Instructions – Read a selection of your colleagues’ responses and respond to at least two of your colleagues ( see below the two colleagues post ) who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Post 1 please focus on gestational diabetes in the response

Post 2 Diabetes Treatment Topic

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Post 1 focus in diabetes type 1 treatment in the response

APA style 3 citations in each response

Diabetes and Drug Treatments

Introduction

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. (McCance & Huether 2019). The symptoms of diabetes result from a deficiency of insulin or cellular resistance to insulin’s actions.

Type 1 diabetes

According to McCance & Huether (2019), type 1 diabetes mellitus (DM) is the most common pediatric chronic disease and affects 0.17% of US children, and the incidence is increasing. Rosenthal & Burchum (2021) notes that in autoimmune-mediated DM, environmental-genetic factors are thought to trigger cell-mediated destruction of pancreatic beta cells. Generally, type 1 diabetes develops during childhood or adolescence, and symptom onset is relatively abrupt (Rosenthal & Burchum 2021). It, however, needs to be noted that type 1 diabetes can also develop during adulthood. Type 1 diabetes was once called juvenile-onset diabetes mellitus or insulin-dependent diabetes mellitus (IDDM). This term is no longer commonly used because older children are frequently diagnosed with type 1 diabetes.

Peak onset at age 11–13 years four is slightly earlier for girls than boys. It is rare in children younger than one year and adults older than 30 years. Type 1 diabetes is characterized by severe insulin deficiency or no insulin secretion. Insulin is the mainstay of therapy for individuals with type 1 diabetes (American Diabetes Association, 2018).

Type 2 diabetes

Type 2 diabetes mellitus (DM) affects 9.3% of adults in the United States (Rosenthal & Burchum 2021). According to Rosenthal & Burchum (2021), age, obesity, hypertension, physical inactivity, and family history are the most well-recognized risk factors. Evidence shows that diet, including diet during pregnancy, influences the long-term risk of type 2 DM in children and adults. Type 2 diabetes is different from type 1 diabetes in that the risk of developing diabetes increases after age 40 years. In general, incidence increases with age into the 70s; among certain races, incidence peaks between 40 and 50 years, then falls with frequent contributing factors to precipitate type 2 diabetes among those susceptible. A significant factor in populations recently exposed to westernized environment increased risk related to duration, degree, and distribution of obesity.

Gestational diabetes

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (McCance & Huether 2019). The management and care of gestational diabetes are much the same as any other diabetic pregnancy: blood glucose should be monitored and controlled with diet and insulin. Rosenthal & Burchum (2021) reports that the diabetic state disappears almost immediately after delivery in most cases, permitting discontinuation of insulin. However, if the diabetic state persists beyond parturition, it is no longer considered gestational and should be rediagnosed and treated accordingly. In women taking an oral drug for type 2 diabetes, the current practice is to discontinue the oral medication and switch to insulin (Rosenthal & Burchum 2021). The only exception is the oral agent Metformin, which is often satisfactory for managing type 2 diabetes in pregnancy. Patients who discontinue oral medications can resume oral therapy after delivery.

Type 2 diabetes

I want to focus more on type 2 diabetes because I have experience providing care to these kinds of patients. Type 2 diabetes can be treated with various oral and injectable drugs. Among the oral medicines, Metformin, and sulfonylureas (e.g., glipizide, Glucotrol) are mostly used. Among the injectable drugs, insulin is used most widely. As type 2 diabetes progresses, less and less insulin is produced. As a result, it is common for people with type 2 diabetes to require insulin therapy to manage glucose levels better eventually.

Treatment option: Metformin (Biguanide).

Metformin is available alone in immediate-release (IR) tablets (500, 850, and 1202 1000 mg) as Glucophage; in extended-release (ER) tablets (500, 750, and 1000 mg) as Glucophage XR, Fortamet, and Glumetza; and in an oral solution (500 mg/5 mL) as Riomet (Rosenthal & Burchum 2021). Typically, Metformin is started immediately after the diagnosis of type 2 diabetes. The most common side effects are gastrointestinal (GI) disturbances: lactic acidosis, a potentially fatal complication rarely noted. Metformin works by lowering blood glucose, improving glucose tolerance by inhibiting glucose production in the liver and by reducing glucose absorption in the gut (Rosenthal & Burchum 2021). Another benefit of Metformin is that it sensitizes insulin receptors in target tissues (fat and skeletal muscle), increasing glucose uptake in response to whatever insulin may be available.

If not contraindicated and if tolerated, Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes (American Diabetes Association, 2018). This therapy should not be discontinued once other therapy treatments are introduced to manage diabetes. Metformin should be continued when used with other agents, including insulin, if not contraindicated and if tolerated.

Complications related to diabetes and treatment option

Diabetes has short- and long-term complications on a patient. Hypoglycemia, upsent GI, unpleasant metallic taste in mouth is some of the short-term complication of diabetes type 2 treatment. The Long-term use of Metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy.

Long term complication includes diabetic neuropathy, cardiovascular disease, and stroke which is twice as common in those with diabetes; Peripheral vascular disease is atherosclerotic occlusive disease of the lower extremity. Diabetic microvascular complications can arise because of diabetes. Diabetic retinopathy which is a leading cause of blindness worldwide is common in diabetic patients. Diabetic kidney disease is the most common cause of chronic kidney disease and end-stage kidney disease (Rosenthal & Burchum 2021). Approximately 50% of individuals with DM develop diabetic kidney disease (McCance & Huether 2019).

A diet rich in fiber, especially cereal fiber, may reduce diabetes risk (Ley et al., 2014). Alcohol consumption has been shown to increase the risk for diabetes. According to Ley et al. (2014), greater intake of sugar-sweetened beverages (SSBs) has been associated with higher type 2 diabetes risk in a meta-analysis. Vegetarian diets devoid of animal products have been demonstrated to reduce diabetes risk.

Conclusion

Diagnosis of diabetes was once made solely by measuring blood levels of glucose. However, in 2010, the American Diabetes Association (ADA) recommended an alternative test based on measuring hemoglobin A1c—a test that provides an estimate of glycemic control over the previous 2 to 3 months. Once a patient receives a diagnosis of diabetes, together with their families, they should be familiar with the signs and symptoms of hypoglycemia. Rapid treatment of hypoglycemia is mandatory: if hypoglycemia is allowed to persist, irreversible brain damage or even death may result (Rosenthal & Burchum 2021).

References

American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2018. Diabetes Care, 41(Supplement 1), S73–S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.full-text.pdf

Ley, S. H., Hamdy, O., Mohan, V., & Hu, F. B. (2014). Prevention and management of type 2 diabetes: Dietary components and nutritional strategies. The Lancet, 383(9933), 1999–2007.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Post 2

Differences Between the Types of Diabetes

Diabetes mellitus (DM) is a metabolic disease of inadequate control of blood levels of glucose (Genuth et al., 2018). Different symptoms characterize different types of diabetes. This discussion will focus on type 1, type 2, gestational and juvenile diabetes.

Type 1 diabetes is also referred to as juvenile diabetes and is an autoimmune attack on the pancreatic beta cells resulting in severe insulin deficiency. Type 1 diabetes represents approximately 5% of all diabetes, and B cell-formed autoantibodies to islet antigens are used as markers of the disease and used to diagnose type 1 diabetes (Genuth et al., 2018). Type 1 diabetes is usually diagnosed early as patients with this disorder are typically born with it. Type 1 or juvenile diabetes are treated with insulin and are generally referred to as insulin dependent.

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Type 2 diabetes is the other primary type of diabetes and comprises 90%–95% of the total cases of diabetes in the United States and worldwide (Genuth et al., 2018). Patients usually are diagnosed later in life and are generally triggered mainly due to poor diet, obesity, genetic and sedentary lifestyle.

Gestational diabetes is triggered by pregnancy. The onset of diabetes during pregnancy is caused by insufficient insulin secretion to compensate for the marked increase in insulin resistance during pregnancy, especially during the second and third trimesters.

Type 2 Diabetes and Medication use

Metformin is usually the drug of choice in treating type 2 diabetes. Metformin is effective and safe, is inexpensive, and may reduce the risk of cardiovascular events and death (American Diabetes Association, 2018). Metformin works by decreasing intestinal glucose absorption, improving peripheral glucose uptake, lowering fasting plasma insulin levels, and increasing insulin sensitivity, which reduces blood glucose concentrations without causing overt hypoglycemia (American Diabetes Association, 2018). Metformin is an oral medication that can be taken with or without food, but it is advisable to avoid common side effects. It is advisable to avoid alcohol when on metformin, as alcohol can raise lactic acid.

Short- and Long-term Impact of Type 2 Diabetes on Patients

Short-term diabetes type 2 are symptoms of hypo/hyperglycemia, which may vary from person to person. Some of the symptoms include polyuria, polydipsia, dizziness, confusion, inability to concentrate, blurry vision, and unconsciousness.

Long-term complications of diabetes include retinopathy, nephropathy leading to renal failure; peripheral neuropathy with risk of foot ulcers, amputations, and Charcot’s joints; and autonomic neuropathy causing gastrointestinal, genitourinary, and cardiovascular symptoms and sexual dysfunction (Diagnosis and Classification of Diabetes Mellitus, 2011).

References

American Diabetes Association (2018). Pharmacologic approaches to glycemic treatment:

Standard of medical care in diabetes. Diabetes Care, 41(sup 1), S73-S85. Retrieved from http://care.diabetesjournals.org/content/41/supplement_1/s73.fulltext.pdf

Diagnosis and Classification of Diabetes Mellitus. (2011). Diabetes Care, 35(Supplement_1), S64–S71. https://doi.org/10.2337/dc12-s064

Genuth, S. M., Palmer, J. P. & Nathan, D. M. (2018). Diabetes in America (3rd ed.). National Institutes of Diabetes and Kidney Disease. https://www.ncbi.nlm.nih.gov/books/NBK568014/

Seidel’s Guide To Physical Examination 9th Edition Ball Test Bank Exam View – Chapter 01

Seidel’s Guide To Physical Examination 9th Edition Ball Test Bank Exam View – Chapter 01

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

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LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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Assignment 1: Elevator Speech On The Role Of The NP.

Assignment 1: Elevator Speech On The Role Of The NP.

Instructions

The purpose of this assignment is to prepare you as future APRNs to communicate your professional role and clarify the difference between APRNs and other advanced practice healthcare providers. Once you have presented this, you will work on making this more concise and compelling since you will be asked these questions in your new role.

1.  What is a Nurse Practitioner?

2.  How does a Nurse Practitioner differ from a Physician Assistant?

3.  How does a Nurse Practitioner differ from a Physician?

4.  Why don’t you just become a physician?

For references, if you have created a PowerPoint for your presentation, please add your references on the last slide. If you have chosen not to create a PPT, then you may add your references to the Word document that contains your YouTube video URL. Please make sure that you adhere to current APA guidelines and submit at least three scholarly references per the Grading Rubric.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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Use the following coupon code :
NURSING10

Independent Contractor.

Independent Contractor.

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS 

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Get a 10 % discount on an order above $ 100
Use the following coupon code :
NURSING10

• Purpose
• What is the problem, and why is it important?
• What is the current practice?
• How was the problem identified?
• What are the PICO components?
• Initial EBP question
• List possible search terms, databases to search, and search strategies.
• What evidence must be gathered?
• Revised EBP question
• Measurement plan