Nursing Care for Type I Diabetes: Diagnostic Procedures, Pathophysiology, and Management

This article discusses the diagnostic procedures, pathophysiology, and nursing management of Type I Diabetes. It covers insulin treatments, dietary management, and pharmacological protocols. It also provides a nursing care plan and discharge care plan for Type I Diabetes.

NURSING CARE CASE STUDY
UNIVERSITY:
NAME :
ASSIGNMENT

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Introduction
Type I diabetes is a chronic diseases which is characterised by increased high blood
pressure referred to as hyperglycaemia. It is autoimmune disease which often results on the
attack of pancreatic better cells produced by insulin. Lack of adequate insulin, leads to rise in
blood glucose, many children are affected by type 1 diabetes, due to the body inactivity to
produce insulin. This leads to breaking down of fats to be used as an alternate source of
energy, these results into release of ketones, (Atkinson, 2014 pp. 70). The child in the case
study has depicted this characteristics couple with increased thirst and urination. Thus this
review assesses the diagnostic procedures suitable for the patient and nursing approach in
managing type 1 diabetes.
Diagnostic procedures of Type 1 Diabetes
Type I diabetes is often diagnosed suddenly or unexpectedly. The disease often presents
with symptoms that appear as cold or flu. Its initial presentation is characterised by flu or
malaise but medical practitioners often spot the signs quickly and request for additional tests.
i) Glycated haemoglobin tests, (A1C)
The blood tests in this diagnostic indicate the average blood sugar level for the last 2-3
months. It is useful in measuring the percentage of blood sugar which is present in the
oxygen carrying capacity in haemoglobin. The higher blood sugar often has more
haemoglobin with sugar attachment. A1C of 6.5% or more in two independent tests is an
indicative of diabetes, (Chiang et al, 2014 pp. 2040).
ii) Random blood sugar tests
The blood sample can be taken at random times which may be confined with repeated
tests. Values are expressed in milligrams per decilirter- mg/Dl or millimolesper litter-
mmol/L .random blood sugar tests of 200mg/Dl or 11.1 mmol/L or higher are often an
indicative of diabetes. When it is compounded with symptoms such as urination and extreme
thirst as for the child in the case study confirms the prognosis.
iii) Fasting blood sugar tests
This involves taking blood samples which are taken over night. A fasting blood sugar
which is less than 100mg/Dl or 5.6 mmol/L shows normal levels. Fasting blood sugar level
from 100-125mg/Dl or 5.6-6.9mmol/L shows a pre diabetes stage, while readings of 126
mg/dL or 7 mmol/L shows diabetes stage, (Orchard et al, 2015, pp 50).
Ongoing monitoring of blood sugar levels is key in diagnosing type 1diabetes. Fasting
blood glucose is key in assessing how the body tolerates blood glucose levels fasting night. It

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gives an overview of how the body works without food impact. Oral glucose tolerant further
is essential, in that people take blood tests, by drinking sugar and then measuring their blood
sugar over period of two hours. This is an indicative measure of benchmarking the tolerance
of sugar in the body, and how carbohydrates re are treated in the body. Random blood sugar
testing is essential in assessing the current status of blood sugar levels of the patient. It is the
first tests taken by doctors to assess elevation.
After diabetes diagnosis, assessment of A1C levels are assessed, as they vary
depending on the age, making comparisons with various tests provides effective management
plan. Further to complement the diagnostic tests, blood and urine samples will be regularly
assessed to check the cholesterol levels, functionality of thyroid, kidney and liver functions,
(Santin et al, 2015, pp. 35).
Path physiology of type 1 diabetes
Type 1 diabetes is chronic diseases affecting the autoimmune system which occurs as
susceptible individual which may be further compounded by environmental factors. The
immune system is triggered by the development of auto immune response which is against
beta cell antigens or molecules which develop the autoimmune response against the beta cell
antigens of pancreas. Is approximated that 85% of type 1 diabetes have circulating islet,
which majority of the patients have detectable anti insulin antibodies, which are against the
glutamic acid decarboxylase in the pancreatic cells, (Dabelea et al, 2017 pp. 828-830).
Various scenarios have been put forward on the development of type 1 diabetes.
Environmental triggers have been shown to trigger and induce islet autoimmunity and beta
cell death, which leads to sequence of pre diabetic stage and eventual onset of type 1
diabetes. In wide variations of time between the autoimmunity and clinical onset of type 1
diabetes, have been shown to be present in the interactions of genetic factors and
environmental factors which contribute to the diseases.
In clinical cases type 1 diabetes occurs due to the circulating insulin which is low or not
available in plasma glucagon or elevated in , there is failure of pancreatic cells in responding
to insulin secretory stimuli. The pancreas exhibit lymphocytic infiltration and destruction
which leads to failure of the cells which secrete the insulin in the langerhands islets, which
causes insulin deficiency. The observed deficiency of insulin causes many physiological
processes which is characterised by the destruction and disruption of glucose uptake. In
extremes cases insulin deficiency leads to osmosis diuresis and dehydration effects, which
lead to elevated diabetic keto acidosis which is life threatening, (Russell et al, 2014 pp. 315-

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320).
The role of insulin is critical in the body, once the cells of islets are destroyed, less
insulin is produced. The pancreas produces insulin which is released into the blood, the
released insulin is circulated into the body allowing the sugar to enter cells. The effect of
insulin thus lowers the amount of sugar in the body.
On the other hand the role of glucose is to be stored in the liver as glycogen. When
there are low levels of glucose, the liver functions by breaking down the glycogen stored as
glucose and keep the glucose within normal ranges. Associated risks factors with type 1
diabetes are often family history, genetics, and geography of the person and the age of the
individual.
In the case the case study the individual is under age fourteen, with prevalent obesity
children between 4-14 years. If left un managed type i diabetes can be life threatening in that
it can cause complications to other organs in the body, which include heart, eyes, kidneys and
nerves, blood vessels. Type i diabetes affects the normal functioning of the heart causing
problems on the cardiovascular problems, which include coronary heart diseases, chest pains,
strokes and even heart attacks, (Lind et al, 2014 pp. 1972).
Further it causes nerve damage in a condition referred to as neuropathy. High sugar
levels in the wall of the blood vessels, which causes tingling, numbing or pain sensations.
Damage to the nerves is danger to the gastrointestinal tracts which affect the nasal tract.
Damage to kidneys is prevalent in chronic diabetes stage. It damages the filtration system of
the body, which leads to severe kidney damage leading to irreversible stage of kidney
damage. Further foot and eye damage can be affected with diabetes. In foot, it leads to nerve
damage which increases foot complications. Eye damage leads to destruction to the retina
which cases partial blindness, (Chamberlain et al, 2016 pp. 545).
Thus if care is not taken cared for the patient, he might be at risks of developing the
above mentioned risk factors. Thus adequate diagnostic management is key in managing the
associated risks with type 1 diabetes.
Nursing care plan
Medical management
Type 1 diabetes has no known cure. The focus of management is to control the serum
glucose level which function by delaying development of complications. Individuals with
type diabetes often use subcutaneous injection of insulin for slow administration.
Insulin treatments

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Due to the inability of the body not to produce insulin, there is need for insulin
management. Insulin can be sourced from different preparations, these include;
Insulin injections
Nursing care plan will entail administering insulin injection to the body. The body
cannot take in of tables due to the inability of the stomachs to digest it. Insulin injections are
administered using syringe or an injection called auto injector, (Thabit et al 2015 pp 2135).
Insulin pump therapy
This is another alternative to insulin injection. Insulin pump is a small device which
holds the insulin. The pump is injected with the needle at the end which is administered on
the skin. This pump allows for insulin to have a smooth flow into the bloodstream at a
controllable rate. This calls for close monitoring of the blood sugar levels closely. Insulin
pump is effective for the patient in the case study as far as there is adult supervision.
Insulin jet system
This is a new system which you can inject insulin into the body without the use of any
needle to the patient. Nursing care can utilises this technique, as it is administered through the
stomach, buttock or the thighs. This method is key in ensuring small stream of insulin is
administered subcutaneously. The insulin thus travels at high speed into the skin surface,
(Herring et al, 2016 pp. 1235).
Dietary management
Dietary management of type 1 diabetes entails distribution of nutrient and calories
throughout the day. The intake of daily calories is geared towards getting at most 50% of
carbohydrates with 30% fat while the remainder is protein. The total caloric intake for the
patient will be assessed based on the age , weight and physical activity level of the patient,
(Bell et al, 2015 pp 1014).
Selection of appropriate caloric allotment is key in ensuring that they get balanced diet
which is based on their age, body size and activity level. The need for physical; activity is
key in that it ensures increase in cellular activity to insulin, which improves the tolerance
level of glucose and weight loss. Engaging in physical exercise for this patient is key in
ensuring that they are concerned of their health status, (Inzucchi et al, 2015 pp 145).
Pharmacological protocols
In the instance when the diet, exercise and healthy weight maintenance are not enough,
patients can be offered help of medication. These medication approaches as highlighted
above include insulin. The patient having type 1 diabetes needs to ensure adherence to insulin

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therapy on a daily basis to replenish the gap created by the pancreas. Due to the inability for
taking insulin as a tablet, there is need for physical injection. Common insulin medication
suitable for the patient is the synthetic human insulin, which prepared through lab process.
The synthetic insulin dont offer the same traits and mimic which the normal insulin does, but
does the same effects on the body, (Atkinson, Eisenbarth & Michels, 2014 pp. 70).
Nursing intervention
Nursing intervention is key in ensuring adequate care process for the type 1 diabetic
patient. The following key points are beneficial in ensuring effective care process for the
patient;
- In order to administered effective care process for the patient, advising the patient on
individualized meal plan and weight loss management is key in order to compliment
compliance efforts.
- There is need to explain to the patient caregiver on the procedure for insulin self
regulation injection
- Advising the patient caregiver on the importance and the need for maintaining and
reducing weight for the child.
- Providing advice on the patient on assessment of blood glucose level after strenuous
activity and ensuring that the child gets adequate carbohydrates and snacks to avoid
hypoglycaemia
- Ensuring adequate dosage intake for the medications for the patient with the help of
the caregiver.
Discharge care plan
As part of nursing care process, there is need for effective discharge care plan for the
patient. Advice for the caregiver of the child is to ensure adequate medication and appropriate
administration of insulin.
Adherence of diet plan is key in ensuring that adjusts on the needs of the body.
Appropriate insulin injection for the patient should be adhered to. Further regular blood and
urine checking is key in ensuring that blood sugar levels are kept and normal ranges. This is a
precautionary measure, which any variations lead to consultation to the physician.
Appropriate skin care and ensuring minimization of skin injuries for the child is essential,
(ADA, 2017 pp. 97).
Conclusion
Type 1 diabetes also referred to as child hood diabetes is significant with the loss of
effective use of insulin in the body. It is as a result of excess body weight and reduced
physical activity which hinders the function of the pancreases in releasing the insulin.
Ensuring adequate diagnostic procedures and following of treatment plan is effective in

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managing the patient in the case study. Appropriate and adherence of nursing care procedures
is key in ensuring that the adverse effects associated to type 1 diabetes are minimised. Thus
appropriate following of medication protocol, diet planning, physical exercises and blood
testing are key steps in ensuring effective management of the disease for the patient.
References
American Diabetes Association, 2015. Standards of medical care in diabetes—2015
abridged for primary care providers. Clinical diabetes: a publication of the American
Diabetes Association, 33(2), p.97.
Atkinson, M.A., Eisenbarth, G.S. and Michels, A.W., 2014. Type 1 diabetes. The Lancet,
383(9911), pp.69-82.
Atkinson, M.A., Eisenbarth, G.S. and Michels, A.W., 2014. Type 1 diabetes. The Lancet,
383(9911), pp.69-82.
Bell, K.J., Smart, C.E., Steil, G.M., Brand-Miller, J.C., King, B. and Wolpert, H.A., 2015.
Impact of fat, protein, and glycemic index on postprandial glucose control in type 1
diabetes: implications for intensive diabetes management in the continuous glucose
monitoring era. Diabetes Care, 38(6), pp.1008-1015.
Chamberlain, J.J., Rhinehart, A.S., Shaefer, C.F. and Neuman, A., 2016. Diagnosis and
management of diabetes: synopsis of the 2016 American Diabetes Association standards
of medical care in diabetes. Annals of internal medicine, 164(8), pp.542-552.
Chiang, J.L., Kirkman, M.S., Laffel, L.M. and Peters, A.L., 2014. Type 1 diabetes
through the life span: a position statement of the American Diabetes Association.
Diabetes care, 37(7), pp.2034-2054.
Dabelea, D., Stafford, J.M., Mayer-Davis, E.J., D’Agostino, R., Dolan, L., Imperatore,
G., Linder, B., Lawrence, J.M., Marcovina, S.M., Mottl, A.K. and Black, M.H., 2017.
Association of type 1 diabetes vs type 2 diabetes diagnosed during childhood and
adolescence with complications during teenage years and young adulthood. Jama, 317(8),
pp.825-835.
Hering, B.J., Clarke, W.R., Bridges, N.D., Eggerman, T.L., Alejandro, R., Bellin, M.D.,
Chaloner, K., Czarniecki, C.W., Goldstein, J.S., Hunsicker, L.G. and Kaufman, D.B.,

Nursing care for Type I diabetes
8
2016. Phase 3 trial of transplantation of human islets in type 1 diabetes complicated by
severe hypoglycemia. Diabetes care, 39(7), pp.1230-1240.
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M.,
Peters, A.L., Tsapas, A., Wender, R. and Matthews, D.R., 2015. Management of
hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position
statement of the American Diabetes Association and the European Association for the
Study of Diabetes. Diabetes care, 38(1), pp.140-149.
Lind, M., Svensson, A.M., Kosiborod, M., Gudbjörnsdottir, S., Pivodic, A., Wedel, H.,
Dahlqvist, S., Clements, M. and Rosengren, A., 2014. Glycemic control and excess
mortality in type 1 diabetes. New England Journal of Medicine, 371(21), pp.1972-1982.
Orchard, T.J., Nathan, D.M., Zinman, B., Cleary, P., Brillon, D., Backlund, J.Y.C. and
Lachin, J.M., 2015. Association between 7 years of intensive treatment of type 1 diabetes
and long-term mortality. Jama, 313(1), pp.45-53.
Russell, S.J., El-Khatib, F.H., Sinha, M., Magyar, K.L., McKeon, K., Goergen, L.G.,
Balliro, C., Hillard, M.A., Nathan, D.M. and Damiano, E.R., 2014. Outpatient glycemic
control with a bionic pancreas in type 1 diabetes. New England Journal of Medicine,
371(4), pp.313-325.
Santin, I., Dos Santos, R.S. and Eizirik, D.L., 2015. Pancreatic beta cell survival and
signaling pathways: effects of type 1 diabetes-associated genetic variants. In Type-1
Diabetes (pp. 21-54). Humana Press, New York, NY.
Thabit, H., Tauschmann, M., Allen, J.M., Leelarathna, L., Hartnell, S., Wilinska, M.E.,
Acerini, C.L., Dellweg, S., Benesch, C., Heinemann, L. and Mader, J.K., 2015. Home use
of an artificial beta cell in type 1 diabetes. New England Journal of Medicine, 373(22),
pp.2129-2140.