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Pharmacologic approaches for Diabetes
Diabetes mellitus is a disease condition that arises when blood sugar levels are above the normal range. Blood sugar forms the chief energy source in our bodies and is dietarily acquired. The levels of glucose in the blood are controlled by glucagon and insulin hormones. Glucagon is produced by alpha cells of Islets of Langerhans located in the pancreas to control the hepatic production of glucose and ketone (Venkataraman et al., 2020). Insulin is produced by beta cells in the Islets of Langerhans. It signals the muscle, liver and fat cells to take in sugar for production of energy, and storage. Glucagon and insulin balance is achieved through a negative feedback loop. Diabetes come in several distinct types including type1, type 2, gestational and juvenile-onset diabetes.
Type 1 diabetes is an insulin-dependent type of diabetes. It arises when the pancreas is unable to produce insulin. Inefficiency of the pancreas may result from autoimmune activity where the pancreatic cells are attacked by antibodies, or genetic related non-functionality of the beta cells and other associated health problems within the pancreas (AMA, 2020). Injection of insulin into the fatty adipose skin tissue may provide better outcomes to patients suffering from this type of diabetes. With type 2 diabetes, the blood sugar levels hike due to the inability of the hepatocytes, muscle and fat cells to utilize insulin. Insulin receptors in these cells are either deficient, or non-functional. Type 2 diabetes is mild, but is associated with reticular, adrenal, and neural complications as well as increased risk of cardiovascular diseases. Healthy weight, exercise and proper diet are key in management of this type of diabetes.
Pregnancy associated insulin resistance may cause diabetes. Diabetes with such etiology is termed as gestational diabetes. It is spotted in middle or late pregnancy (Venkataraman et al., 2020). Control of this type of diabetes is important in consideration of the fetal health, growth and development. Gestational diabetes is managed through careful planning of meals, controlling weight gain, and daily exercise. Juvenile-onset diabetes is a type of diabetes that is diagnosed in childhood. Proper care and management of this type of diabetes is essential to enable these children lead a healthy life to adulthood.
Insulin therapy for Type 1 diabetes
Insulin dependent (Type 1) diabetes is treated through administration of insulin. Daily injections of basal and prandial insulin, or infusion of insulin into the subcutaneous tissue is recommended for the management of type 1 diabetes. The medication dosage is weight-based. Start-up doses range from 0.4-1.0 units per kilogram body weight per day. Metabolically stable patients should start insulin therapy at 0.5 unit/kg/day (AMA 2018). A patient presenting with ketoacidosis may require a higher weight-based dosage. Prandial insulin dosage should be matched with carbohydrate intake, anticipated exercise, and pre-meal sugar levels. Hypoglycemia can be reduced by administration of rapid acting analogs of insulin among Type 1 diabetic patients. Patients with successful use of continuous intra-subcutaneous insulin infusion are recommended to continually access the therapy post the age of 65 years.
Impacts of Type 1 diabetes to patients
Type 1 diabetes cause high blood pressure due to the build-up of osmotically active sugar in blood. It is associated with health complications such as nephropathy, cardiovascular diseases and stroke, neuropathy, retinopathy, skin infections and foot problems in the long run. Medical management of the disease increases the cost of living. Insulin therapy, the novel treatment of Type 1 diabetes is associated with increased heart rate, impaired concentration, sweating, dizziness, blurred vision and hunger (Venkataraman et al., 2020). It may also cause anxiety, slurred speech and mood variations.
References
American Diabetes Association (2018) 8. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018 Jan; 41(Supplement 1): S73-S85. https://doi.org/10.2337/dc18-S008
American Diabetes Association. (2020). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2020. Diabetes care, 43(Supplement 1), S14-S31. https://doi.org/10.2337/dc20-S002
Venkataraman, A. P., Kamath, L., & Shankar, S. (2020). Knowledge, Attitude and Practice of Insulin Use of Diabetic Patients in India. medical care, 5, 6. https://doi: 10.15416/pcpr.v4i3.26564
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