Diabetes Care and Family Impact

Health Variations 2
Assessment 1: Case study Type 1 diabetes
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Question 1. Pathophysiology of clinical manifestations of Type 1 diabetes
1. High blood glucose level
Briana was given a provisional diagnosis of type 1 diabetes. Type 1 diabetes is
an autoimmune disorder, prevalent mostly at an early age, in and around puberty,
although any age group can be affected. In type 1 diabetes selective destruction of
the pancreatic insulin-producing β-cells occur, as the body mistakenly identifies the
target cells as “non-self”. Type 1 diabetes often overlaps with other autoimmune
diseases like autoimmune thyroid disease, coeliac disease, Addison’s disease and
so on.
Genetic predisposition is considered to be the most potent trigger of type 1
diabetes. Several genetic regions have been identified and linked with the disease,
some of which even include susceptibility to other autoimmune diseases. Person
having a specific HLA (human leucocyte antigen) complex are generally more
susceptible to the disease, which codes for antigen that may trigger the autoimmune
response. Apart from a genetic predisposition several environmental factors may
play a role in triggering the disease. Viral infections have been found to be
associated with onset of the disease, among which enterovirus infections attracts
most interest. Studies have shown that there is a temporal variation in the
occurrence of the disease. It has a particular seasonal pattern, occurring more
frequently during the cold season. However, progression of the disease requires a
genetic predisposition, a precisely timed trigger and exposure to a driving antigen.
Some other significant triggers associated with type 1 diabetes are childhood
vaccination such as smallpox, tuberculosis and such, low levels of vitamin D and
introduction of cow’s milk (Bluestone, Herold & Eisenbarth, 2010). As the patient’s
mother suffers from coeliac disease, and considering the age of onset, the
suspected trigger of her condition would be an underlying genetic factor.
The activated autoimmune cells against the pancreatic β-cells invade the islets
and mediate their action through several cellular pathways like Fas/FasL,
perforin/granzyme, reactive oxygen and nitrogen species and inflammatory
cytokines. The most common antigens that are affects are glutamic acid
decarboxylase, tyrosine phosphatase-like protein and insulin. Macrophages and
dendritic cells are the first cells to infiltrate the islets; these recruit T-helper cells by
antigen presentation which in turn secrete several inflammatory molecules such as
IL-1β and INF-γ which further increases secretion of antigen presenting cells and
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other free radicals and cytokines that directly affect the pancreatic cells (Knip, M., &
Siljander, H. (2008). Upon destruction of the β-cells, insulin production is reduced
substantially and circulating glucose concentration in blood increases causing
hyperglycaemia.
2. Glucose in the urine
The abnormal presence of glucose in urine is known as Glucosuria. Due to lower
levels of insulin in blood sufficient amount of glucose is not absorbed from the blood
as are result of which blood glucose level increases. As a compensatory mechanism
the kidneys try to remove the excess glucose, causing traces of glucose to be found
in urine samples of the patient (Lytvyn et al., 2015).
3. Increased urination
The scientific term used to define the condition of increased urination is Polyuria.
During the formation of urine the kidneys absorb the glucose present in blood and
return it to the bloodstream through selective reabsorption. When excess glucose is
found in the filtrate, as observed in diabetes, the kidney is unable to return all the
glucose to the bloodstream and the osmotic pressure of the filtrate increases,
causing excess water to be absorbed from blood into the filtrate and consequently
producing large amounts of urine.
4. Increased thirst
The condition of excessive thirst is known as polydipsia. As a result of polyuria
as mentioned earlier the body suffers from increased water loss and consequently
there is an increased thirst in the patient.
5. Increased appetite
Polyphagia is the scientific term used to describe increased hunger and appetite
in patients with diabetes. As in the absence of insulin the body is unable to use the
glucose present in blood as a source of energy. As a consequence hunger and
appetite increases. However, eating does not solve the problem if the diabetic
condition is not managed properly.
6. Ketones in the urine and blood
Lack of glucose utilization causes breakdown of fats for optimum supply of
energy. Ketones are produced in the Liver during fatty acid metabolism. Hence, in
diabetic patients due to increased ketone production ketones are found in blood.
Presence of ketone in urine is called Ketouria. Although ketones are found in blood
of Briana it has not yet led to excessively high levels causing ketoacidosis.
7. Weight loss
With breakdown of fat for energy production, patients with diabetes suffer from
weight loss as in case of Briana, who suffered a 5kg weight loss since her last
appointment.
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Question 2. Nursing considerations related to the administration of NovoRapid
Prior to administration
1. Validate the medication order
Medication orders are written descriptions, essential for administration of
medicines to an individual in a healthcare facility. Several standard abbreviations are
often used in such orders. A valid medication order must essentially contain Patient
name, Medical Record Number, Date and Time when the order was written, dosage,
route and frequency of administration and signature of the prescribing practitioner
(Eslami, de Keizer & Abu-Hanna, 2008). For “as required’ medications the dosage
frequency, maximum daily dosage and clinical criterion for administration must be
provided.
2. Have comprehensive knowledge of the medication
Novorapid is a drug used for treatment of diabetes mellitus in adults, adolescents
and children above the age of 1 year. It is an insulin analogue and has a faster mode
of action and higher peak concentration when compared to regular human insulin. The
action commences within 10-20 minutes and maximum effect is exerted between 1-3
hours after administration. The apparent half-life of Novorapid is less, facilitating faster
elimination. Hypoglycemia is the most common side effect (Nordisk, 2016). Other side
effects include redness, itching and swelling at the site of injection, vision problems,
swelling around ankles and joints; allergic reaction and unconsciousness are the most
adverse side effects. The maximum dosage in children is 10 units. The route of
administration is in the subcutaneous layer.
3. Prepare the medication safely
The five rights of medication are the right patient, right time and frequency of
administration, right dose, and right route and most importantly the right drug. As
Briana is only 7 years old a short needle is required to inject the drug. The shortest
needle of 4mm length would be appropriate for Briana.
4. Assess the patient
Before administration of the drug the vital signs must be examined along with the
patient’s prior history to allergy and possible drug interactions. The normal random
blood glucose level is 11.1 mmol/L (American Diabetes Association. 2014). The last
recorded blood glucose level of Briana was 26.0 mmol/L and hence the drug can be
safely administered. The appetite of the patient must be assessed so that she can
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