In-Depth Case Study: Comprehensive Management of Type 1 Diabetes

This case study delves into the intricacies of managing Type 1 Diabetes, focusing on a patient named Ben and his treatment with insulin Aspart (Novorapid) and insulin Glargine (Lantus Solostar). It addresses the essential components of insulin prescriptions, the pharmacological actions of the prescribed medications, and the importance of proper timing for insulin administration. The study also highlights the causes, symptoms, and treatment of hypoglycemia, emphasizing the crucial role of nurses in medication administration, including adherence to the five rights and appropriate injection techniques. Furthermore, it explores potential long-term complications of Type 1 Diabetes and the psychosocial challenges patients may face, providing a comprehensive overview of the multifaceted aspects of managing this chronic condition. Desklib offers a platform for students to access this and many other solved assignments and past papers to aid in their studies.

Running Head: CASE STUDY ON DIABETES TYPE 1
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CASE STUDY ON DIABETES TYPE 1
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Table of Contents
Part A....................................................................................................................................................2
Answer first of part A........................................................................................................................2
Answer second of part A...................................................................................................................2
Answer third of part A.......................................................................................................................3
Answer fourth of part A.....................................................................................................................3
Answer fifth of part A.......................................................................................................................4
Answer sixth of part A.......................................................................................................................4
Answer seventh of part A..................................................................................................................4
Answer eighth of part A....................................................................................................................5
Answer ninth of part A.....................................................................................................................5
Answer tenth of part A......................................................................................................................5
Answer eleventh of part A.................................................................................................................6
Part B.....................................................................................................................................................6
Answer first of part B........................................................................................................................6
Answer second of part B....................................................................................................................7
References.............................................................................................................................................8

CASE STUDY ON DIABETES TYPE 1
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Part A
Answer first of part A
Components of insulin medication
1. date and the time when the order is written
2. name of the drug
3. dosage of drug
4. dosage strength
5. dosage form
6. route of administration of the drug
7. The angle of the injection
8. Frequency and duration of drug administration
9. Duration of therapy
10. Indication for use
11. Signature of physician
Importance of these components
 To avoid any confusion related to the drug administration
 To prevent the medication errors
 To provide the right medication to the right patient (Steineck, Cederholm,
Eliasson, Rawshani, Eeg-Olofsson, Svensson, & Gudbjörnsdóttir, 2015)
Answer second of part A
As discussed in the case study that the patient admitted to the emergency department
due to severe hypoglycaemia which occurs due to imbalanced insulin or insulin resistant.

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Aspart injected subcutaneously helps to decrease the blood glucose level and takes only 10 to
20 minutes to act after injected. Lantus Solostar is the long acting medicine that starts to work
several hours after delivering and it keeps working for around 24 hours. The two medicines
help to act immediately and exhibit long lasting effects. Therefore prescribing these
medicines to Bens was a good idea.
Diabetes type 1 is the result of autoimmune destruction of beta cells that produce
insulin in the pancreas. Insulin Aspart binds to the beta subunits consisting of receptors on the
fat and muscle cells and inhibits the secretion of glucose out of the liver. The primary action
of insulin Glargine (Lantus) is regulating glucose metabolism. It lowers blood glucose levels
by triggering peripheral glucose uptake by muscles and inhibiting the hepatic glucose uptake.
(Haidar, Elleri, Kumareswaran, Leelarathna, Allen, Caldwell, & Dunger, 2013)
Answer third of part A
The onset of action of Aspart insulin occurs within ten to twenty minutes of injection.
The duration of action of is three to five hours. Peak time is 15 minutes. This insulin should
be administered after or shortly before or shortly after eating to control the levels of blood
glucose after a meal. This is because the levels of insulin disturbed after meal. Taking
Novorapid 15 to 20 minutes before eating can provide a significant improvement in after-
meal control (Slattery, Amiel, & Choudhary, 2018)
Answer fourth of part A
Hypoglycaemia (low blood sugar) is the condition which occurs when insulin levels
are high and glucose (sugar) levels are low in the blood. Causes of hypoglycaemia includes
Excessive use of insulin or other medications that increase insulin levels, disturbed eating
habits after taking medications, Skipping meals, Exercising vigorously without proper

CASE STUDY ON DIABETES TYPE 1
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nutrition, and Excess consumption of alcohol when on medications, especially if it replaces
food.
Symptoms
Symptoms of hypoglycaemia includes Excessive sweating, Shakiness, Dizziness,
Moodiness and irritability, Drowsiness, and Confusion (Kalra, Mukherjee, Venkataraman,
Bantwal, Shaikh, Saboo, & Ramachandran, 2013).
Treatment
The patient with hypoglycaemia needs to eat or drink juices or fruits that can rise blood
sugar level immediately for example, sugar tablets, fruit juice and carbohydrate snack. In
severe case of hypoglycaemia the patient may be prescribed glucagon hormone.
(International Hypoglycaemia Study Group, 2015).
Answer fifth of part A
Understanding the medication before administration is very important for every nurse
or register nurse to avoid any medication errors like wrong medicine, wrong doses, wrong
time, route of administration and concentration. Understanding the medication also helps the
nurse to have information about the possible side effects of a particular medication and any
allergies that the patient has related to a specific type of medicine (Athanasakis, 2015).
Answer sixth of part A
The five rights of medication administration include
1. The right patient
2. Right time
3. Right Dose

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4. The right route of administration
5. Right drug
Why it is important to follow these rights
 The right drug at right time with right doses helps to achieve the goal already set for
the patient. Avoiding these rights may cause health issues and the patient might take
legal issues against the health provider (Kim & Bates, 2013).
Answer seventh of part A
The insulin pen needle size should be used in case of Ben is 4 mm which is the standard
length. It was also found that needles with long size cause more pain to compare to short
needles. 4 mm needle is enough to deliver the drug in subcutaneous tissues of the body and
fear might be there when administrating the medication (Frid, Kreugel, Grassi, Halimi, Hicks,
Hirsch, & Kalra, 2016).
Answer eighth of part A
Nursing Assessment
 The patient should be examined for any allergy to insulin Novorapid or any
other contents of this medicine. Because the allergies can impact the beneficial
effects of the medicine (American Diabetes Association, 2016).
 A nurse should use new needle, already used needle may spread infection
(Heise, Hövelmann, Brøndsted, Adrian, Nosek, & Haahr, 2015).
Answer ninth of part A
The best site for injecting Novorapid is abdomen in case of Ben because this part of the
body is easy to reach and the insulin is absorbed more quickly. The skin should be folded 1 or
2 inches to reduce the risk of reaching the injection to muscles. The medicine should be

CASE STUDY ON DIABETES TYPE 1
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injected at 90-degree angle as it is the easiest angle to inject in the folded skin and ben may
feel less pain in this way (Frid, Kreugel, Grassi, Halimi, Hicks, Hirsch, & Kalra, 2016).
Answer tenth of part A
The documentation should be done inpatient data sheet or EMAR (electronic
medication administration record) and it will include information of:
 The timing of injection and understanding of insulin action
 Site for injection
 Needle length
 Correct dose selection
 Evidence of damaged injection site with size and location of damage
 Issues like physical deficit or psychological issues
 And any side effects
Keeping records is necessary to ensure that the right medicine has been administered to
the right patient art right time and in a prescribed quantity (Australian Commission on Safety
and Quality in Health Care, 2014).
Answer eleventh of part A
 After administration insulin to ben nurse should examine the blood glucose level. This
is because checking the levels confirms that the medication worked for him
 Ben should be checked for blood ketone level to ensure that the ketone levels are
controlled.
 He should also be assessed for any side effects (Adhikari, Poudel, Rajbanshi, &
Shrestha, 2018)

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Part B
Answer first of part B
 The patient may feel continue fatigue and this may result in a lack of exercise
 He may also have gastroparesis which means delayed emptying the food material
from the stomach. This may leads to bloating, nausea, heartburn.
 Kidneys damage may also occur over time due to reduced blood filtration.
 Decreased blood flow to the routine can cause eye damage or blindness (Freeborn,
Dyches, Roper, & Mandleco, 2013).
Answer second of part B
 The patient may feel tired due to regular testing of blood glucose
 Ben may also face a problem in remembering to take the medication on time
 Stress may be there
 Sometimes the patients develop “why me” thoughts and feeling alone with their
diabetes
 He likes to play football, being tired due to fatigue may not allow him to do exercise
and this may affect him.
 Diabetes may also cause behavioral changes (Nicolucci, Kovacs Burns, Holt,
Comaschi, Hermanns, Ishii, & Tarkun, 2013).

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References
Adhikari, S., Poudel, R. S., Rajbanshi, L., & Shrestha, S. (2018). Assessment of Insulin
Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal. Nursing
Research and Practice, 2018. 6
American Diabetes Association. (2016). 13. Diabetes care in the hospital. Diabetes
Care, 39(1), S99-S104.
Athanasakis, E. (2015). The method of checking medications prior to administration: an
evidence review. International Journal of Caring Sciences, 8(3), 801.
Australian Commission on Safety and Quality in Health Care (2014). User guide for nursing
and care staff. Retrieved from:
https://www.safetyandquality.gov.au/wp-content/uploads/2012/02/SAQ123_NursesUse
rGuide_V6.pdf
Freeborn, D., Dyches, T., Roper, S. O., & Mandleco, B. (2013). Identifying the challenges of
living with type 1 diabetes: child and youth perspectives. Journal of clinical
nursing, 22(13-14), 1890-1898.
Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., & Kalra, S. (2016).
New insulin delivery recommendations. In Mayo Clinic Proceedings, 91(9), 1231-1255
Haidar, A., Elleri, D., Kumareswaran, K., Leelarathna, L., Allen, J. M., Caldwell, K., &
Dunger, D. B. (2013). Pharmacokinetics of insulin Aspart in pump-treated subjects with
type 1 diabetes: reproducibility and effect of age, weight, and duration of
diabetes. Diabetes Care, 36(10), e173-e174.

CASE STUDY ON DIABETES TYPE 1
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Heise, T., Hövelmann, U., Brøndsted, L., Adrian, C. L., Nosek, L., & Haahr, H. (2015).
Faster‐acting insulin Aspart: earlier onset of appearance and greater early
pharmacokinetic and pharmacodynamics effects than insulin Aspart. Diabetes, Obesity
and Metabolism, 17(7), 682-688.
Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to
guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.
Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., &
Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™):
Cross‐national benchmarking of diabetes‐related psychosocial outcomes for people
with diabetes. Diabetic medicine, 30(7), 767-777.
Slattery, D., Amiel, S. A., & Choudhary, P. (2018). The optimal prandial timing of bolus
insulin in diabetes management: a review. Diabetic Medicine, 35(3), 306-316.
Steineck, I., Cederholm, J., Eliasson, B., Rawshani, A., Eeg-Olofsson, K., Svensson, A. M.,
& Gudbjörnsdóttir, S. (2015). Insulin pump therapy, multiple daily injections, and
cardiovascular mortality in 18 168 people with type 1 diabetes: observational
study. BMJ, 350, h3234.
International Hypoglycaemia Study Group. (2015). Minimizing hypoglycemia in
diabetes. Diabetes Care, 38(8), 1583-1591.
Kalra, S., Mukherjee, J. J., Venkataraman, S., Bantwal, G., Shaikh, S., Saboo, B., &
Ramachandran, A. (2013). Hypoglycemia: The neglected complication. Indian journal
of endocrinology and metabolism, 17(5), 819.