Classmate reply-Gestational diabetes treatment

Discussion: Diabetes and Drug Treatments
Various differences exist between different types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Type 1 diabetes, for example, predominantly develops in childhood or adolescence and tends to have an abrupt onset of symptoms, whereas type 2 diabetes most commonly occurs during middle age and gradually progresses (Rosenthal, Laura & Burchum, Jacqueline, 2021). Type 1 diabetes occurs due to the loss of insulin-producing pancreatic b cells, whereas type 2 is related to improper insulin secretion and insulin resistance that occurs gradually (Rosenthal, Laura & Burchum, Jacqueline, 2021). Gestational diabetes has an onset during pregnancy and subsides shortly after delivery. Gestational diabetes may be challenging to treat, due to various physiological processes accompanied by pregnancy (such as hormones produced by the placenta that antagonize insulin’s action), and delayed or improper treatment may result in harm to the unborn child (Rosenthal, Laura & Burchum, Jacqueline, 2021).
Drug Treatment for Gestational Diabetes
Successful management of gestational diabetes relies on maintaining normal glucose levels in, both, the mother and fetus (Rosenthal, Laura & Burchum, Jacqueline, 2021). Care for gestational diabetes not only requires a detailed glycemic target plan, but varies widely from other types of diabetes in that it requires strict and ongoing monitoring for various reasons, such as dosing adjustment requirements around 16 weeks of gestation, due to a peak of insulin resistance which occurs around this period in gestation. The preferred drug treatment for gestational diabetes in the U.S. is insulin, such as lispro, and its dose must match the patient’s needs, by that paying close consideration to consumption of carbohydrates and fluctuating daily physical demands, etc (American Diabetes Association, 2020). Furthermore, some women may be prescribed Metformin alongside insulin, but Metformin and glyburide should not be prescribed as first-line treatments, as these cross the placenta to the fetus (American Diabetes Association, 2020). The use of insulin in GD should follow a strict regimen and be patient-specific and match their nutritional requirements and lifestyle. Frequent monitoring is required and glycemic target goals for blood sugar levels are as follows:
Fasting glucose <95 mg/dL (5.3 mmol/L) and either One-hour postprandial glucose <140 mg/dL (7.8 mmol/L) or Two-hour postprandial glucose <120 mg/dL (6.7 mmol/L) (American Diabetes Association, 2020). The type and dosing schedule of insulin should rely on the specific blood glucose elevation, whether fasting, or after a meal, etc. Insulin Lispro which is a short duration- rapid acting analog (American Diabetes Association, 2018), for example, acts more rapidly (15-30 minutes) than Regular insulin (30-60 mins.), but has a shorter duration of action. Administration is via daily, multiple subcutaneous injections, within 15 minutes before or following meals, and injection sites principles, including rotation of sites remain standard, but injections in the abdomen are preferred for best absorption. Lispro may also be used with an insulin pump, and also comes in an insulin pen (Blum, 2016). Dietary Considerations Due to Glycemic-index targets being more stringent for pregnancy than in non pregnant individuals, it remains essential that pregnant women with diabetes have a consistent intake of nutritional carbohydrates to match their insulin dosage and avoid episodes of hyperglycemia or hypoglycemia. Providers should refer women with gestational diabetes to a registered dietitian to establish a proper nutrition plan (American Diabetes Association, 2020). Short and Long-Term Effects of Gestational Diabetes and Drug Treatment Effects True GD ceases once delivery takes place, and if condition of diabetes remains after birth, it is no longer considered gestational diabetes and the patient must be re-evaluated by their health care provider (Rosenthal, Laura & Burchum, Jacqueline, 2021). However, women with GD have an increased chance of experiencing it with future pregnancies, as well as a greater risk of developing type 2 diabetes later in life. Gestational Diabetes in women is one of the strongest predictors of type 2 diabetes later in life, and nearly 50% of women develop it within 10 years post-pregnancy (Damm et al., 2016). Some complications that may arise related to long-term subcutaneous insulin drug treatment is lipodystrophy (LD), a disorder of the adipose tissue, as well as increased chances for bruising at the level of the injection site (Gentile et al., 2016). References American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes -2018 [PDF]. https://care.diabetesjournals.org/content/diacare/41/Supplement_1/S73.full.pdf American Diabetes Association. (2020). 14. Management of diabetes in pregnancy: Standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement 1), S200–S210. https://doi.org/10.2337/dc21-s014 Blum, A. K. (2016). Insulin use in pregnancy: An update. Diabetes Spectrum, 29(2), 92–97. https://doi.org/10.2337/diaspect.29.2.92 Damm, P., Houshmand-Oeregaard, A., Kelstrup, L., Lauenborg, J., Mathiesen, E. R., & Clausen, T. D. (2016). Gestational diabetes mellitus and long-term consequences for mother and offspring: A view from denmark. Diabetologia, 59(7), 1396–1399. https://doi.org/10.1007/s00125-016-3985-5 Gentile, S., Strollo, F., & Ceriello, A. (2016). Lipodystrophy in insulin-treated subjects and other injection-site skin reactions: Are we sure everything is clear? Diabetes Therapy, 7(3), 401–409. https://doi.org/10.1007/s13300-016-0187-6 Rosenthal, Laura & Burchum, Jacqueline. (2021). Lehne's pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.

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