• Subject Name : Nursing

Question 1: Need for Insulin and Pathophysiology of The Disease

Answer: Insulin is a hormone produced by the pancreas that helps in regulating the blood glucose levels of the body. Poor management of blood glucose due to poor secretion or absorption of insulin results in diabetes. Diabetes type I is a medical condition where the body of a patient fails to produce an adequate amount of insulin required for glucose level management due to damaged insulin-producing cells (Lin et al., 2018). The digestion of food results in its metabolism to simpler compounds where complex carbohydrates are broken into simpler sugars like glucose that acts as the primary source of energy in the body. Insulin present in the blood signals the uptake of this glucose (Meldgaard et al., 2019). However, if insulin-producing cells of the pancreas are compromised the amount of insulin required for healthy blood glucose levels in individual drops resulting in the accumulation of glucose in the blood stream.

This glucose is not taken up by the cells and result in excessive urination and dehydration along with tissue damage and multiple health complexities. Type I diabetes occurs when the insulin-producing cells of the pancreas, beta cells are damaged by the immune system that can be triggered because of multiple genetic or epigenetic factors (Dewangan & Pandey, 2017). In the case of Zach, administration of insulin is the suitable choice as it will help in immediate normalization of the blood glucose levels and thus prevent damage to the body caused by excessive blood sugar levels. Administration of insulin will help in absorption of the blood glucose in the body and thus promote lowering of the blood glucose levels in the patient, that is, to blood glucose levels to be less than 140mg/dl after two hours of food consumption (Riddell et al., 2017).

Question 2: Suitable Time for Novo Rapid Administration

NovoRapid has a fast onset and is ideally provided immediately before consumption of meal in a hyperglycemic individual with a high blood glucose level. Patients with high blood glucose levels can also be administered NoviPaped soon after the meal (Amini et al., 2019). The insulin through this method is administered using CSII in a pump system to promote insulin infusion. The administration of NovoRapid should be critically monitored as per the meals. The compound needs 10-20 minutes to work in action after injection in the body. The drug has maximum effect for from 1 hour to 3 hours on injection and is rendered ineffective after 3 to 5 hours (Kwok et al., 2017). It is critical to follow the timings of NovoRapid administration as poor knowledge or intake in respect with meals can lead to severe side effects and hypoglycemic health conditions in the patients (Amini et al., 2019).

Question 3: Significance of Checking Blood Glucose Levels Before and After a Meal in Diabetes

Checking the blood glucose levels before and after meals is a significant management strategy in the patients with diabetes as it helps in testing the blood glucose levels before and after food consumption and identify how the meal is affecting your health (Lennerz et al., 2018). Therefore, it becomes easier for the patients to monitor their health and record the observations about what food is suitable for them and thus help in the management of the health condition. Further, effective monitoring of blood glucose levels before and after meals also helps in the determination of diabetes medications and acknowledge the health and management goals. For Zach, it becomes crucial to test the blood glucose levels before and after administration of NovoRapid to see the impact of drug and its efficacy for successful glucose level management (MacFarlane, 2017).

Question 4: Physical Challenges with Diabetes Type I and Emotional Impacts on The Life of Zach

Answer: Zach is only 15 years old and has been diagnosed with a chronic health condition of Diabetes. Management of the health condition and need of precautions for life long will require Zach to bring changes in his lifestyle and everyday activities and thus will have severe impacts on the physical as well and emotional health of Zach. The physical impacts of diabetes include increased thirst and frequent need to urinate (MacFarlane, 2017). The patient will also experience fatigue that will restrict excess physical movement which could impact the physical play time in the life of Zach (Amini et al., 2019). Diabetes also contributes to blurred vision and may cause a tingling sensation and pain in the limbs of the patient (Speight et al., 2020). This will limit the movement of Zach and thus will also affect the game he plays with his mates. Other than these physical challenges, Zach is also likely to face several emotional challenges that are associated with chronic disease management. Having developed a condition at a young age Zach will be required to demonstrate extreme patience and will to control his diet intake in terms of sugars and carbohydrates. Given that Zach works in McDonald's in his part-time as a high school student, it can be difficult at times for Zach to control his urge. These control measures can sometimes result in anxiety and stress for not being able to do things that fellow school mates might be able to and thus impact the overall quality of life of Zach., Therefore, not only physical care and management of diabetes will be required to ensure the well being of the patient, but, immense psychological support to promote self-management and healthy living will also be needed (Lin et al., 2018). Anxiety, stress, and disordered eating will also require management with constant support to ensure that Zach controls his blood glucose levels effectively to limit the comorbidities and live a healthy life (Speight et al., 2020).

References for Pathophysiology and Management of Diabetes

Amini, F. G., Nia, A. F., Sharbafi, M. H., Khandari, A., & Gargari, S. S. (2019). Comparison between the effect of regular human insulin and NPH with novo-rapid and levemir insulin in glycemic control in gestational diabetes. Human Antibodies, 27(4), 285-289 https://content.iospress.com/articles/human-antibodies/hab190385 .

Dewangan, V., & Pandey, H. (2017). Pathophysiology and Management of Diabetes: A Review. Research Journal of Pharmacology and Pharmacodynamics, 9(4), 219-222. http://www.indianjournals.com/ijor.aspx?target=ijor:rjppd&volume=9&issue=4&article=011

Kwok, R., Sztal‐Mazer, S., Hopkins, R. E., Poole, S. G., Grannell, L., Coutsouvelis, J., & Topliss, D. J. (2017). Evaluation of NovoRapid infusion as a treatment option in the management of diabetic ketoacidosis. Internal Medicine Journal, 47(11), 1317-1320. https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.13607

Lennerz, B. S., Barton, A., Bernstein, R. K., Dikeman, R. D., Diulus, C., Hallberg, S., ... & Ludwig, D. S. (2018). Management of type 1 diabetes with a very low–carbohydrate diet. Pediatrics, 141(6). https://pediatrics.aappublications.org/content/141/6/e20173349?fbclid=IwAR0KQiHeJnh6sBSWqfbK4NqLlLSIyeSQQjJVhhfDMvW_sYbvfJTMyTdMz1k

Lin, Y. C., Chang, Y. H., Yang, S. Y., Wu, K. D., & Chu, T. S. (2018). Update of pathophysiology and management of diabetic kidney disease. Journal of the Formosan Medical Association, 117(8), 662-675. https://www.sciencedirect.com/science/article/pii/S0929664617308033

MacFarlane, B. (2017). Advancing your practice: Blood glucose monitor accuracy: Why it is so important. AJP: The Australian Journal of Pharmacy, 98(1164), 58. https://search.informit.com.au/fullText;dn=996377948820922;res=IELAPA

Meldgaard, T., Keller, J., Olesen, A. E., Olesen, S. S., Krogh, K., Borre, M., ... & Drewes, A. M. (2019). Pathophysiology and management of diabetic gastroenteropathy. Therapeutic Advances in Gastroenterology, 12, 1756284819852047. https://journals.sagepub.com/doi/abs/10.1177/1756284819852047

Riddell, M. C., Gallen, I. W., Smart, C. E., Taplin, C. E., Adolfsson, P., Lumb, A. N., ... & Annan, F. (2017). Exercise management in type 1 diabetes: a consensus statement. The lancet Diabetes & Endocrinology, 5(5), 377-390. https://www.sciencedirect.com/science/article/pii/S2213858717300141

Speight, J., Holmes‐Truscott, E., Hendrieckx, C., Skovlund, S., & Cooke, D. (2020). Assessing the impact of diabetes on quality of life: what have the past 25 years taught us?. Diabetic Medicine, 37(3), 483-492. https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.14196

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