The Use of GLP 1 Analogues

Type 1 diabetes is a serious chronic condition that tends to arise prior to adulthood. The disease requires substantial lifestyle changes in order to cope, and can lead to several debilitating outcomes if left unchecked. According to the American Diabetes Association ([ADA], 2017), Type 1 diabetes is defined as a chronic condition where the body no longer produces the insulin hormone, and is therefore unable to utilize and store glucose. As a result, individuals with Type 1 diabetes may experience excessively high or low blood glucose levels: hyperglycemia and hypoglycemia respectively (ADA, 2017). Both sides of the spectrum can have devastating effects on the body’s cardiovascular and renal activities, in addition to deteriorating the peripheral

The purpose of the study is to gauge and keep the blood glucose levels, the lipid and lipoprotein levels and the blood pressure levels at a normal and safe range, as well as to prevent or slow the growth of chronic diabetes complications by nutrition controls and intense lifestyle

Prevention and slowing the progression of DPN via glucose control has been demonstrated to be effective in patients with type 1 diabetes, but may not be as effective in patients with type 2 diabetes (Callaghan BC 201211). Other studies found no correlation between glycated hemoglobin (HbA1C) with mean of 6.9% and the severity of DPN (Owolabi MO 201212). Diabetic patients are more susceptible to dyslipidemia and metabolic syndrome. Those patients have body mass index (BMI) ≥30Kg/m2, abnormal glucose metabolism with insulin resistance, high low-density-lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), and low high-density lipoprotein (HDL). Those abnormal findings expose patients to atherosclerotic changes and microvascular complications together with hypertension and cardiovascular diseases (Mooradian AD

Bode and Garg (2016) state that intensive insulin therapy is required to prolong the onset of micro and macrovascular complications in T1DM. American Diabetes Association has recommended reduction of A1c targets to 7.5% in all pediatric populations, and A1c of 7.0% in adult population, where even normal levels can be aimed for in patients with short duration of disease, larger life expectancy and no cardiovascular disease history as long as severe, recurrent hypoglycemia is avoided (Chiang et al., 2014). But along with numerous limitations of insulin use (Bode and Garg, 2016), intensive insulin therapy’s most common side effect remains to be increased frequency of hypoglycemia (George and McCrimmon, 2012). Recurrent hypoglycemia can lead to autonomic dysfunction with decreased sympatho-adrenal response causing decline in awareness of hypoglycemia (Chiang et al., 2014; and Bode and Garg, 2016). Complications from hypoglycemia can result in death from ventricular dysrhythmia, 3.4 times increase in risk of mortality over 5 years, and double the risk of cardiovascular diseases. Weight gain can also result from ‘defensive eating’ and decreased physical activity from the fear of hypoglycemia in T1DM patients (Bode and Garg, 2016).

By keeping your blood glucose level in a normal range through supper arranging, physical action, and pharmaceuticals, you can maintain a strategic distance from long term confusions of diabetes. These entanglements create over many years, and they all identify with how blood glucose levels can influence your veins. After some time, increased blood glucose can harm the body's veins, both minor and huge. Damage to your little veins causes microvascular complexities; damage to your large vessels causes macrovascular entanglements.

Guidelines from the American Heart Association (AHA)/American Diabetes Association (ADA) [7] and the European Society of Cardiology [8] present different recommendations for individuals with diabetes depending on an individual 's risk profile. To identify patients who will benefit most from

Type 2 diabetic clients are at higher risk for diabetic complications in the presence of chronically elevated glucose levels: consequences include higher risk factors for cardiovascular disease, neuropathy, nephropathy, retinopathy, skin conditions, loss of hearing, and Alzheimer’s disease (Mayo Clinic, 2016).

The American Association of Clinical Endocrinologist (AACE) treatment goals are individualized and aimed at lowering A1C and prevention of hypoglycemia along with decreased comorbidities associated with diabetes. Diabetics who are at an increased risk for hypoglycemia include: a diagnosis of greater than 15 years, advanced macrovascular disease, hypoglycemia unawareness, limited life expectancy and severe comorbidities (Garber, Blonde, Bush, Einhorn, & Garber,et al., 2017). In addition Fowler (2010) notes that those with renal or hepatic dysfunction are at an increased risk for hypoglycemia due to the combination of less endogenous glucose production and longer insulin half life. This combination can result in a rapid lowering of glucose.

In Type 2 Diabetes, the body either doesn’t make or process insulin well (NIH, 2014). This deficiency stops glucose from feeding cells energy and increases levels in the blood stream (NIH, 2014). According to the National Institutes of Health (2014), high blood

There is an increasing body of evidence to show that apart from control of acute blood sugar fluctuations in the peri-operative period, long- term control of blood sugar levels also plays an important role in reducing diabetic complications after surgery.

to be the main cause of chronic diabetic complications, in particular at a microvascular level (Moussa 2008).

The writer will examine the prevalence of diabetes among the patients with end-stage renal disease (ESRD), potential benefits, and harm during management of underlying cause, and analysis of glycemic index hemoglobin A1c (HgbA1c) in managing diabetic ESRD patients. Diabetes is one of the frequent reasons and common persistent complications of ESRD (Kovesdy, Park, & Kalantar-Zadeh, 2010). According to the United States Renal Data System (USRDS), diabetes is the primary cause leading to ESRD. Among 20.8 million diabetic population, approximately 232,984 were affected by ESRD that accounted for increase in Medicare budget from 5.4% to 6.3% at the end of 2011 (United States Renal Data System [USRDS], 2013). Not everyone with diabetes develop ESRD, thus strictly controlling blood sugar level lower the chances of getting kidney disease (Mehrotra, Kalantar-Zadeh, & Alder, 2011).

Microvascular complications:are basically created by diminished flow through the littlest arterioles of the body's organs, and are specifically connected with drawn out hyperglycemia bringing about retinopathy (prompting to visual impairment), nephropathy (prompting to renal disappointment), and neuropathy (prompting to Charcot foot and fringe diseases). Different reviews have demonstrated that the improvement of these microvascular confusions can be altogether postponed by strict and steady control of the blood glucose, most regularly by keeping up glucose at under 126 mg/dl.

Opposing this American Diabetes Association and European Association published theorem against the use of rosiglitazone. Unfortunately, it had no impact and the drug was still in market. Moreover, in 2009 the annual sale baffled $1 billion. Further, the US Senate Committee on Finance disclosed the reports of analysis done by GSK and USFDA, Rosiglitazone Evaluated for Cardiac Outcomes and Regulations of Glycemia in Diabetes (RECORD). This study depicted a deficient and inconsistent data to allow or controvert the demonstration of risk of MI. Further ADOPT study and DREAM study were conducted. These two also certified that rosiglitazone is not showing significant side effect as CV or

The article I chose for the patient I had in clinical is titled Heart in Diabetes: A microvascular disease. I chose it based on his diagnoses of type 2 diabetes mellitus, coronary artery disease, and his need for coronary artery bypass graft. The study looked at clinical trials for the “common soil hypothesis in diabetes complications” and how diabetes is associated with cardiovascular disease and death. It confirmed that the risk of macrovascular disease, but especially coronary artery disease, is increased two-four times in diabetic patients. The article also said that while there are many other factors in the risk for death from cardiovascular disease, the effects that diabetes has on the microvascular system has a substantially higher detrimental