Diabetes and Drug Treatments

The Endocrine system is a vast series of internal glands which produce and secrete hormones that the body uses to control
many bodily functions. It is released to the circulatory system, affecting every organ in the human body through cell signaling,
influencing physiologic processes such as the regulation of homeostasis, metabolic demands, and sensory perception to the
reproductive hormones that affect both male and female development (NIH, n.d.). However, when glands do not generate the
appropriate amount of hormones, diseases can develop and potentially alter a person's way of living. One of the common
endocrine conditions related to inadequate functioning or lack thereof is the deficiency of the pancreas to produce insulin
(Pietrangelo, 2020). Insulin is accountable for maintaining blood glucose in our bodies throughout feeding or fasting (McGuckin
et al., 2020). It is also responsible for regulating protein and lipid metabolism, amino acids, and electrolyte transport. Ultimately,
its anabolic nature helps with the storage of carbohydrates, fats, and proteins, a deficiency that many people with diabetes suffer
from.
Types of Diabetes
A potential life-threatening autoimmune disorder, Type 1 diabetes (T1D), is characterized by T-cell mediated destruction of
pancreatic B-cells, triggering deficiencies in excretion and synthesis of insulin (Akil et al., 2021). Experts have suggested that
T1D is highly connected with genetics, accounting for at least 50% of studied cases, and the incidence of T1D has been rising
globally, with an annual increase of three to four percent over the past three decades. Studies have shown that T1D genetic
predisposition coupled with multifactorial triggers such as infections, early life diets, pollutants, toxins, geography, or even
vaccinations can create the initiation for autoimmune destruction of pancreatic B-cells (Akil et al., 2021). For these individuals,
signs, and symptoms many patients experience may come silently, that it may come impossible to prevent the course of the
disorder. Nonetheless, there is no natural way to predict who gets T1D. Once a person has T1D, they are treated for life. This is
especially difficult with young children and teens as they also deal with the psychosocial aspect of having the disorder.
Blood glucose, commonly known as blood sugar, is our body's primary energy source, and it comes from the food we ingest.
Insulin aids glucose transport into the cells to be utilized as energy. For type 2 diabetics, the body does not make enough insulin
allowing glucose to stay in the bloodstream. Initially, it comes off as a resistance, and the body attempts to produce more insulin
to offset the increasing amount of blood glucose. Still, in time, the pancreas can not make any more insulin; hence the increased
blood sugar that is often observed with patients who are obese, patients with sedentary lifestyles, and individuals over the age of
45 with genetic predispositions (NIH, 2017). Most of the time, diet alone is not enough to reduce blood sugars. Medications
coupled with lifestyle modifications are needed to offset the elevation in blood sugar, preventing serious complications down the
road.
Gestational diabetes mellitus (GDM), like other types of diabetes, affects how your body utilizes sugar. The rise in blood
sugar after the twentieth week of pregnancy, according to experts, is due to increased maternal caloric intake, maternal weight
gain, race, prediabetes, resistance to hormones responsible for placental growth, as well as prolactin, HPL, and growth hormone
production (Lende & Rijhsinghani, 2020). As the placenta develops, additional hormones are made, and insulin resistance
develops more significantly. Failure of pancreatic B-cells to secrete more insulin results in an inadequate rise in blood sugar
resulting in GDM. Complications are typically controllable and avoidable. Careful monitoring of blood sugar levels and early
detection is vital to prevent mother and infant complications.
Treatment for Type 2 Diabetes
The main objective of treating type 2 diabetes is keeping blood sugar levels under control. However, a more significant aim
for people with Type 2 diabetes is how Advance practitioners can help with weight loss or weight management, education,
lifestyle modifications, and the recommended medications for individuals with type 2 diabetes. Every person is unique, and there
is no one-size-fits-all approach to diabetes management (ADA, 2021).
Diet plays a crucial role for patients with Type 2 diabetes. Losing extra pounds through a low-calorie diet will improve
insulin sensitivity allowing a more manageable blood sugar regulation. A well-balanced diet that includes vegetables provides
various nutrients and at the same time keeping an individual full. Reducing alcohol intake, drinking plenty of fluids, and quitting
smoking will help patients with diabetes and improve general health. Patients need to understand that this is a lifelong affectation.
A diet you can abide will help in the long run to preventing life-threatening complications.
When our muscles are at work, they take in energy in the form of glucose in our blood, liver, and surrounding tissues.
Physical activity improves our blood sugar levels (ADA, 2021). Talking to your provider about the type of activities you can
participate in and set a fitness goal to help you be motivated. One way to assess progress with lifestyle modification is through
measuring or monitoring your blood glucose. Blood sugar monitoring is a valuable tool as it shows how physical activity and diet
modification impacts blood sugar levels. It's a great morale booster.
Current health guidelines have recommended Metformin as the first-line medication therapy to manage Type 2 diabetes (Jia
et al., 2020). Metformin is FDA-approved and helps reduce blood sugar levels by decreasing glucose production in the liver,
thereby decreasing intestinal absorption and increasing a patient's sensitivity to insulin (Corcoran & Jacobs, 2021). It comes in
immediate-release and extended-release forms and is known to be used in conjunction with other antidiabetic medications when
monotherapy fails to improve a patient's A1C and blood sugar levels. Metformin is used to manage not just Type 2 diabetes but
also gestational diabetes, Polycystic ovary syndrome, and antipsychotic-induced weight gain (Corcoran & Jacobs, 2021).
Metformin dosage is from 500mg to 2550 mg per day. It is taken orally, preferably with meals, to avoid the incidence of stomach
upsets. Doses are titrated weekly with increments of 500 mg depending on blood sugar levels and laboratory workups. Extended-
release doses are advised to be taken in the evening with a full glass of water. Patients taking Metformin should be educated
about its side effects to not discourage patients from taking the medication. Diarrhea, nausea, and vomiting are common
symptoms (Corcoran & Jacobs, 2021). Metabolic acidosis can develop from prolonged use of this medication and should be

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 monitored. Risks factors for patients with renal insufficiency are amplified as Metformin is eliminated via the kidneys affecting
its pharmacokinetics. If the blood sugar levels are under control via monotherapy, a second medication can be included to aid
Metformin. Incretin mimetics are medications that simulate the actions of glucagon-like-peptide-1 (Jia et al., 2020). It helps by
increasing the amount of insulin produced by the body and decreasing the glucagon released. Long-term effects of these
medications are still not known as it is relatively new. Talking to your provider if using incretin mimetic medications is right for
you to avoid complications.
Short-term and Long-term Impact of Type 2 Diabetes
Hypoglycemic events can happen when taking medications such as insulin, metformin, and sulfonylurea medications to treat
your diabetes. Exercise, eating less, or not adhering to your required diet potentiate the actions of these types of drugs. Rapid
heart rate, nausea, vomiting, sweating, and confusion, among other things, are telltale signs that you are hypoglycemic. It is wise
to carry butterballs or a piece of candy with you at all times when you feel these symptoms arise.
Diabetic Ketoacidosis (DKA) is more common in persons with T1D. However, DKA can occur with most people with an
established disease like type 2 diabetes (Stratigou et al., 2019). With decreased insulin concentrations and increased release of
offending hormones like catecholamines, glucagon, and cortisol will result in hyperglycemia and ketosis. The increased lipolysis
with subsequent release into the circulation and hepatic fatty acid oxidation to ketone bodies can lead to a state of metabolic
acidosis and ketonemia. DKA is a significant short-term complication for patients whose bodies have the inability to produce
insulin. Some examples of patients who can develop DKA are teens or young adults who forgot to take their medications as they
are mainly active and individuals who have changed or abruptly stopped their drug regimen for unknown reasons. also, patients
with diabetes and have systemic Infections can play a big role in developing DKA and individuals who are newly diagnosed with
diabetes. (Stratigou et al., 2019).
Uncontrolled blood sugar levels over time can damage both large and small vessels in our bodies. It can affect the eyes,
causing cataracts and retinopathy and ultimately loss of vision. It can cause our kidneys to fail to result in poor kidney function or
diabetic nephropathy. Uncontrolled blood sugar levels can also damage the nerves, causing diabetic neuropathy leading to
numerous complications like peripheral neuropathy of the feet were if left untreated, can lead to infection and amputation
(Leontis & Hess, 2021). A more serious long-term complication of uncontrolled blood sugar is plaque build-up on large vessels
causing heart attacks and strokes.
Conclusion
For Advance practitioners, understanding how our body reacts to different hormones is essential. A firm understanding of the
endocrine system's physiology and pathology will allow us to improve our skills in determining our patients' differential
diagnosis, laboratory values and appropriately prescribe medications. The endocrine system is very intricate; the answers to our
questions are not always straightforward.

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