401209 Health Variations Assessment

401209 Health Variations 2 Assessment 2 Case study
Question 1. (10 marks)
Explain why Sarah has been prescribed insulin. Relate to the pathophysiology of
type 1 diabetes and the mechanism of action of insulin. Support your answer with
academic references.
Type 1 diabetes is a metabolic disorder which is characterised by the destruction of
immune mediated pancreatic Beta cells causing insulin deficiency (Oram, sims &
Evans-Molina, 2019). People with type 1 diabetes have a reduced Beta cell mass in
association with insulitis which is a characteristic lymphocytic infiltration limited to the
islets of Langerhans and early diagnosis (Pugliese, 2016). The autoimmune
destruction takes place in the individuals who are susceptible genetically by
triggering of one or more environmental factors and gradually progresses with time
(Paschou, 2018).
The primary clinical characteristic of diabetes is hyperglycaemia (Zaccardi et al.,
2016). Early diagnosis is important to prevent any complications from arising from
diabetes. Studies show that children under 15 years of age are mainly affected by
type 1 diabetes (Kumar, 2015). Children who have type 1 diabetes must include
insulin in their treatment plan because in type 1 diabetes, the body cannot make
insulin anymore and therefore, patients with diabetes type 1 must get the proper
amount of insulin to keep their sugar levels in the blood in a normal range.
Sarah is diagnosed with type 1 diabetes and hence must be prescribed with insulin.
Insulin functions by targeting the cell and then binds with the receptor on the cell
surface. This helps in taking the glucose into the body from the blood stream. Insulin
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functions by inhibiting gluconeogenesis in the liver and stimulates glycogenesis
thereby increasing the amino acid uptake into the cells. Insulin also helps in
stimulating protein synthesis and promote or increases the fat storage, eventually
leading to maintaining a normal glucose level in the blood of the affected individual
(Petersen & Shulman, 2018).
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Question 2. (5 marks) Support your answer with academic references
a) What is the onset, peak and duration of action for NovoRapid insulin according to
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed.)?
According to Bullock and Manias, 2017, the onset of action of NovoRapid is 15
minutes, peak time is 1-3 hours and the duration is 5 hours.
b) When should NovoRapid be administered in relation to food and why?
NovoRapid is always administered just before a proper meal containing
carbohydrates. This is because the fast onset of action of NovoRapid closely mimics
the normal physiological postprandial insulin release than the soluble insulin in
humans (Rini et al., 2015).
Question 3. (10 marks) Support your answer with academic references
a) Define hypoglycaemia
Hypoglycaemia is a condition characterised by a lower blood glucose level less than
4 mmol/L when tested with a blood glucose meter. Hypoglycaemia is caused when
the body produces insulin in a larger amount causing the sugar level in the blood to
drop or significantly reduce (Mathew & Thoppil, 2018).
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b) What causes hypoglycaemia?
Hypoglycaemia is caused by an imbalance between insulin, glucose and activity of
the body. When a person takes an overdose of insulin or any other diabetic
medication, or having insufficient or skipping meal causes hypoglycaemia.
c) What are the symptoms of hypoglycaemia?
Symptoms of hypoglycaemia can be categorized into three phases –
1. Early symptoms are shakiness, sweating, hunger, headache, anxiety
2. Night-time symptoms include tiredness, irritation feeling, nightmares and
confusion when waking up from sleep
3. The severe symptoms of hypoglycaemia include clumsiness, muscle
weakness, difficulty in speech, blurry vision, confusion, unconsciousness.
d) How is hypoglycaemia treated?
The major treatment of hypoglycaemia includes instantaneous treatment in elevating
the glucose level, and treatment of the major cause that’s causing hypoglycaemia.
Early symptoms can be treated by consuming about 15-20 grams of carbohydrates.
If the symptoms are severe, and there is difficulty in the consumption of meal
through mouth, then glucagon injection or intravenous (IV) glucose should be
provided. If the condition is far more severe and there are continuous reoccurrence
of hypoglycaemia then doctor should be consulted.
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