Diabetes mellitus paper Introduction
Diabetes mellitus is a disease that affect the function of the body system primarily on the
way the body utilizes the blood glucose and the use of insulin (Zheng, Ley& Hu, (2018).
Glucose is very crucial in the functioning of the body because it is a source of energy to the body
cells that makes up the tissues and the organs of the body. Diabetes melittues are classified into
four types depending on the realize and the effect of insulin on the glucose in the body.
The four types include gestational diabetes mellitus, type 2 diabetes, juvenile diabetes and type 1 diabetes mellitus.
This paper discusses the four types of diabetes mellitus and metformin a medication that is used to manage type 2 diabetes.
Differentiating types of diabetes
Type 1 diabetes is a rare type of diabetes than type 2 diabetes. The difference between
the types of diabetes involves the role of insulin. According to (Katsarou et al., 2017), people
with type 1 diabetes are unable to produce insulin at all from their pancreas cells. Type 1
diabetes is managed with one medication, which is the use of insulin for life. When type 1
diabetes occurs in children of less than 14 years, we call it juvenile diabetes because type 1
diabetes can as well affect people who are of 40 years of age. Zheng, Ley& Hu, (2018) argues
that people with type 2 diabetes produce insulin, but the cells in the muscles, fat tissues and the
liver cannot absorb the insulin, therefore, cannot regulate the release and the utilization of insulin
as expected. In type 2 diabetes, the pancreas compensates to the inability of the cells to absorb
insulin as expected with increased pumping of insulin by the pancreas. As time goes by the
pancreas cannot maintain its ability to maintain high levels of insulin.
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Gestational diabetes occurs when a pregnant woman is unable to produce enough of the
hormone insulin during pregnancy. Therefore causing the blood glucose level to be higher than
normal throughout pregnancy. Gestational diabetes is aggravated by the release of human
placenta lactogen produced from the placenta, which modifies the metabolism of the mother and
the processing of the carbohydrates and lipids (Katsarou et al., 2017). Therefore, causing high
levels of blood glucose.
Metformin is a first-line treatment that is used to manage diabetes mellitus type 2.
Metformin is one of the medications that is administered to the majority of the patients with
diabetes mellitus type 2 in all world. Metformin is a biguanide medication because it is used to
lower the blood glucose levels, both basal and postprandial glucose levels. It is found as a
monotherapy or in combination with other medications that are used to manage diabetes such as
insulin and sulfonylureas.
According to (Zheng, Ley& Hu, 2018) metformin act by inhibiting the production of glucose from the liver, lowers the rate at which glucose is being absorbed from the intestines and by increasing the rate at which glucose is being utilized in the body primarily by the body muscles.
Apart from lowering the blood glucose level, metformin helps in reducing the lipid levels
in the plasma, weight reduction among obese patients and in the prevention of cardiovascular
disorders. Besides, metformin helps in improving the sensitivity of insulin by increasing the
uptake and the use of glucose in the body system. Metformin is administered orally after meals
and the time that it takes to reach the maximum plasma metformin concentration is achieved
after 7- 8 hours of administration (Maruthur et al., 2016). The agent is not metabolized and is
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excreted unchanged through the urine. It has a half-life of around five hours. Metformin is
excreted in the kidney through active tubular secretion. After absorption from the intestines, the
drug is distributed into various body tissues that include the liver, intestines and the kidney.
Different people have different metformin pharmacokinetics.
Before taking metformin to ensure you have eaten well because metformin is
administered immediately after meals. According to (Maruthur et al., 2016) the recommended
starting dose for metformin is 500 mg twice in a day and is administered orally or a dose of
850mg once in a day orally and is administered with meals or immediately after meals. The dose
is increased in the basis of 500mg in a week or 850mg after two weeks of the initial
administration with the main focus being the glycemic control and the tolerability of the
medication. The dose can be increased up to a maximum dose of 2550mg in a day but in a
divided dose. The dose that is more than 2000mg should be administered three times a day with
meals to enhance the tolerability of the medication.
Assess the renal and liver function of the patient before the administration of the
medication. Ensure you assess the hypersensitivity of metformin before the drug is prescribed,
and every time it is being administered to the patient. Besides, evaluate and interpret the blood
glucose levels and ensure that metformin is administered with meals or immediately after meals.
In cases of renal impairment, metformin should not be prescribed nor administered and in the
situation whereby the patient had been on metformin, and the glomerular filtration rate drops to
the levels that are below 45ml/min/1.73m2 assess the benefit of continuing the medication
(Maruthur et al., 2016). If at all, the patient is at risk of much kidney failure, discontinue the
medication. The administration of metformin should be stopped during the procedures of an
iodinated contrast imaging in patients with renal impairment.
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While taking metformin, the patient should avoid taking alcohol. Alcohol causes the
metformin to break down too much of the lactate in the liver, which is a byproduct of amino
acids and the glucose. Therefore, the intake of alcohol while using metformin increases the risk
of developing lactic acidosis and should be avoided throughout the administration of metformin.
Long term and short term effects of diabetes
Diabetes lowers the function of the immune system to prevent and fight against infection
in the body due to high blood glucose levels. The white blood cell, which always protects the
body from infection, is slowed down by the higher levels of the glucose in the blood. Therefore,
patients with diabetes are at risk of developing diseases such as candidiasis, pneumonia and flu.
Hypoglycemia is a short-term complication of diabetes mellitus.
According to Lotfy et al., 2017,) hypoglycemia occurs due to the use of insulin medication or any sulfonylurea drug that makes the body to produce insulin throughout the day.
With insulin, when the patient is eating less food than usual or when the patient is involved in too many activities, the blood glucose levels may get too low, thus leading to hypoglycemia.
Erectile dysfunction is a disorder that affects most men with diabetes mellitus. The disease occurs due to the reduced supply of blood and nerve damage that navigate the reproductive system of men.
Erectile dysfunction further leads to insufficient for satisfactory sexual performances.
Retinopathy occurs among people with diabetes mellitus due to the damage of the blood
vessels in the retina, which eventually affects the vision of the patient. When the blood vessel in
the retina are damaged, macula swells up, and fluid begins to accumulate inside the macula, thus
causing macular oedema (Lotfy et al., 2017). The macula can get damage and may lead to
blurred vision. The more the fluid that accumulates in the macula, the higher the intraocular
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pressure that builds up in the eye, which finally results in glaucoma in people with diabetes.
Nephropathy is another long- term complications of diabetes mellitus. The small blood vessels
that nourish the kidney begin to change with time. The disease is difficult to detect because it is
painless and does not show symptoms in the early stages until it advances to kidney disease.
The difference in the types of diabetes involves the role of insulin in the body. Type 2
diabetes is the common type of diabetes mellitus that affect various people in the current world.
Metformin is the first line treatment that is used in the management of type 2 diabetes mellitus. It
is taken with meals or immediately after meals to enhance its effectiveness. According to
(Zheng, Ley& Hu, 2018) Metformin acts by inhibiting the rate at which glucose is being
produced in the liver and by reducing the absorption of glucose in the intestines.
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Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., …
& Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease primers, 3,
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes
mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88.
Lotfy, M., Adeghate, J., Kalasz, H., Singh, J., & Adeghate, E. (2017). Chronic complications of
diabetes mellitus: a mini review. Current diabetes reviews, 13(1), 3-10.
Maruthur, N. M., Tseng, E., Hutfless, S., Wilson, L. M., Suarez-Cuervo, C., Berger, Z., … &
Bolen, S. (2016). Diabetes medications as monotherapy or metformin-based combination
therapy for type 2 diabetes: a systematic review and meta-analysis. Annals of internal
medicine, 164(11), 740-751.