Question

Describe the major pathophysiologic difference between type 1 and type 2 Diabetic Mellitus.

Outline the teaching you need to provide to diabetic patient regarding oral hypoglycemic therapy

Answer 1

Major pathophysiological differences between type 1 and type 2 diabetes mellitus.

The diabetes is mainly classified into type 1 and type 2. Both types are chronic diseases and affect the regulation of blood sugar or glucose. Insulin is the enzyme helping in the metabolism and regulation of glucose in the body. Any imbalance in the insulin production of utilization can lead to diabetes mellitus.

When the insulin production in the body is disturbed or inadequate insulin production can cause type 1 diabetes. It occurs as an autoimmune disorder in which the immune system attacks and destroys the insulin-producing beta cells in the pancreas and that leads to the inadequate insulin production. It is mainly managed with insulin injection.

The type 2 diabetes occurs as a result of the inability of the inability of the insulin receptors to respond to insulin or insulin resistance. In spite of the normal insulin production, the body is unable to use it effectively. Mostly managed with oral hypoglycemic agents.

Outline the teaching you need to provide to a diabetic patient regarding oral hypoglycemic therapy (OHA therapy)

Most of the people with type 2 diabetes can be managed with lifestyle modifications and dietary changes initially. But most of them will have needed to progress to oral medication within 2 years of diagnosis. In type 2 Diabetes Mellitus (DM) the (fasting plasma glucose [FPG] will be > 7.0 mmol/L and 2 hours post-prandial level more than 11.1 mmol/L) and thereby the “osmotic symptoms” like thirst, polyuria, weight loss, tiredness occurs. The three basic abnormalities occur in type 2 diabetes are insulin resistance, insulin deficiency, and increased hepatic (liver) glucose output. The fasting and post-meal glucose levels help to determine an optimal regimen. Following a strict diet regimen is the key factor in controlling blood sugar levels along with the drugs. The commonly used drugs are Sulfonylureas, thiazolidinediones, Biguanides, _Alpha- inhibitors, Meglitinides, Phenylalanine derivatives.

Information should include:

Overview of DM

Glucose monitoring

Diet and Medication management

Complications

Side effects of drugs

Regular follow up

It is important to discuss the concerns of responsible professional and person with diabetes while starting or changing OHA treatment. Sharing a common goal helps in short term adherence to treatment, and thereby mid-term evaluation of efficacy, and the ultimate long-term aim of reduced risk of complications.

The patient’s concerns like “why do I need to take medication, when I do not feel ill, ?” have to be answered.

The proper health education regarding the side-effects and management of medications has to given well in advance and in proper intervals.

Common instructions to patients:

• Take the pills daily, at the same time each day, ( in case of sulfonylureas before meals are common.)
• Drugs like Glucotrol has to be taken 30 minutes before eating and other oral agents should be taken at the meal.
• Do not change the dose of the pills without guidance from the healthcare provider.
• Oral hypoglycemic agents are often taken in combination with other diabetes pills and/or insulin to obtain effective glucose control.
• Avoid alcohol if taking Diabinese, due to the combined effect of dizziness and stomach upset.
• Forgotten pills should be taken within 2 hours from your dosage time.
• Contact the healthcare provider if the dose is missed.
• Check for the side effects regularly
• Monitor glucose frequently
• Always aware of the side effect of hypoglycemia. Keep a candy always in hand to manage a hypoglycemic event.
• Frequent health check-ups to monitor glucose level and manage the OHA therapy is recommended.