Defining Structured Diabetes Education

Introduction

Structured diabetes education predominantly comprises of the fundamental tenets of self-management education for individuals diagnosed with diabetes. The primary objective of a comprehensive education framework is to prevent costly implications that are associated with treatment of diabetes. In essence, the participation in such education programs equips patients with the necessary proficiencies and utmost confidence that allows them to gain control of their condition.

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Diagnosing Diabetes Type 1 (TD1) and Type 2

The most fundamental test for detecting the presence of diabetes is through the Glycated haemoglobin (A1C) test. This test comprises of blood analysis where blood glucose level is a measure for a period of 2 to 3 months. In essence, the percentage of the blood glucose level that has a high affinity for haemoglobin. The higher the blood glucose levels recorded, the more haemoglobin an individual will have with glucose attached. Accordingly, an A1C level of 6.5 percent or higher that is consistently recorded in two separate tests indicates the presence of TD1. In the absence of the A1C test, a random blood sugar test may be applied, and it involves collecting a blood sample at random intervals which is then confirmed through repeated testing. The clinical diagnosis using this test indicates that regardless of what a person ate, a random blood glucose level that is above 11.1 mmol/L postulates that the presence of diabetes (Seaquist et al., 2013). Moreover, other signs and symptoms that are indicative of diabetes include extreme thirst and frequency of urination. Another test that may be considered in the identification for the presence of diabetes would be the fasting blood sugar test. In this case, a blood sample from an individual is collected following an overnight fast. A fasting blood glucose level that is less than 5.6 mmol/L is regarded as being normal; between 5.6 to 6.9 mmol/L is suggestive of pre-diabetes while a recording of 7 mmol/L or higher confirms the presence of diabetes (Weber et al., 2014). Additionally, the clinician may run blood tests to look out for autoantibodies that are common in TD1. The collection of these tests is essential as it assists the doctor to distinguish between TD1 and TD2 in case of uncertainty clearly. Moreover, the presence of ketones which is a by-product of a breakdown of fat, suggest the presence of type 1 diabetes rather than type 2.

In Abby's case, the diagnosis of TD1 may be ruled out since the Oral Glucose Tolerance Test (OGTT) that was administered recorded 7.9 mmol/L, and the repeat test indicated 12.1 mmol/L. Conventionally, TD1 is represented by a recording of between 5.6 and 6.9 mmol/L thus Abby represents characteristics of an individual with TD2 (American Diabetes Association, 2016). Additionally, a patient should cease taking oral medication although medication such as glyburide and metformin may be continued during the first trimester before administering insulin. Oral medication is avoided to avoid the advent of severe hyperglycaemia which may be harmful to the unborn child.

Why Abby does not have TD1

To achieve an optimal glycaemic regulation during pregnancy for women with a pre-existing condition of diabetes, rapid-long acting insulin s recommended. This may be attributed to the fact that a dose of long-acting insulin is safe for use during pregnancy since it indicates improvements blood glucose levels even after meals with reduced instances of hypoglycaemia

Classes of Oral Agents for Treatment of TD2

Biguanides present oral regimens that contain anti-diabetic properties, and its use has evolved with the comprehension of the disease pathogenesis and the underlying complications of drug use. Metformin has emerged as the most effective form of biguanide which has been widely applied in the treatment of TD2 owing to its unique ability to augment insulin sensitivity. Metformin is administered orally together with insulin and its mode of includes a reduction in macrovascular complications of TD2 that is synonymous with overweight patients (Copeland et al., 2013)Additionally, studies indicate that biguanides stimulate fibrinolysis, reducing body weight and improve serum lipoprotein parameters. Nonetheless, some of the side effects of biguanides are mostly associated with the gastrointestinal tract. The most common outcomes include feelings of nausea, diarrhoea, loss of appetite and abdominal cramps.

Sulphonylureas function as a stimulant for the secretion of insulin from the pancreatic beta cell. In essence, the adenosine triphosphate (ATP)- sensitive potassium conduits contain sulphonylureas which leads to the blockage of the potassium channels and the consequent opening of the calcium channels. This represents the fundamental mode of action through which sulphonylureas trigger the pancreas to release insulin. Gliclazide, glibenclamide, and glipizide are the most commonly used sulphonylureas that have been clinically approved for the treatment of TD2. The most effective means of administering sulphonylureas is through the combination with other agents such as metformin which diminishes instances of insulin resistance. Moreover, sulphonylureas may be given together with basal insulin injection which provides enhanced insulin secretion after meals. Nevertheless, these drug regimens augment the instances of hypoglycaemia with glibenclamide registering the highest frequencies as compared to other agents. Additionally, the prolonged use of sulphonylureas culminates in the progressive decrease in the effectiveness of the drug regimen.

Thiazolidinediones are also referred to as glitazones which strategically targets insulin resistance which is the fundamental physiologic shortcoming in patients diagnosed with TD2. Gliztones may be administered as a monotherapy or may be used in combination with other agents such as metformin or sulphonylureas. In essence, glitazones are utilized for purposes of improving glucose control by acting as agonists of peroxisome proliferator-activated receptor-gh (PPAR- gh) nuclear receptors. Additionally, glitazone is instrumental in the process of lowering blood pressure, improving vascular reactivity and rheologic anomalies that are associated with TD2 as well as improving lipid metabolism (Seaquist et al., 2013). Some of the side effects of this class of drugs include water retention, eyesight problems, chest pain and allergic skin reactions. Recently, studies concluded that the safety of thiazolidinediones (Avandia) might not be guaranteed as rosiglitazone was associated with an augmented risk of heart attacks or stroke. Consequently, clinicians concluded that heart failure was a side effect of the drug which ultimately led to the ban of Avandia for diabetics as the benefits no longer outweighed the underlying risks.

Alpha-glucosidase inhibitors are oral glucose-lowering drug agents which explicitly inhibit alpha-glucosidases which are located in the brush border of the small intestine. In essence, these enzymes facilitate the release of glucose from complex carbohydrates. In the process, postprandial glucose limits are inhibited leading to decreased insulin levels. The most commonly used types of alpha-glucosidase inhibitors include voglibose, acarbose, and miglitol. When these drugs are utilized in monotherapy, they reduce the HbA1c level by nearly 8 percent (Chamberlain et al., 2016). Nonetheless, alpha-glucosidase inhibitors are associated with significant gastrointestinal side effects which affect almost half of all the drug users. This occurrence may be attributed to the overproduction of colonic gas production which is as a result of the fermentation of the unabsorbed carbohydrate. As a result, the subsequent side effect include cramping, abdominal bloating diarrhea or flatulence. Therefore, individuals with chronic diseases associated with gastrointestinal tract should avoid alpha-lucoside inhibitors.

The function of dipeptidyl peptidase-IV (DPP-4) inhibitors assumes two approaches namely as a signaling factor and a regulatory enzyme. In essence, DPP-4 inhibition culminates in increased concentration of the GLP-1 (incretin hormones glucagon-like peptide-1) and the gastric inhibitory polypeptide (GIP). As a result, there is an expected surge in the glucose-dependent activation of insulin secretion which leads to the reduction of blood glucose levels. Contemporary research demonstrates that DPP-4 inhibitors can cause a noteworthy decline in levels of glycosylated haemoglobin (HbA1c) levels. The DPP-4 inhibitors may be used in combination with other anti-diabetic drug regimens or as a monotherapy. Nonetheless, the adverse effects of DPP-4 comprise of skin reactions that are characterized by painful rashes; gastrointestinal challenges such as diarrhoea and nausea and flu-like symptomologies such as diarrhoea and vomiting.

The application of incretin mimetics involves the post-prandial improvement in insulin secretion that is as a result of factors drawn from the gut. In a much as incretin mimetics produce similar outcomes to those of natural incretin mimetics, the drug regimens functions to inhibit the DPP-4 enzyme and in the process, the plasma concentration of the incretins increases thus increasing their biologic effects (Fadini et al., 2015). Since GLP-1 is a type of incretin hormone, it has been identified as the fundamental target for the treatment of TD2. Some of the actions that are synonymous with the incretin hormone include stimulation of hepatic glucose production, inhibiting the production of glucagon and triggering glucose-induced insulin secretion, Nonetheless, the utilisation of incretin-based therapies for the regulation of glucose homeostasis has been associated with various side effects including the augmented risk of pancreatitis and the development of C-cell carcinoma.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are applied in clinical practice as an anti-hyperglycemic therapeutic intervention. Moreover, the mode of action for this class of drugs is based on the uniqueness of glycosuric mechanism which has been associated with the decrease in body weight. Other tools of SGLT2 include the natriuretic effects and diuretic effects that contribute to the contraction of plasma volume and a decrease in the diastolic and diastolic blood pressure to the recommended levels which is beneficial to the kidneys and organs associated with the cardiovascular system (Di Pierro et al., 2012). Nevertheless, the use SGLT2 causes more glucose to the excreted in urine which augments the possibilities of contracting urinary tract infections. Additionally, the utilization of SGLT2 inhibitors in combination with other anti-diabetic medications leads to the increased risk of hypoglycaemia. Equally important is the fact that SCLT2 inhibitors lead to the development of the adverse but rare condition dubbed diabetic ketoacidosis.

Hence, metformin is recommended as the ideal drug for use during the post-partum period as it has less side effects on the user.

Benefits of Insulin Regimen

The administration of the basal-bolus regimen presents a fundamental advantage where the intervention enables the body of an individual to match how the agency would naturally release insulin. Another advantage is the fact that the basal-bolus regimen facilitate flexibility as to when meals are to be consumed. This phenomenon is demonstrated in the use of self-adjusting insulin doses which implies that the patient has control over the amount of carbohydrate that is consumed in a day during different meals. In essence, basal insulin is required during fasting where the blood glucose levels are to be kept under control and to create an allowance for the cells to absorb glucose to release energy. Additionally, the bolus...