A brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples. Diabetes mellitus (DM) is a metabolic disease process resulting in hyperglycemia. This increase in blood glucose levels is caused by a defect in insulin secretion, insulin action, or both. Type 1 diabetes, also known as juvenile diabetes, is distinguished by beta-cell destruction, which leads to insulin deficiency and supplemental insulin dependency. The most common cause is autoimmune cellular-mediated destruction of pancreatic beta-cells. Type 2 diabetes is the most common type of diabetes and is characterized by a gradual and progressive loss of pancreatic beta-cell function caused by genetic defects. Type 2 diabetes is not commonly insulin-dependent, but it may necessitate some insulin supplementation. Gestational diabetes mellitus is a type of glucose intolerance that develops or is discovered during pregnancy. It is caused by a combination of insulin resistance and insufficient insulin secretion in response to elevated blood glucose levels (McCance, 2018). An oral glucose tolerance test, performed as part of routine antenatal care, is used to diagnose it. PO diabetes medications will be discontinued routinely in inpatient hospital settings, and patients will be transitioned to pre-prandial and nightly blood glucose checks. Finally, clinicians strive for tight glycemic control with no hypoglycemic episodes. This is accomplished by administering insulin subcutaneously. Insulin for medical use is produced using recombinant DNA technology and is either identical to or modified to be human insulin. Analogs have the same effects and pharmacologic action as human insulin but with different onset, peak, and duration times (Rosenthal & Burchum, 2018). Insulin is delivered subcutaneously in the form of a prepared substance in a vial or pen device. The prescribed dose will be administered by the patient who has received suitable instruction or by a healthcare professional while a patient. The skin at the injection site is cleaned with an alcohol swab and allowed to dry naturally without being blown or fanning. A 45° or 90° angle is chosen when inserting the needle into the cleaned skin location. Then, insulin is injected into the skin and left there for five seconds by pushing the plunger of the syringe or the pen button. The type of insulin prescribed can vary based on the patient's needs. One example regimen combines long-acting insulin with mealtime insulin with quick onset. This will influence the patients' day-to-day lives since they must monitor their gl ...

1. A brief explanation of the differences between the types of
diabetes, including type 1, type 2, gestational, and juvenile
diabetes. Describe one type of drug used to treat the type of
diabetes you selected, including proper preparation and
administration of this drug. Be sure to include dietary
considerations related to treatment. Then, explain the short-term
and long-term impact of this type of diabetes on patients.
including effects of drug treatments. Be specific and provide
examples.
Diabetes mellitus (DM) is a metabolic disease process resulting
in hyperglycemia. This increase in blood glucose levels is
caused by a defect in insulin secretion, insulin action, or both.
Type 1 diabetes, also known as juvenile diabetes, is
distinguished by beta-cell destruction, which leads to insulin
deficiency and supplemental insulin dependency. The most
common cause is autoimmune cellular-mediated destruction of
pancreatic beta-cells. Type 2 diabetes is the most common type
of diabetes and is characterized by a gradual and progressive
loss of pancreatic beta-cell function caused by genetic defects.
Type 2 diabetes is not commonly insulin-dependent, but it may
necessitate some insulin supplementation. Gestational diabetes
mellitus is a type of glucose intolerance that develops or is
discovered during pregnancy. It is caused by a combination of
insulin resistance and insufficient insulin secretion in response
to elevated blood glucose levels (McCance, 2018). An oral
glucose tolerance test, performed as part of routine antenatal
care, is used to diagnose it.
PO diabetes medications will be discontinued routinely in
inpatient hospital settings, and patients will be transitioned to
pre-prandial and nightly blood glucose checks. Finally,
clinicians strive for tight glycemic control with no

2. hypoglycemic episodes. This is accomplished by administering
insulin subcutaneously. Insulin for medical use is produced
using recombinant DNA technology and is either identical to or
modified to be human insulin. Analogs have the same effects
and pharmacologic action as human insulin but with different
onset, peak, and duration times (Rosenthal & Burchum, 2018).
Insulin is delivered subcutaneously in the form of a prepared
substance in a vial or pen device. The prescribed dose will be
administered by the patient who has received suitable
instruction or by a healthcare professional while a patient. The
skin at the injection site is cleaned with an alcohol swab and
allowed to dry naturally without being blown or fanning. A 45°
or 90° angle is chosen when inserting the needle into the
cleaned skin location. Then, insulin is injected into the skin and
left there for five seconds by pushing the plunger of the syringe
or the pen button.
The type of insulin prescribed can vary based on the patient's
needs. One example regimen combines long-acting insulin with
mealtime insulin with quick onset. This will influence the
patients' day-to-day lives since they must monitor their glucose
levels before meals and receive multiple daily injecti ons. Long-
acting insulin, such as insulin glargine or Lantus, is
administered in a predetermined dose once a day. It has no
peak, an onset of 1-1.5 hours, and a duration of 20-24 hours.
Rapid-acting insulins, such as Humalog or NovoLog, have an
onset of 15 to 30 minutes or 10 to 20 minutes, a peak of 30 to
90 minutes or 40 to 50 minutes, and a duration of 3 to 5 hours.
Pre-meal blood glucose levels determine the dosage. In
addition, patients can determine prandial insulin dosages using
carb counting or a sliding scale.
Billington et al., 2007, studies have shown a long-term
improvement in A1C levels for people who utilize a sliding
scale as opposed to measuring carbohydrates. Counting carbs

3. necessitates certain dietary considerations to match the number
of carbs in each meal with the serving size. The blood glucose
level at the time of the meal is treated using a sliding scale, and
the rapid-acting agent should be provided up to 15 minutes
before the meal or immediately after eating.
Insulin is not always the first-line medication for at-home
diabetes management, but it is a standard and widely used
option. Patients will be encouraged to make changes to their
diet and exercise routines at first. Later, they can be started on a
PO biguanide, metformin, followed by sulfonylurea. Whatever
the treatment method, it is critical for the clinician to speak
with the patient and coordinate a plan that will work with the
patient's lifestyle and overall health needs. Insulin is not always
the first-line medication for at-home diabetes management and
is a widely used option.
References
Billington, E., Fraser, T., Tawashy, A., & Tildesley, H. D.
(2007). Carbohydrate counting vs. sliding scale for insulin
dosage estimation.
Canadian Journal of Diabetes
,
31
(2), 117-124.
McCance, S.H. K. (2018). Pathophysiology. [VitalSource
Bookshelf]. Retrieved from
https://bookshelf.vitalsource.com/#/books/9780323583473/
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s
pharmacotherapeutics for advanced practice providers. St.
Louis, MO: Elsevier.000
REPLY

4. QUOTE
EMAIL AUTHOR
9 hours ago
Elizabeth Arnold
RE: Discussion: Diabetes and Drug Treatments
COLLAPSE
Hello Rosalie,
I enjoyed reading your post and was really interested in your
discussion regarding sliding scale insulin and carbohydrate
counting. Adherence to medication regimens, diet plans and
activity recommendations have been long standing issues
identified in the diabtic patient population. It has been further
identified that patients with increased risk for comorbidities,
poor prognosis, increased stress, and depression are more likely
to struggle with long term compliance (Katsaridis et al., 2020).
I have been reading about the efficacy of sliding scale insulin
orders for the inpatient population. The sliding scale based on
glucose reading alone is a reactive approach that is based on the
previous insulin given rather than the anticipated or expected
insulin needed. For example, if a patient has a blood glucose
level prior to eating, they may not receive insulin based on the
sliding scale. After that patient eats they may be at increased
risk of hyperglycemia for several hours until the next blood
glucose reading (Abuelsoud & Khalaf, 2020). This may be one
reason for the move towards carbohydrate counting as a method
for glucose control, in addition to basal insulin regimens (
Abuelsoud & Khalaf, 2020). The technique in which insulin is
administered is also very important. In addition to the angle of
the injection, the length of the needle is also important.
Literature has been recognizing and recommending shorter
needles to ensure subcutaneous injection rather than mistakingly

5. entering the muscle (Hirsch & Strauss, 2019). The development
of lipohypertrophy can also occur with needle reuse and
improper injection site rotation (Hirsch & Strauss, 2019).
Ongoing education and support for this patient population is so
important to help minimize disease related complications and
increase dietary and medication adherence.
References
Abuelsoud, N., Khalaf, H. (2020). Studying the efficacy of
insulin sliding scale: clinical pharmacy
approach. The Journal of Pharmaceutical Science 33(3). 947-
952.
DOI.org/10.36721/PJPS.2020.33.3REG3947-952.1.
Hirsch, L., & Strauss, K. (2019. The injection technique factor:
what you don’t know or teach can
make a difference. Clinical Diabetes Journal.
https://doi.org/10.2337/cd18-0076
.
Katsaridid, S. et al. (2020. Low reported adherence to the 2019
American Diabetes Association Nutrition recommendations
among patients with type 2 diabetes mellitus, indicating a need
for improved nutrition
education and diet care. Nutrients.
DOI:10.3390/nu12113516.