Case Study: Managing Type 1 Diabetes in a Community Setting

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Long-term conditions usually lead to poor quality of life, cause longer hospital stays and also
have poorer clinical outcomes. These are the conditions that lack any direct cure and only
the complications and symptoms can be controlled, up to an extent, for these conditions
through appropriate treatment modalities. If these are managed effectively in the
community, the lives of affected people can be relatively stabilised and frequent hospital
visits can also be reduced (Goodwin et al. 2010). This case study aims to explore a patient’s
management of a long-term condition (LTC), Type 1 diabetes, in the community setting. It
considers the patient’s management holistically and describes the impact of the illness on
her physical and mental well-being. The role of a nursing associate in assessment of the
patient’s anatomical, physiological and pharmacological state will be further defined.
75yrs old, Mrs. X has been referred to the hospital following fall at her home. She stays
alone at her home and was going to bathroom, when she fell down. She had no injuries but
got little anxious following the incident. She had been brought to the hospital to manage her
mental state along with her blood sugar level owing to her type 1 diabetes. She is a known
case of insulin dependent diabetes since last 5 yrs and takes insulin twice a day.
Diabetes is a group of progressive and chronic disorders with the characteristic sign of
elevated blood sugar level (Atkinson et al, 2011). Generally, it can be type 1 or type 2 where
the type 1 diabetes is an autoimmune disease caused by the destruction of insulin-secreting
alpha cells. In this condition, little or no insulin is produced in the body (Bluestone, Herold
and Eisenbarth, 2010). As insulin is not produced in the body, blood glucose builds up in the
body and is also passed out in urine leading to symptoms like increased thirst, increased
urination, tiredness, increased appetite, weight loss and blurred vision (Diabetes UK, 2016).
Long term conditions (LTCs) include diseases like asthma, epilepsy, hypertension, etc and
diabetes is a commonly occurring LTC. The cases of this disease are rising at an alarming rate
and a large part of National Health Service Budget is being spent on diabetes affected
people (Kings Fund, 2015). It is estimated that around 10 billion pounds are spent every year
on managing diabetes cases that is almost 10% of total NHS budget and therefore, it is
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recommended by NHS Five Year Forward View (2014) to effectively manage diabetes on
priority (Mishra, Cavan and Sinclair, 2015). However, nearly 90% of all diabetes cases
account for Type 2 diabetes, but the incidence of type 1 diabetes is on the rise as well
(Diabetes UK, 2015). Once it was thought that type 1 diabetes only affect children and
adolescents but established, now, it is an established fact that type 1 can occur at any age
(Atkinson et al, 2011). (Ostman et al, 2008).
As Mrs. X was bought to the hospital following the fall, she was first of all assessed for any
injuries. It was found that there were no physical injuries; however, the patient had become
quite anxious after the incidence. Mrs. X lives alone in her house and her children, a son and
a daughter lives quite far. They try to make frequent visits to Mrs. X but are able to visit only
twice or thrice a week. On daily basis, Mrs. X is supported and assisted by a carer but she
also leaves at night. Thus, Mrs. X got very scared and anxious after falling.
On her further assessment, she was found with unstable blood glucose levels. Although Mrs,
X was having insulin regime of taking premixed 70/30 before breakfast, regular insulin prior
dinner and NPH at the bedtime. She was also found to have thorough knowledge of
recommended diet, used to measure blood glucose at home and also know about normal
blood sugar range. But still, her blood glucose was unstable that may be due to her high
anxiety and stress level (Rundell and Wise, 2002).
Unstable blood glucose levels have devastating impact on overall health of patient. They
suffer from regular symptoms of polydipsia, polyphagia, polyuria, reduced weight, etc and
the chances of complications also increases manifold (Rubin et al, 2014). It may exert
negative impact on major organs and systems as cardiovascular system and renal system
and can lead to renal failure and cardiovascular diseases (Gale, 2005). It is further revealed
that the chances of myocardial infection and stroke is 10 times more in patients with type 1
diabetes as compared to type 2 (Orchard et al, 2006). In addition, the basic quality of life of
affected person becomes poor where there is loss of independence, reduced functionality
and psychological distress (Moussavi et al, 2007). Thus, to improve quality of life of Mrs. X
and prevent complications, it becomes essentially important to manage this unstable blood
glucose level (NHS, 2015). It required reconsideration of her medications, dietary regime
and her physical activity schedule. Along with this, she needed to be supported mentally
and emotionally (Hirsch, 2009).
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For managing anxiety and stress of Mrs. X, social support, psychotherapy or cognitive
therapy may be used. Her family may be actively involved in designing her care and
treatment plan that can address her individual needs in most appropriate manner (Dean,
2014). Following the assessment of her anxiety levels, she would be educated about anxiety
and its impact on her diabetes and overall health. Relaxation techniques may be used like
deep breathing or music therapy and other stress management techniques may also be
used. She may be encouraged to involve in social groups, activities, etc (Rubin, Wadden, and
Bahnson, 2014). Further, for her enhanced safety and mental peace, improved safety
measures of putting bars, handles, anti skid flooring, etc may be installed at her house. This
would increase her confidence and wellness. Her daughter, who is very close to Mrs. X, may
also be contacted and involved to support her well and overcome this difficult situation
(Miller and Rollnick, 2002).
It can be concluded from this report that people suffering from long-term condition need
high-quality care so that associated complications can be prevented and they can lead a
quality life. As Mrs. X came to the hospital following fall and is also known to have type 1
diabetes, it becomes essential for service providers to assess her individual needs and
address these needs effectively. In addition to identifying her physical health needs, her
social and emotional needs must also be identified and addressed to enhance health
outcomes and patient satisfaction levels. Nursing assessment should include a holistic view
of the patient as well as careful consideration of physical signs and symptoms (Price, 2015).
This means appropriate assessment also considers the patient's lifestyle, mental health,
financial situation and family support. Thus, following her treatment of fall and other
immediate requirements, she was supported and educated to control her long-term
condition diabetes (Wilkes et al. 2013).
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