Pathophysiology: Diabetes Type 1 and 2

Type 1 Diabetes

Core defects: An autoimmune disease; the immune system of the body attacks the beta cells of the pancreas, which results in the elimination of insulin production (Atkinson, Eisenbarth, & Michels, 2013). Polydipsia and polyphagia, as well as hyperglycemia, are the symptoms of diabetes 1.

Class of medication: Insulins. Rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting insulins are used in the treatment of type 1 DM. Depending on the type of insulin, the time of onset and the peak effect can vary. The following medications are used in the treatment of type 1DM: Novolog (insulin aspart) and Humalog (insulin lispro). Novolog’s side effects include hypoglycemia, various allergic reactions, chest pain, headache, nausea, diarrhea, also urinary tract infections.

Humalog’s side effects include hypoglycemia, headache, flu syndrome, nausea, diarrhea, pharyngitis.

Nutrition: a healthy diet is essential for patients with type 1 DM. The amount of salt, sugar, and fat needs to be reduced; on the contrary, the amount of fiber is to be increased. Fruit and vegetables, as well as starchy carbohydrates, are recommended. Added fructose is not recommended because it can have an adverse impact on plasma lipids (Goff & Dyson, 2015).

Culture and ethnicity: mean hemoglobin A1c was reported to be higher in black individuals compared to white or Hispanic individuals; diabetic

ketoacidosis and severe hypoglycemia are also more common among black people (Willi et al., 2015). No significant differences were detected between white and Hispanic patricians of the research (Willi et al., 2015)

Socioeconomics: it remains unclear whether socioeconomic factors can have a positive or negative influence on the condition; however, it is possible to assume that people with financial difficulties will have poor diabetes management due to their inability to purchase medications and other needs.

Complementary therapies: CAM therapies used for diabetes include acupuncture and herbal treatment. The efficiency of CAM therapies is debated.

Type 2 Diabetes

Core defects: the pathophysiological core is the insulin resistance of the liver and muscle (DeFronzo, Triplitt, Abdul-Ghani, & Cersosimo, 2014). Target cells are unresponsive to insulin (Adams, Holland, & Urban, 2014).

Class of medication: Six groups: “alpha-glucosidase inhibitors, biguanides, incretin enhancers, meglitinides, sulfonylureas,

and thiazolidinediones” (Adams et al., 2014, p. 684). Precose/Glyset, Riomet/Fortamet, Tradjenta/Januvia, Prandin/ Starlix, Glucotrol/Amaryl, and Actos/Avandia are used respectively to the group (Rejeski et al., 2012).

May cause abdominal cramping/diarrhea/flatulence, nausea/vomiting/diarrhea, abdominal pain/headache/nasopharyngitis, hypoglycemia, weight gain/GI distress, edema/fast heartbeat/bone fractures, respectively (DeFronzo et al., 2014).

Nutrition: starches, vegetables, fruits, milk, meat, and meat substitutes are recommended in specific servings. Limiting fats and sweets is necessary for a healthy diet because they can result in weight gain and increased blood fats (Rejeski et al., 2012). Alcohol is not recommended because it can decrease blood glucose levels.

Culture and ethnicity: It is important to educate patients to adjust their diets that are based on culture and beliefs to the recommended nutrition style. Moreover, as patients might not be native English speakers, healthcare professionals need to choose corresponding language and definitions to provide guidance (Goff & Dyson, 2015).

Native Americans, non-Hispanic black Americans, and Hispanic Americans are at risk of developing type 2 DM (Goff & Dyson, 2015). Moreover, minorities are at higher risk of dying from this disease compared to non-Hispanic whites.

Socioeconomics: Individual levels of education and neighborhood conditions, as well as housing conditions, can influence the development of type 2 DM (Rejeski et al., 2012). Adverse housing conditions and low educational attainment is linked to the development of the disease.

Complementary therapies: acupuncture, mind-body practices, functional foods, and supplements can be used by individuals; however, additional research is needed to prove their efficiency (Adams et al., 2014).

References

Adams, M. P., Holland, N., & Urban, C.Q. (2014). Pharmacology for nurses: A pathophysiologic approach. New York, NY: Pearson Higher Ed.

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2013). Type 1 diabetes. The Lancet, 383(9911), 69-82.

DeFronzo, R. A., Triplitt, C. L., Abdul-Ghani, M., & Cersosimo, E. (2014). Novel agents for the treatment of type 2 diabetes. Diabetes Spectrum, 27(2), 100-112

Goff, L., & Dyson, P. (2015). Advanced nutrition and dietetics in diabetes. Hoboken, NJ: John Wiley & Sons.

Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q. (2012). Lifestyle change and mobility in obese adults with type 2 diabetes. New England Journal of Medicine, 366(13), 1209-1217.

Willi, S. M., Miller, K. M., DiMeglio, L. A., Klingensmith, G. J., Simmons, J. H., Tamborlane, W. V., & Lipman, T. H. (2015). Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics, 135(5), 424-434.