Diabetes is a group of metabolic conditions that are similar in terms of disorder development, symptoms, and potential complications. Three main groups of diabetes include type 1 diabetes mellitus, type 2 diabetes mellitus, and gestational diabetes. All types of diabetes are characterized by similar symptoms, such as polyuria and hyperglycemia, but the causes of diabetes are often different and require a personalized approach to drug therapy and lifestyle management.
The onset of type 2 diabetes usually occurs because adipose tissue and muscle cells lose insulin sensitivity or because the pancreas loses the ability to produce enough insulin (Arcangelo & Peterson, 2013). Those changes result in elevated blood sugar levels. However, blood glucose levels alone are not enough to diagnose type 2 diabetes. Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and intermediate hyperglycaemia (IH) are more reliable diagnostic factors present in all patients who are developing diabetes (World Health Organization [WHO], 2006).
Type 1 diabetes is also called juvenile diabetes because it has an early onset. Unlike type 2 diabetes, type 1 is an autoimmune disorder because it is characterized by pancreatic beta cell destruction. The presence of various anti-bodies, such as insulin antibodies, indicates that individuals are at a high risk for developing type 1 diabetes (Knip et al., 2005). Another key difference between type 1 and type 2 diabetes is the impact of heredity on disease onset. Type 1 diabetes is mainly caused by genetic susceptibility while external factors, such as responsiveness to enteroviruses or nutrition during infancy, are less common causes (Knip et al., 2005).
Gestational diabetes is very similar to type 2 diabetes, but it occurs only during pregnancy. While women recover in most cases after childbirth, this type of diabetes can cause perinatal death and places women at risk for type 2 diabetes mellitus (Ali & Alexis, 1990). According to Harris (1988), women who develop gestational diabetes during pregnancy usually show the same risk factors as type 2 diabetes patients.
Although type 2 diabetes is a chronic disorder that requires self-monitoring blood glucose (SMBG) and maintaining adequate levels of blood sugar to prevent acute complications associated with diabetes, such as dehydration, ketoacidosis, or diabetic coma, it is simple to manage. In most cases drug therapy is not required if the patient adheres to dietary and physical activity requirements. Lifestyle management also minimizes the risks of developing other long-term complications associated with diabetes, such as cardiovascular disorders, neurological disorders, and nephropathy.
If lifestyle management in type 2 diabetes patients proves inadequate, drug therapy is initiated. The drug therapy is modeled after observing several factors. For example, sulfonylureas are used in thin patients with blood glucose levels over 250 mg/dL while thiazolidinediones are used for patients with metabolic syndrome (Arcangelo & Peterson, 2013). Combination therapy is used only when a single agent does not produce results, and different types of combination therapy may require monitoring liver and renal functions to prevent adverse events (Arcangelo & Peterson, 2013).
Tolbutamide is an example sulfonylureas agent used in patients with hyperglycemia issues. However, this particular agent is used when patients also show higher risks for developing cardiovascular disorders and its effectiveness may reduce over time, so revising the treatment or initiating combination therapy might be required (Arcangelo & Peterson, 2013). Tolbutamide can cause easy bruising, weakness, memory problems, and various other side-effects. Most importantly, it can induce hypoglycemia in elderly patients, so SMBG remains an important part of therapy.
Drug therapy alone is not effective in managing diabetes because it can produce several side-effects or lose effectiveness over time, so medical nutrition therapy is applied in patient education to modify lifestyle factors associated with managing diabetes and preventing complications. For example, a healthcare provided may prescribe a very low caloric diet, which was found effective in managing fasting plasma glucose levels, blood glucose levels, and improving peripheral insulin sensitivity (Henry, Scheaffer, & Olefsky, 1985). Increasing dietary fiber intake in type 2 diabetes patients also showed improvements in fasting blood glucose and reduced the risks associated with coronary disorders (Post et al., 2012).
References
Ali, Z., & Alexis, S. D. (1990). Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad. Diabetes Care, 13(5), 527-529.
Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.
Bennett, W. L., Odelola, O. A., Wilson, L. M., Bolen, S., Selvaraj, S., Robinson, K. A., . . . Puhan, M. A. (2012). Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus: A systematic review. Annals of Internal Medicine, 156(1), 27-36.
Cerner Multum. (2011). Tolbutamide side effects. Retrieved from http://www.drugs.com/sfx/ tolbutamide-side-effects.html
Harris, M. I. (1988). Gestational diabetes may represent discovery of preexisting glucose intolerance. Diabetes Care, 11(3), 402-411.
Henry, R. R., Scheaffer, L., & Olefsky, J. M. (1985). Glycemic effects of intensive caloric restriction and isocaloric refeeding in noninsulin-dependent diabetes mellitus. The Journal of Clinical Endocrinology \& Metabolism, 61(5), 917-925.
Knip, M., Veijola, R., Virtanen, S. M., Hyöty, H., Vaarala, O., & Akerblom, H. K. (2005). Environmental triggers and determinants of type 1 diabetes. Diabetes, 45(s2), S125-S136.
Post, R. E., Mainous, A. G., King, D. E., & Simpson, K. N. (2012). Dietary fiber for the treatment of type 2 diabetes mellitus: A meta-analysis. Journal of the American Board of Family Medicine, 25(1), 16-23.
World Health Organization (2006). Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. Retrieved from http://www.who.int/diabetes/publications/ Definition%20and%20diagnosis%20of%20diabetes_new.pdf
