Methods of Treatment for Diabetes – Diabetes Mellitus Example

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"Methods of Treatment for Diabetes" is an interesting example of a paper on diabetes mellitus. Diabetes mellitus commonly known as type 2 diabetes is a chronic condition that is characterized by an increase in blood sugar to a level of more than 11.1 mmol/L. During the past few decades, there has been a growing burden of diabetes worldwide mainly as a result of lifestyle and demographic changes (Marianne et al, 2009). In Canada, statistics show that over forty thousand Canadians die annually as a result of diabetes and related conditions and up to nine million Canadians have been diagnosed with diabetes (Ting et al, 2013).

It is also important to note that diabetes is characterized by access morbidities which include nephropathy, cardiovascular disease, atherosclerosis, depression, and retinopathy thus has resulted in high socioeconomic costs. Canadian Association of Diabetes (CAD) estimates the costs of treatment of diabetes to be a minimum of $14 and is estimated to rise. It is estimated that the annual cost of treatment and management for diabetes will cost the Canadian government up to 16.9 billion CAD (Ting et al, 2013).

This increase in prevalence poses a serious public health risk. The treatments of diabetes can be achieved through the combination of lifestyle change and pharmacotherapy treatments. The purpose of this paper is to outline the current methods of treatments of diabetes recommended by the Canadian diabetes association and how to manage the co-occurring conditions. Treatments Treatments for type 2 diabetes can be best understood and implemented when the pathophysiology is understood as well. Diabetes mellitus occurs mainly due to two physiological malfunctions in the body. The first and most important defect resulting in type 2 diabetes is insulin resistance.

Insulin resistance contributes to over 92% of all diabetes cases worldwide. Insulin resistance refers to the deformity response to the effects of insulin which includes effects on protein, lipid, and glucose metabolism and affects the vascular endothelial functions (Müller & Goldstein, 2008). The peripheral insulin resistance often takes place within the adipose tissues s well as muscles thus combine with the escalated hepatic glucose output. The second cause of insulin resistance is due to beta-cell dysfunction and this occurs in the early stages of diabetes.

  During this time, the post-prandial rise in glycemia is attenuate; however, increasing deteriorations causes severe damage and the longer an individual is likely to stay with diabetes. The following treatments can be administered to effectively manage type 2 diabetes. Oral Antihyperglycemic Agents There are various oral antihyperglycemic agents; sulfonylurea that has been developed in Canada for a long time. However, there are modern and newer sulfonylurea have been released including gliclazide and glimepiride modified. The most important advancement in these new developments is that they are once-daily medication. Research has shown that these treatments exhibit very low weight gain as well as low hypoglycemia levels compared to the previous medication such as glyburide (Müller & Goldstein, 2008).

It is however important to note that gliclazide and glimepiride are mainly administered to the patients with very severe renal impairment and liver damages. There are also other medications namely thiazolidinediones (TZDs) which function mainly as insulin sensitizers thus reduce insulin resistance by the adipose tissues resulting in a reduction in the hepatic glucose output. Thiazolidinediones rosiglitazone’ s indications are monotherapy which is used together with sulfonylurea or metformin.

Cautions should be taken while administering these medications, especially when combining thiazolidinediones and insulin since they are mainly contraindicated with patients with class III, class IV, and heart failure (). There are other nonglycemic control benefits of Thiazolidinediones rosiglitazone including improvement in the lipid profile including cholesterol and lower incidences of microalbuminuria when compared to glyburide. Other medications include metformin, nateglinide, repaglinide, and orlistat. Metformin is an oral antihyperglycemic that is mainly used as initial therapy for obese patients. It exhibits very small weight gains compared to sulfonylurea.

However, it has limiting factors related to gastrointestinal. It is recommended for significant cardiac, renal, or hepatic dysfunctions since use may result in lactic acidosis and is most effective when combined with other oral agents. Repaglinide is an anti-diabetic agent which is a short-acting insulin secretagogue (Zeydanli, 2009). It exhibits low hypoglycemia as well as reduces weight gains, especially when taken during the meals. It is mainly recommended for patients who eat irregularly and those patients with mild liver and renal impairment. Nateglinide was first released in Canada in 2002.

It can be classified as an insulin secretagogue and is recommended to be taken three times a day with meals assuming meals are taken three times a day. Despite the fact that the chemical composition is less that of repaglinide and sulfonylurea, it should never be combined with these agents (Zeydanli, 2009). It also exhibits lower weight gains as well as fewer instances of hypoglycemia. Nateglinide is recommended for patients with mild hepatic and renal impairment and is easily metabolized by the liver and easily excreted. There are many oral antihyperglycemic treatments that are available for the management of diabetes currently.

It is, however, important to note that these medications are used in sequence thus it is important to use the right medication at the right level of diabetes. Insulin therapy In order to help patients reach the target glycemic levels, it is important to incorporate other methods together with oral antihyperglycemic agents in the management of type 2 diabetes. The inclusion of insulin therapy as a method is therefore very important.   Insulin therapy is recommended for initiation only when other methods such as it, oral agents, and exercise have failed to reduce glycemic levels to the required.

However, a combination of oral, exercises, and diet is very effective in controlling glucose levels. Insulin therapy is often administered as a single dose injection at bedtime. Lente insulin is the most common insulin used in Canada. However, there is often a risk of hypoglycemia especially due to the fact that it is administered at night. The overnight hypoglycemia is under research and the development of insulin, insulin glargine is expected to resolve the problem.

As stated by Müller & Goldstein (2008), research shows that glargine insulin is least associated with few episodes of overnight hypoglycemia. If post-prandial hyperglycemia is the target of insulin therapy, then it is important to administer short-acting insulin may be administered during meal times Examples of short-acting insulin available for Canadian healthcare include aspart insulin and Lispro insulin. These are modern insulin that is easily absorbed compared to regular insulin. Moreover, research shows that these short-acting insulin exhibit very low rates of hypoglycemia overnight compared to regular insulin. Glucose Monitoring The monitoring of glucose levels is very important in the management and control of diabetes.

According to (), self-monitoring of glucose levels has revolutionized the management of diabetes as well as treatment. It is important to note that the earlier diabetes is diagnosed, the more effective different treatment options are likely to work. However, as Müller & Goldstein (2008) note, many diabetic people are not able to monitor their glucose levels because of costs or the pain experienced with the old methods of self-monitoring. Technological advancement in the treatment of diabetes has seen immense development in the self-testing of glucose levels.

GlucoWatch biography is a modern self-monitoring machine for glucose levels and monitors the interstitial glucose levels without inversion. The continuous glucose monitoring devices are meant to be used by both the patients and their doctors in order to record a comprehensive glucose profile within 72hours. This information is required by the doctors to initiate treatments that would be effective. It involves the use of a glucose sensor that is placed subcutaneously after which reading is taken every five minutes and then downloaded into a personal computer.

Accurate measurement of glucose levels is also important for intervention procedures such as exercise, diet, and oral agents, two or all can b administered for patients. Conclusions The major goal of controlling blood glucose through the various treatment options is to avoid instability in blood glucose, avoid acute hypoglycemia, and prevent the adverse effects of diabetes while preserving the health of the patients. Before starting an oral treatment or insulin therapy, it is important to consider the costs as well as tolerability since these two factors affect compliance in the long run.

The stepwise approach to the treatment of diabetes is provided by the Canadian Association of Diabetes (CAD) outlines the therapy procedures that are administered once an individual has been diagnosed with type 2 diabetes. The administration of oral antihyperglycemic agents should be administered with regard to the level of severity and stage of diabetes. Other factors to consider also include side effects and reactions of different oral agents mentioned above. Insulin therapy should be implemented as the last option after exploring diet, exercise, and oral agents but should be administered in a combination of the three interventions.

It is also important to use a combination of products in order to increase patients' adherence to medications but care should be taken to ensure the patients’ dose is not compromised.

References

Zeydanli, E. N., & Turan, B. (2009). Omega-3E treatment regulates matrix metalloproteinase and prevents vascular reactivity alterations in diabetic rat aorta. Canadian Journal Of Physiology & Pharmacology, 87(12), 1063-1073.

Marianne E., G., Ian, J., William, P., Finlay A., M., Christina M., B., Michel, J., & ... Norman R.C., C. Clinical research: Prevalence, Awareness, Treatment, and Control of Hypertension among Canadian Adults with Diabetes, 2009. Canadian Journal Of Cardiology, 28367-374

Ting-Yu, W., Tamblyn, R., & Eguale, T. (2013). Guidelines adherence in the treatment of patients with newly diagnosed type 2 diabetes: a historical cohort comparing the use of metformin in Quebec pre and post-Canadian Diabetes Association guidelines. BMC Health Services Research, 13(1), 1-15

Müller-Wieland, D., & Goldstein, B. J. (2008). Type 2 Diabetes : Principles and Practice. New York: Informa Healthcare.

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