To Prepare
Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.

ANSWER

Gestational Diabetes

Introduction

Diabetes is a common and immedicable disease. It transpires when the pancreas does not produce adequate insulin or in cases when the body unproductively uses insulin. When insulin, a blood sugar regulator, does not operate effectively, an individual is susceptible to developing Type 1, Type 2, gestational, and juvenile diabetes. Type 1 diabetes or juvenile diabetes results from the deficient production of insulin required for daily administration, which materializes when insulin-producing cells are attacked and destroyed. Type 2 results from inefficient body utilization of insulin, as pancreas cells are resistant to the action of producing insulin. In both types of diabetes, instead of sugar being transported in cells, it builds up in the bloodstream (NIH, 2020). Gestational diabetes occurs during pregnancy, characterized by high glucose or sugar levels in the blood. During pregnancy, the placenta generates pregnancy sustainability hormones, which makes cells resistant to insulin. In response, the pancreas produces extra amounts of insulin to overcome resistance. At times, it cannot keep up, resulting in little glucose absorption in cells and increased accumulation in the bloodstream.

Gestational Diabetes 

As explained above, gestational diabetes occurs during pregnancy due to hyperglycemia, which affects the utilization of sugar in body cells. The high amounts of blood sugar affect a mother’s pregnancy, baby’s health, and make the mother susceptible to developing type 2 diabetes; however, it normalizes after delivery. Notable effects on the baby include preterm birth, severe breathing difficulties, hypoglycemia, obesity risks, and stillbirth. On a mother, effects include the contraction of preeclampsia and type 2 diabetes in the future. Established short-term impact of gestational diabetes includes preterm or stillbirth and hypoglycemia among babies and preeclampsia among mothers. Long-term effects include the susceptible contraction of type 2 diabetes among mothers and children as well as obesity in their future lives.

The treatment of gestational diabetes requires both non-pharmacological interventions and pharmacotherapy. One primary drug used in the treatment and medication of gestational diabetes includes metformin, an oral form of medication. Metformin is an antidiabetic agent used as monotherapy and in combination with diet and exercise when ineffective. In gestational diabetes, it is preferred as an insulin alternative, working to decrease blood sugar in the bloodstream during pregnancy that is present in breast milk and crosses the placenta. Metformin increases sensitivity to insulin, ensures decrement of hepatic gluconeogenesis, and improves blood sugar uptake (Priya & Kalra, 2018). All these functions lower blood glucose in the bloodstream, which utterly minimizes the risks of hypoglycemia and increased weight gain.

The administration of metformin is orally done dosed from at least 500 to 2250 milligrams daily. It is administered with a meal to facilitate that decrement of GI or gastrointestinal upset. Over the weeks, the dose is titrated in increments of 500mg or, in some cases, 850mg to reduce the GI risks. Patients are advised to take metformin drug at the same time daily, once, with a full glass of water, and with an evening meal (Corcoran & Jacobs, 2020). According to research conducted on a Metformin in Gestational Diabetes trial in Australia and New Zealand, showed the efficacy and safety administering of metformin among expectant women. Risks of congenital malformations seemed to reduce even when the fetus was exposed to it during the first trimester (Brown, Martis, Hughes, Rowan, & Crowther, 2017). However, there is a need for extra caution due to significant potential exposure to fetuses for long-term safety.

Adverse effects of metformin drugs include gastrointestinal risks and side effects such as vomiting and diarrhea frequent in up to 30% of patients. Long-term taking metformin results in decreased vitamin B12, which requires monitoring, chest discomforts, hypoglycemia, rhinitis, and weaknesses. A severe but also the rare side effect is lactic acidosis, which results in risk factors such as hepatic and renal impairment that react to decrease blood pH that is difficult to eliminate (Priya & Kalra, 2018).

References

Brown, J., Martis, R., Hughes, B., Rowan, J., & Crowther, C. (2017). Oral medication for the treatment of women with gestational diabetes. Cochrane.

Corcoran, C., & Jacobs, T. F. (2020). Metformin. StatPearls.

NIH. (2020). What is Diabetes? Retrieved from NIH: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes#:~:text=Diabetes%20is%20a%20disease%20that,to%20be%20used%20for%20energy

Priya, G., & Kalra, S. (2018). Metformin in the management of diabetes during pregnancy and lactation. Drugs Context (NCBI).