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Endocrine System and Diabetes Management

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Added on  2023/05/30

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This presentation analyzes a case study of an 8-year old girl suffering from Type-1 Diabetes. It covers medication management, nursing process, family education, and alternative interventions for diabetes management.

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ENDOCRINE SYSTEM AND
DIABETES
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The following presentation aims to analyze a
case study of a 8-year old girl suffering from
Type-1 Diabetes.
The presentation will initiate medication
management of Daisy followed by nursing
process associated with Type 1 Diabetes
Management and Family Education
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Medications prescribed to Daisy Miller
8u NPH (neutral protamine Hagedorn) Insulin
BID
Novolin Regular BID
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Rational of Medication
NPH is intermediate acting insulin. It helps in decrease in the
blood glucose level of patients with type 1Diabetes Mellitus. Daisy
was administered with NPH insulin as her HbA1c is at margin
(5.2%). It will help to reduce the level of insulin in blood at the
normal range (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in
terms of its mode on diabetes mellitus. Journal of Traditional
Chinese Medicine, 34(2), 234-237.

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Rational of Medication
According to Ahmad (2014), NPH insulin works best when it is
administered with rapid-acting monomeric analogue insulin.
Novolin regular is rapid-acting monomeric analogue insulin. It
will help to reduce the random blood glucose level of Daisy
(22.3 mmol/L while the normal range is 4.4 to 7.8 mmol/L)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin
in terms of its mode on diabetes mellitus. Journal of
Traditional Chinese Medicine, 34(2), 234-237.
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Mode of Action of Insulin
Insulin once in blood binds to alpha subunit of glycoprotein receptor on
the surface of the cell
Insulin bound glyco-protein receptor is stimulated by insulin at the beta
subunit of the receptor
This lead to receptor activation followed by receptor tyrosine kinase
activity at the downstream
The activation of receptor leads to uptake of glucose molecule in blood
inside the cells (Pernicova & Korbonits, 2014)
References
Pernicova, I., & Korbonits, M. (2014). Metformin—mode of action and
clinical implications for diabetes and cancer. Nature Reviews
Endocrinology, 10(3), 143.
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Details of Insulin Mechanism
Hall, J. E. (2015). Guyton and Hall textbook of medical physiology e-
Book. Elsevier Health Sciences.

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Mode of Action of NPH Insulin and Novoline
NPH insulin is crystalline insulin suspension with protamine and since
which act as intermediate acting insulin.
The onset of action occurs during 1 to 3 hours with duration up to 24 hours
The peak action time is 6 to 8 hours
Novolin binds to insulin receptors on muscle and adipocytes
It immediately lowers the blood glucose level by facilitating the cellular
uptake of glucose (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in terms of its
mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2),
234-237.
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Desired Effects over the Patients
Action of NPH insulin and Novoline helps in the reduction of
blood glucose level of Daisy
It will mainly work in reducing the random blood glucose level
which will help in reduction in the appearance of glucose in
the urine (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin
in terms of its mode on diabetes mellitus. Journal of
Traditional Chinese Medicine, 34(2), 234-237.
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Steps of Preparing NPH Insulin
NPH is given through subcutaneous (SC) injection
It is prepared through mixing with regular insulin
Both the NPH insulin (8u) and regular insulin (7u) is combined with the help of
same syringe
NPH and normal insulin bind when mixed thus mixing should be done only
before the time of medicine administration (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in terms of its
mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2), 234-
237.

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Adverse Effects of Insulin
The common side effects of insulin administrations include
Sudden drop in the blood glucose level (hypoglycemia) leading to nausea,
dizziness, lightheadedness, sweating and fast heart rate. (Pedersen-Bjergaard et
al., 2014)
This is the reason why doctors recommended for periodic monitoring of the
blood glucose level of Daisy
References
Pedersen-Bjergaard, U., Kristensen, P. L., Beck-Nielsen, H., Nørgaard, K., Perrild, H.,
Christiansen, J. S., ... & Tarnow, L. (2014). Effect of insulin analogues on risk of
severe hypoglycaemia in patients with type 1 diabetes prone to recurrent severe
hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-
endpoint crossover trial. The lancet Diabetes & endocrinology, 2(7), 553-561.
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Other adverse effects of insulin
Swelling of arms and legs
Weight gain
Confused state
Difficulty in communicating
At the site of injection there can be irritability, swelling and itching
(Pedersen-Bjergaard et al., 2014)
References
Pedersen-Bjergaard, U., Kristensen, P. L., Beck-Nielsen, H., Nørgaard, K., Perrild, H., Christiansen, J. S., ... & Tarnow, L.
(2014). Effect of insulin analogues on risk of severe hypoglycaemia in patients with type 1 diabetes prone to
recurrent severe hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-endpoint
crossover trial. The lancet Diabetes & endocrinology, 2(7), 553-561.
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Interaction of Insulin with other Medication
Externally supplied insulin can interact with other medications like
Other anti-diabetic agent
Anti-bacterial and antiviral agent
Agent affecting growth hormone
(American Diabetes Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80.

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Nursing Process
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Pre-Medication Assessment
Pre-medication assessment will mainly include proper assessment of
the blood glucose level along with monitoring of the weight. This will
help to determine dosage
Other pre-medication assessment include
Checking the sterilization of the needle
Injection site selection
(American Diabetes Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in
diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80.
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Post Medication Assessment
Post Medication Assessment will be done mainly by checking the blood glucose level by random
blood glucose test and HbA1c test.
Checking blood glucose level can be done by the use of glucometer
The level of extra blood glucose will also be tested by the urine test (American Diabetes
Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes
care, 37(Supplement 1), S14-S80

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Alternative Intervention
Diet management
Diet plan of daisy will mainly include regular small meals at frequent interval
Meal will be rich in protein, fruits and vegetables
Meal will avoid deserts, chocolates and aerated drinks and other junk food
(Atkinson, Eisenbarth & Michels, 2014)
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1
diabetes. The Lancet, 383(9911), 69-82.
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Expected Outcome and Evaluation
Expected outcome will be reduction in the blood glucose level
Reduction in the blood glucose level can be monitored by
conducting blood test like random blood glucose test and
HbA1c test (Atkinson, Eisenbarth & Michels, 2014)
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1
diabetes. The Lancet, 383(9911), 69-82
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Expected Outcome and Evaluation
Improvement in the body mass index of Daisy
This will be monitored by measurement of the body
weight and the body mass index
Monitoring of the level of ketone bodies in blood.
Decrease in the level of ketone bodies will indicate
positive outcome
(Atkinson, Eisenbarth & Michels, 2014).
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014).
Type 1 diabetes. The Lancet, 383(9911), 69-82

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Patient/Family Education
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Family Education
Three important factors contributing Type 1 Diabetes
among Children are
Genetic Predisposition
Lack of physical activity
Increased consumption of calorific food
(Hilliard et al., 2013)
References
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood,
K. K. (2013). Predictors of deteriorations in diabetes
management and control in adolescents with type 1
diabetes. Journal of Adolescent Health, 52(1), 28-34.
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Indicators of type 1 Diabetes
Sudden loss of weight
Increase in appetite
Fatigue
Nausea
Appearance of glucose in blood
Increase level of thrust
(Hilliard et al., 2013)
References
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K.
(2013). Predictors of deteriorations in diabetes management and
control in adolescents with type 1 diabetes. Journal of Adolescent
Health, 52(1), 28-34.

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Path physiology of Diabetes
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K.
(2013). Predictors of deteriorations in diabetes management and
control in adolescents with type 1 diabetes. Journal of Adolescent
Health, 52(1), 28-34.
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Proper Management of Diabetes
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013).
Predictors of deteriorations in diabetes management and control in
adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28-
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Special Education To Daisy’s Mother
Importance of immunization
A detailed feedback of the ideal body weight
and body mass index of Daisy

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Conclusion
Proper medication management and proper
regulation of diet and physical activity helps
in effective management of type 1 diabetes
mellitus
For effective dosage modulation (insulin
dose) periodic monitoring of blood glucose
level is important
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