• Subject Name : Nursing

Type 1 Diabetes Mellitus

Ans 1) In the present case scenario, Zach was given a provisional diagnosis of Type I diabetes mellitus (T1DM). T1DM is also known as juvenile diabetes because it affects young adults and children. T1DM can be defined as an autoimmune disorder characterised by insufficient production of insulin due to β-cells (present in the pancreas) destruction (Kahanovitz et al., 2017). Factors associated with the T1DM pathogenesis are an epigenetic, immunologic, environmental and genetic factor. The above-stated factors lead to the autoimmune reaction which causes destruction of the pancreatic β-cells, further, leads to progressive and predictable loss of these cells’ insulin secretion capacity (Paschou et al., 2018).

Deficient insulin secretion can lead to hyperglycaemic condition (increased blood sugar level). Zach has been prescribed insulin to regulate his blood glucose level to normal limits. Subramanian et al., (2016) illustrated that hyperglycaemic condition can lead to microvascular and macro-vascular complications and such complications can be managed by insulin therapy. Exogenous insulin aids in the stimulation of blood glucose uptake by the body tissues and organs, for instance, liver, adipose tissues and skeletal muscles. Satoh, (2014) stated that insulin stimulates membrane transferring of the GLUT 4 (glucose transporter) from its storage vesicles to the plasma membrane in the adipose tissue and skeletal muscle, hence aids in the glucose uptake from the blood circulation. In the present case, exogenous insulin treatment will aid in glucose utilization to maintain the blood glucose level (Kahanovitz et al., 2017).

Ans 2) NovoRapid is colourless, aqueous and sterile insulin analogues prescribed for the blood glucose levels management in the patients suffering from type 1 diabetes mellitus. NovoRapid has faster and shorter action onset that occurs within 10 to 20 minutes after injecting the insulin analogue (Bullock & Manias, 2017). Further, after 1 to 3 hours of injection, its peak effects arise and last for 3 to 5 hours. Usually, the blood glucose levels incline to increase within 30 minutes after the major meal. Slattery et al., (2018) stated that the fast-acting insulin analogues must be administered 15 to 20 minutes before consumption of major meal to enhance the management of postprandial glucose levels. Hence, in the present case, for better results, NovoRapid must be administered before the meal.

Ans 3) Assessment of blood glucose level aids in the determination of diabetic patients' plasma sugar concentration. Blood glucose assessment is paramount in optimising the glycaemic control in diabetic patients to upkeep improved health outcomes. In accord with the American Diabetes Association (2019), assessment of blood sugar levels of diabetic patients is vital to check whether the patient's sugar levels are falling within the normal acceptable range or not. After evaluation of the blood sugar levels, the health care provider can precisely and accurately determine the intervention options for the patient. Further, the blood sugar level of the patients is indicative of various risk complications associated with the dose of the insulin analogue. For instance, the patient may develop high or low sugar levels due to inadequate or high dose respectively (DiMeglio et al., 2018).

It is vital for Zach that the sugar levels examination must be undertaken to evaluate his blood sugar levels to commenced anti-diabetic therapy immediately. Zach blood sugar levels must be checked after 5 hours as NovoRapid is fast-acting insulin analogue. As already discussed, its peak effect and last effect period are 1 to 3 hours and 3 to 5 hours individually. In the present case, the higher dose can lead to hypoglycaemic condition (Morales & Schneider, 2014). Further, low insulin dose can cause a hyperglycaemic condition. And, both hypoglycaemic and hyperglycaemia have a deleterious impact on the body of the patient (Bullock & Manias, 2017).

Ans 4) Type I diabetes mellitus patients have various negative health-associated outcomes. Moreover, such a patient usually has poor life quality. Colberg et al., (2015) demonstrated that type I DM imposed physical limitations on the patients. The patient might develop hypoglycaemia and body fatigue due to involvement in physical activity. In the present case, Zach is a 15-year-old boy and his interest in cricket. Children usually with his age engage in various physical activities and it is demonstrated in various piece of literature that physical exertion can lead to the development of hypoglycaemia (Abraham et al., 2018). Therefore, there is a maximum possibility that Zach can also develop hypoglycaemic episodes when he participates in cricket.

Morales & Schneider, (2014) explained the complication associated with the low and high blood sugar levels. The patient can develop weakness, low mental concentration, headaches and behaviour changes, which can hinder the patient's involvement in physical activity with their age mates. Further, complications develop due to T1DM leads to frequent hospitalization and check-up that can negatively impact the children' s presence in the school. Therefore, Zach is negatively affected by his medical condition throughout his life. Along with physical impact, the TIDM has a deleterious impact at the psychological level. Delamater et al., (2014) stated that young adults and children suffering from TIDM are also affected by anxiety, depression, psychological stress and eating disorder as compared to healthy counterparts.

In the present case scenario, Zach maybe feels low when he came to know that he will not actively participate in cricket now onwards. Therefore, it is paramount to monitor the blood sugar levels and interventions for hypo- and hyper-glycaemia. Moreover, the family members of the patients suffering from TIDM should take care of the nutritional intake and physical activities involvement of the patient. Additionally, children suffering from TIDM have restriction of not attending trips, camping, playing and sleeping at the friend's home. The above-stated restriction can impact Zach emotionally as he would think that he is not a normal kid. Further, unusual fear of development of hypoglycemic condition can also threaten the kid and make him stressed. Therefore, family and medical health care team support are paramount in the present case (Naranjo & Hood, 2013).

References for Type 1 Diabetes Mellitus

Abraham, M. B., Jones, T. W., Naranjo, D., Karges, B., Oduwole, A., Tauschmann, M., & Maahs, D. M. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Assessment and management of hypoglycemia in children and adolescents with diabetes.

American Diabetes Association. (2019). The big picture: Checking your blood glucose. Retrieved from https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/checking-your-blood-glucose

Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology. Pearson Higher Education AU.

Colberg, S. R., Laan, R., Dassau, E., & Kerr, D. (2015). Physical Activity and Type 1 Diabetes: Time for a Rewire? Journal of Diabetes Science and Technology, 9(3), 609-618.

Delamater, A. M, de Wit, M., McDarby, V., Malik, J., & Acerini, C. L. (2015). Psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes, 15(Suppl. 20), 232-244.

DiMeglio, L. A., Acerini, C. L., Codner, E., Craig, M. E., Hofer, S. E., Pillay, K., & Maahs, D. M. (2018). ISPAD Clinical Practice Consensus Guidelines 2018:Glycemic control targets and glucose monitoring for children,adolescents, and young adults with diabetes

Kahanovitz, L., Sluss, P. M., & Russell, S. J. (2017). Type 1 Diabetes – A Clinical Perspective. Point Care, 16(1), 37-40.

Morales, J., & Schneider, D. (2014). Hypoglycemia. The American Journal of Medicine,127(10 Suppl), S17-S24.

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine Connections, 7(1): R38–R46.

Satoh, T. (2014). Glucose uptake by Small Guanosine Triphosphatases in skeletal muscle and adipocytes. International Journal of Molecular Sciences, 15, 18677-18692; doi: 10.3390/ijms151018677

Slattery, D., Amiel, S. A., & Choudhary, P. (2018). Optimal prandial timing of bolus insulin in diabetes management: a review. Diabetic Medicine, 35(3), 306–316. https://doi.org/10.1111/dme.13525

‌Subramanian S, Baidal D, Skyler JS, Hirsch, B. (2016).The management of Type 1 diabetes. In K. R. Feingold. B. Anawalt, A. Boyce A (Eds.), Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc

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