, and symptom onset is relatively abrupt (Rosenthal & Burchum 2021). It, however, needs to be noted that type 1 diabetes can also develop during adulthood. Type 1 diabetes was once called juvenile-onset diabetes mellitus or insulin-dependent diabetes mellitus (IDDM). This term is no longer commonly used because older children are frequently diagnosed with type 1 diabetes. Peak onset at age 11–13 years four is slightly earlier for girls than boys. It is rare in children younger than one year and adults older than 30 years. Type 1 diabetes is characterized by severe insulin deficiency or no insulin secretion. Insulin is the mainstay of therapy for individuals with type 1 diabetes (American Diabetes Association, 2018). Type 2 diabetes Type 2 diabetes mellitus (DM) affects 9.3% of adults in the United States (Rosenthal & Burchum 2021). According to Rosenthal & Burchum (2021), age, obesity, hypertension, physical inactivity, and family history are the most well-recognized risk factors. Evidence shows that diet, including diet during pregnancy, influences the long-term risk of type 2 DM in children and adults. Type 2 diabetes is different from type 1 diabetes in that the risk of developing diabetes increases after age 40 years. In general, incidence increases with age into the 70s; among certain races, incidence peaks between 40 and 50 years, then falls with frequent contributing factors to precipitate type 2 diabetes among those susceptible. A significant factor in populations recently exposed to westernized environment increased risk related to duration, degree, and distribution of obesity. Gestational diabetes Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first re ...

1. Instructions - Read a selection of your colleagues’ responses
and respond to at least two of your colleagues ( see below the
two colleagues post ) who selected a different type of diabetes
than you did. Provide recommendations for alternative drug
treatments and patient education strategies for treatment and
management. Post 1 please focus on gestational diabetes in the
response
Post 2
Post 1 focus in diabetes type 1 treatment in the response
APA style 3 citations in each response
Diabetes and Drug Treatments
Introduction
Diabetes mellitus (DM) is a group of metabolic diseases
characterized by hyperglycemia resulting from defects in insulin
secretion, insulin action, or both. (McCance & Huether 2019).
The symptoms of diabetes result from a deficiency of insulin or
cellular resistance to insulin's actions.
Type 1 diabetes
According to McCance & Huether (2019), type 1 diabetes
mellitus (DM) is the most common pediatric chronic disease and
affects 0.17% of US children, and the incidence is increasing.
Rosenthal & Burchum (2021) notes that in autoimmune-
mediated DM, environmental-genetic factors are thought to
trigger cell-mediated destruction of pancreatic beta cells.
Generally, type 1 diabetes develops during childhood or
adolescence, and symptom onset is relatively abrupt (Rosenthal
& Burchum 2021). It, however, needs to be noted that type 1
diabetes can also develop during adulthood. Type 1 diabetes
was once called juvenile-onset diabetes mellitus or insulin-
dependent diabetes mellitus (IDDM). This term is no longer
commonly used because older children are frequently diagnosed
with type 1 diabetes.
Peak onset at age 11–13 years four is slightly earlier for girls
than boys. It is rare in children younger than one year and

2. adults older than 30 years. Type 1 diabetes is characterized by
severe insulin deficiency or no insulin secretion. Insulin is the
mainstay of therapy for individuals with type 1 diabetes
(American Diabetes Association, 2018).
Type 2 diabetes
Type 2 diabetes mellitus (DM) affects 9.3% of adults in the
United States (Rosenthal & Burchum 2021). According to
Rosenthal & Burchum (2021), age, obesity, hypertension,
physical inactivity, and family history are the most well -
recognized risk factors. Evidence shows that diet, including diet
during pregnancy, influences the long-term risk of type 2 DM in
children and adults. Type 2 diabetes is different from type 1
diabetes in that the risk of developing diabetes increases after
age 40 years. In general, incidence increases with age into the
70s; among certain races, incidence peaks between 40 and 50
years, then falls with frequent contributing factors to precipitate
type 2 diabetes among those susceptible. A significant factor in
populations recently exposed to westernized environment
increased risk related to duration, degree, and distribution of
obesity.
Gestational diabetes
Gestational diabetes mellitus (GDM) is defined as any degree of
glucose intolerance with onset or first recognition during
pregnancy (McCance & Huether 2019). The management and
care of gestational diabetes are much the same as any other
diabetic pregnancy: blood glucose should be monitored and
controlled with diet and insulin. Rosenthal & Burchum (2021)
reports that the diabetic state disappears almost immediately
after delivery in most cases, permitting discontinuation of
insulin. However, if the diabetic state persists beyond
parturition, it is no longer considered gestational and should be
rediagnosed and treated accordingly. In women taking an oral
drug for type 2 diabetes, the current practice is to discontinue
the oral medication and switch to insulin (Rosenthal & Burchum
2021). The only exception is the oral agent Metformin, which is
often satisfactory for managing type 2 diabetes in pregnancy.

3. Patients who discontinue oral medications can resume oral
therapy after delivery.
Type 2 diabetes
I want to focus more on type 2 diabetes because I have
experience providing care to these kinds of patients. Type 2
diabetes can be treated with various oral and injectable drugs.
Among the oral medicines, Metformin, and sulfonylureas (e.g.,
glipizide, Glucotrol) are mostly used. Among the injectable
drugs, insulin is used most widely. As type 2 diabetes
progresses, less and less insulin is produced. As a result, it is
common for people with type 2 diabetes to require insulin
therapy to manage glucose levels better eventually.
Treatment option: Metformin (Biguanide).
Metformin is available alone in immediate-release (IR) tablets
(500, 850, and 1202 1000 mg) as Glucophage; in extended-
release (ER) tablets (500, 750, and 1000 mg) as Glucophage
XR, Fortamet, and Glumetza; and in an oral solution (500 mg/5
mL) as Riomet (Rosenthal & Burchum 2021). Typically,
Metformin is started immediately after the diagnosis of type 2
diabetes. The most common side effects are gastrointestinal
(GI) disturbances: lactic acidosis, a potentially fatal
complication rarely noted. Metformin works by lowering blood
glucose, improving glucose tolerance by inhibiting glucose
production in the liver and by reducing glucose absorption in
the gut (Rosenthal & Burchum 2021). Another benefit of
Metformin is that it sensitizes insulin receptors in target tissues
(fat and skeletal muscle), increasing glucose uptake in response
to whatever insulin may be available.
If not contraindicated and if tolerated, Metformin is the
preferred initial pharmacologic agent for the treatment of type 2
diabetes (American Diabetes Association, 2018). This therapy
should not be discontinued once other therapy treatments are
introduced to manage diabetes. Metformin should be continued
when used with other agents, including insulin, if not
contraindicated and if tolerated.
Complications related to diabetes and treatment option

4. Diabetes has short- and long-term complications on a patient.
Hypoglycemia, upsent GI, unpleasant metallic taste in mouth is
some of the short-term complication of diabetes type 2
treatment. The Long-term use of Metformin may be associated
with biochemical vitamin B12 deficiency, and periodic
measurement of vitamin B12 levels should be considered in
metformin-treated patients, especially in those with anemia or
peripheral neuropathy.
Long term complication includes diabetic neuropathy,
cardiovascular disease, and stroke which is twice as common in
those with diabetes; Peripheral vascular disease is
atherosclerotic occlusive disease of the lower extremity.
Diabetic microvascular complications can arise because of
diabetes. Diabetic retinopathy which is a leading cause of
blindness worldwide is common in diabetic patients. Diabetic
kidney disease is the most common cause of chronic kidney
disease and end-stage kidney disease (Rosenthal & Burchum
2021). Approximately 50% of individuals with DM develop
diabetic kidney disease (McCance & Huether 2019).
A diet rich in fiber, especially cereal fiber, may reduce diabetes
risk (Ley et al., 2014). Alcohol consumption has been shown to
increase the risk for diabetes. According to Ley et al. (2014),
greater intake of sugar-sweetened beverages (SSBs) has been
associated with higher type 2 diabetes risk in a meta-analysis.
Vegetarian diets devoid of animal products have been
demonstrated to reduce diabetes risk.
Conclusion
Diagnosis of diabetes was once made solely by measuring blood
levels of glucose. However, in 2010, the American Diabetes
Association (ADA) recommended an alternative test based on
measuring hemoglobin A1c—a test that provides an estimate of
glycemic control over the previous 2 to 3 months. Once a
patient receives a diagnosis of diabetes, together with their
families, they should be familiar with the signs and symptoms
of hypoglycemia. Rapid treatment of hypoglycemia is
mandatory: if hypoglycemia is allowed to persist, irreversible

5. brain damage or even death may result (Rosenthal & Burchum
2021).
References
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.ful
l-text.pdf
Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014).
Prevention and management of type 2 diabetes: Dietary
components and nutritional strategies. The Lancet, 383(9933),
1999–2007.
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The
biologic basis for disease in adults and children (8th ed.). St.
Louis, MO: Mosby/Elsevier.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s
pharmacotherapeutics for advanced practice nurses and
physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Post 2
Differences Between the Types of Diabetes
Diabetes mellitus (DM) is a metabolic disease of inadequate
control of blood levels of glucose (Genuth et al., 2018).
Different symptoms characterize different types of diabetes.
This discussion will focus on type 1, type 2, gestational and
juvenile diabetes.
Type 1 diabetes is also referred to as juvenile diabetes and is an
autoimmune attack on the pancreatic beta cells resulting in
severe insulin deficiency. Type 1 diabetes represents
approximately 5% of all diabetes, and B cell-formed
autoantibodies to islet antigens are used as markers of the
disease and used to diagnose type 1 diabetes (Genuth et al.,
2018). Type 1 diabetes is usually diagnosed early as patients
with this disorder are typically born with it. Type 1 or juvenile
diabetes are treated with insulin and are generally referred to as

6. insulin dependent.
Type 2 diabetes is the other primary type of diabetes and
comprises 90%–95% of the total cases of diabetes in the United
States and worldwide (Genuth et al., 2018). Patients usuall y are
diagnosed later in life and are generally triggered mainly due to
poor diet, obesity, genetic and sedentary lifestyle.
Gestational diabetes is triggered by pregnancy. The onset of
diabetes during pregnancy is caused by insufficient insulin
secretion to compensate for the marked increase in insulin
resistance during pregnancy, especially during the second and
third trimesters.
Type 2 Diabetes and Medication use
Metformin is usually the drug of choice in treating type 2
diabetes. Metformin is effective and safe, is inexpensive, and
may reduce the risk of cardiovascular events and death
(American Diabetes Association, 2018). Metformin works by
decreasing intestinal glucose absorption, improving peripheral
glucose uptake, lowering fasting plasma insulin levels, and
increasing insulin sensitivity, which reduces blood glucose
concentrations without causing overt hypoglycemia (American
Diabetes Association, 2018). Metformin is an oral medication
that can be taken with or without food, but it is advisable to
avoid common side effects. It is advisable to avoid alcohol
when on metformin, as alcohol can raise lactic acid.
Short- and Long-term Impact of Type 2 Diabetes on Patients
Short-term diabetes type 2 are symptoms of
hypo/hyperglycemia, which may vary from person to person.
Some of the symptoms include polyuria, polydipsia, dizziness,
confusion, inability to concentrate, blurry vision, and
unconsciousness.
Long-term complications of diabetes include retinopathy,
nephropathy leading to renal failure; peripheral neuropathy with
risk of foot ulcers, amputations, and Charcot's joints; and
autonomic neuropathy causing gastrointestinal, genitourinary,
and cardiovascular symptoms and sexual dysfunction (Diagnosis
and Classification of Diabetes Mellitus, 2011).

7. References
American Diabetes Association (2018). Pharmacologic
approaches to glycemic treatment:
Standard of medical care in diabetes. Diabetes Care, 41(sup 1),
S73-S85. Retrieved
from http://care.diabetesjournals.org/content/41/supplement_1/s
73.fulltext.pdf
Diagnosis and Classification of Diabetes Mellitus.
(2011). Diabetes Care, 35(Supplement_1), S64–
S71. https://doi.org/10.2337/dc12-s064
Genuth, S. M., Palmer, J. P. & Nathan, D. M. (2018). Diabetes
in America (3rd ed.). National Institutes of Diabetes and Kidney
Disease. https://www.ncbi.nlm.nih.gov/books/NBK568014/
Assignment: Locate two new academic articles from a
professional, peer-reviewed journal related to a topic of your
interest. These articles should involve experimental or quasi -
experimental designs and should be two NEW articles (i.e., not
articles you used previously in this course).
Skim the two articles to understand the key issues and methods
they address. Be sure to completely answer all questions in each
bullet point. There should be two sections, one for each
numerical bullet below. Separate each section in your paper
with a clear heading that allows your professor to know which
bullet you are addressing in that section of your paper. The
essay should be 2,000 words and should include proper citations
for the two articles being reviewed. Make sure to reference the
citations using the APA writing style for each article. Include a
cover page and a reference page, which do not count towards
the minimum word limit.
· Summarize both professional, peer-reviewed articles by
addressing the following for each study. Repeat this sequence
for each article.
. What question/hypothesis was the researcher trying to answer

8. or investigate?
. Define the variables studied.
. Describe the sample.
. How did the researcher gather data in the study? Were the data
gathering techniques appropriate for the purposes of the study?
In other words, did the data collection procedures produce data
that allowed for the accurate examination of the original
questions/hypothesis for the study?
. What were the results? How do the results affect your
understanding of the world?
· Compare and contrast both studies and explain how the
similarities and differences with regards to experimental/quasi -
experimental research designs.
Assignment Expectations
Length: 2,000 words
Structure: Include a title page and reference page in APA style.
These do not count towards the minimum word amount for this
assignment.
References: Use the appropriate APA style in-text citations and
references for all resources utilized to answer the questions.
Include at least three (3) scholarly sources to support your
claims.