Diabetes Treatment Guide PDF

**Type 1 Diabetes** Type 1 diabetes is an autoimmune condition where the immune system destroys the insulin-producing beta cells in the pancreas, leading to insulin deficiency. This type of diabetes typically manifests in children and young adults, requiring them to manage their condition with life...

**Type 1 Diabetes** Type 1 diabetes is an autoimmune condition where the immune system destroys the insulin-producing beta cells in the pancreas, leading to insulin deficiency. This type of diabetes typically manifests in children and young adults, requiring them to manage their condition with lifelong insulin therapy, diet adjustments, and regular blood glucose monitoring to prevent acute and chronic complications.  **Type 2 Diabetes** Type 2 diabetes develops when cells and tissues become resistant to insulin or when the pancreas cannot produce enough insulin, often related to genetic, lifestyle, and environmental factors. It is more prevalent in adults, although the incidence in children is rising. Management focuses on lifestyle modifications such as diet and exercise, oral medications and non-insulin injectables to improve insulin sensitivity or stimulate insulin production, and potentially insulin therapy as the disease progresses.  Metformin is a biguanide, a first-line drug used to lower blood glucose levels in many clients with type 2 diabetes. **Prototype: metformin (Glucophage) ** - **Category**: Biguanide (Oral Hypoglycemic Agent)  - **Primary Function**: Metformin works to lower blood glucose levels and is the first-line drug for treating type 2 diabetes. It is typically started immediately after a type 2 diabetes diagnosis for many clients without certain comorbidities.  - **Unique Features**: Metformin has a lower risk of hypoglycemia than other diabetes medications.  Mechanism of Action - Metformin lowers blood glucose levels in several ways. Primarily, it inhibits glucose production in the liver, effectively reducing the liver\'s contribution to high blood glucose levels. Additionally, metformin reduces glucose absorption in the gastrointestinal tract, which helps lower post-meal blood glucose spikes. Most importantly, metformin sensitizes insulin receptors in target tissues, such as fat and muscle cells, improving their ability to take in glucose in the presence of insulin. This mechanism does not involve the stimulation of insulin release from the pancreas, thereby not directly lowering blood glucose levels but making the body more efficient at using its insulin.  Indications and Therapeutic Uses - **Diabetes**: Metformin is utilized to improve glycemic control in clients with prediabetes, gestational diabetes, and type 2 diabetes.  - **Polycystic Ovarian Syndrome (PCOS)**: Metformin can increase insulin sensitivity and lower androgen levels to treat PCOS.  Side Effects and Adverse Reactions **Side Effect** **Description** ----------------------------- ------------------------------------------------------------------------------------------------------------------------ GI Disturbances Metformin can cause nausea, diarrhea, and decreased appetite. Altered Nutrient Absorption Metformin can cause decreased absorption of vitamin B12 and folic acid, potentially leading to pernicious anemia. Metabolic Acidosis Metformin has a black box warning of this severe side effect, with clients with renal impairment particularly at risk. Precautions and Contraindications **Precautions** - Caution in clients with renal impairment due to the risk of metabolic acidosis.  - Discontinue metformin for 1-2 days in clients receiving iodinated radiocontrast media to prevent acute kidney injury and lactic acidosis. In planned imaging, metformin should be withheld before and 48 hours after administering contrast, resuming only after renal function reassessment.  **Contraindications** - Contraindicated in clients with heart failure due to the increased risk of lactic acidosis.  **Black Box Warning** - Metformin can cause metabolic acidosis, especially in clients with renal impairment.  Drug Interactions - There is an increased risk of acute kidney injury and lactic acidosis in clients taking metformin who receive **\[iodinated contrast media\]**. Metformin should be withheld before and 48 hours after administering contrast, resuming only after renal function reassessment.  - Consuming **\[alcohol\]** with metformin increases the risk of lactic acidosis.  - Taking **\[cimetidine\]** with metformin can increase the risk for metabolic acidosis, so another h2 blocker should be chosen if treatment to reduce gastric acidity is required.  Dosing, Administration, & Client Teaching **Dosing** - Dosing varies based on the condition, severity, and client response.  - Check drug dosing guidelines for individualized dosing.  - PO dosing (immediate release, extended-release, or oral solution) once or twice per day.  - Available in combination medications.  - Start with a low dose, gradually increasing to minimize gastrointestinal side effects.  **Administration** - PO administration.  - Take with meals to reduce gastrointestinal upset.  **Client Teaching** - Educate client to take with meals to reduce gastrointestinal upset.  - Educate about signs of lactic acidosis and when to seek medical attention.  - Clients should regularly monitor their blood glucose levels to avoid hypoglycemia.  - Clients should be educated on recognizing the signs and symptoms of hypoglycemia and how to manage it should it occur.  Labs to Monitor **Basic Metabolic Panel (BMP)** - Renal function tests are indicated before starting treatment and periodically.  **Vitamin B12 Levels** - Vitamin B12 blood levels may be indicated, especially in clients with anemia or peripheral neuropathy.  **Hemoglobin A1c** - Monitoring hemoglobin A1c will provide information on the effectiveness of the treatment regimen.