Type 2 Diabetes Mellitus
Diabetes mellitus (DM) is a common chronic disease that brings burden on health care systems worldwide and the ninth major cause of death (Marie et al., 2018, Zheng et al., 2018). DM
is a clinically and genetically heterogeneous group of disorders characterized by abnormally high blood glucose levels as a result of either insulin deficiency or cellular resistance to the action
of insulin (Arcangelo et al., 2016). Type 2 diabetes mellitus (T2DM) is the most prevalent form of DM accounting to 90% to 95% of the DM cases. In T2DM, there is insulin resistance and
inappropriate insulin secretion.  Family history of DM, obesity (205 over desired body weight), Race/ethnicity (African Americans, Hispanic Americans, Native Americans, Asian Americans,
Pacific Islanders have increased risk), age older than 45 years-old, previously identified as having impaired fasting glucose, hypertension, high-density lipoprotein (HDL) cholesterol level
greater than 35 mg/dl or triglyceride level greater than 250 mg/dl, history of gestational DM, and sedentary lifestyle are the major risk factors for T2DM (Rosenthal & Burchum, 2018).
Drug for T2DM
The Association for the Study of Diabetes (ADA) and the European Association for the study of Diabetes recommended a four-step approach in managing hyperglycemia for
T2DM. Metformin is the first drug of choice for T2DM after diagnosis (Rosenthal & Burchum, 2018). Biguanides (metformin) are oral antidiabetic drugs. However, are not considered
hypoglycemic agents because their primary pharmacologic action does not increase insulin secretion (Arcangelo et al., 2016). Metformin is started immediately along with lifestyle and diet
changes. Metformin when used as monotherapy does not caused hypoglycemia and do not promote hyperinsulinemia or weight gain. Metformin reduces low-density lipoprotein (LDL) and
raised HDL. Common side effects are lactic acidosis, gastrointestinal reactions (nausea, upset stomach and diarrhea). Patients’ needs to take metformin before meals in the morning and
evening. The dosage is started low (500 or 850 mg daily or twice daily for the IR tablets) and can be increased weekly as needed to the maximum (2,550 mg per day). Metformin should be
carefully titrated in elderly and contraindicated in children, alcoholics, presence of kidney and hepatic dysfunction (Rosenthal & Burchum, 2018). 
Short-term impact of uncontrolled DM
Maintaining a healthy body weight by engaging in regular physical activity, consuming a healthy diet and medication adherence is important for reducing the risks of chronic
uncontrolled DM (hospitalizations due to diabetic ketoacidosis and coma) ( Zheng et al., 2018).
Long-term impact of uncontrolled DM
Insulin dysfunction affects many body systems causing hypertension, coronary heart disease, and other complications like neuropathies, retinmopathies, amputation that may affect social
life and quality of life ( Zheng et al., 2018). Advanced practice registered nurses have a vital role in focusing on preventative healthcare maintenance to promote quality of life and prevent
uncontrolled DM impacts.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for advanced practice (4th ed.). Lippincott Williams And Wilkins.
Marie, M. H., Andersen, H. U., Thorsteinsson, B., & Pedersen- Bjergaard, U. (2018). Hypoglycemic exposure and risk of asymptomatic hypoglycemia in type 1 diabetes assessed by
continuous glucose monitoring. The Journal of Clinical  Endocrinology and Metabolism, 103(6), 2329-2335. doi:http://dx.doi.org.ezp.waldenulibrary.org/10.  1210/jc.2018-00142
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Speed Pharmacology. (2017). Drugs for Diabetes (Made Easy) [Video]. https://www.youtube.com/watch?v=LWDQyaKVols&t=79s
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), 88-98.
doi:http://dx.doi.org.ezp.waldenulibrary.org/10.1038/nrendo.2017.151

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Diabetes mellitus (DM) is a common chronic disease that appeared first on homework handlers.

1. One of the novel’s key themes is the difference between rumor and fact. Look at the passages in the first chapter in which Scout describes what she knows about Boo Radley. Which statements seem to be fact and which seem to be fiction? And do you think the child (Scout is six years old when the story begins) can tell the difference? How can you tell?

2. Scout never says how old she was when the book’s events begin, but she offers clues that tell us her exact age at the time. How old is she when she meets Dill? Is her age important to keep in mind as you read the novel? Why or why not?

3. What kind of relationship does Scout have with her brother and her father? How does the loss of her mother affect her and Jem differently, at least according to Scout?

4. In Chapter 2, why does Walter Cunningham’s jaw muscle twitch when his teacher asks him if he forgot his lunch? What other evidence from Chapters 2 and 3 offers insight into the social and economic differences in Maycomb?

5. In Chapter 3, what is the “simple trick” that Atticus advises Scout to use? What evidence is there in this chapter that Atticus uses this “trick” himself? Is there any evidence that he doesn’t always use this “trick” when he talks about people?