Type 1 Diabetes Management

This article discusses the management of type 1 diabetes and diabetic ketoacidosis, including the pathophysiology, nursing interventions, and medication management. It provides insights into the importance of fluid and electrolyte replacement, insulin therapy, and lifestyle changes for better symptom management.

Running head: TYPE 1 DIABETES MANAGEMENT
TYPE 1 DIABETES MANAGEMENT
Name of the student:
Name of the university:
Author note:

1
TYPE 1 DIABETES MANAGEMENT
Introduction:
Type-1 Diabetes can be described as an auto-immune disorder which takes place when
the immune system of the body attacks and destroys its own insulin-producing beta cells present
in the pancreas (Danne et al., 2019). Diabetic ketoacidosis (DKA) might also follow when the
symptoms of type-1 diabetes is not managed successfully. The present case study show a patient
named Bill suffering from type-1 diabetes along with (DKA). This assignment would show how
nursing professionals can undertake proper interventions, strategies and medication management
to help the patient overcome the disorders successfully.
Pathophysiology of type 1 diabetes and diabetic ketoacidosis:
Type 1 diabetes can be described as the culmination of the two actions – lymphocytic
infiltration as well as destruction of the insulin secreting cells beta cells of the islets of
Langerhans in the pancreatic region. Researchers are of the opinion that when beta cell mass that
are responsible for secreting insulin gets decreased, insulin secretion also falls down below the
required level. This occurrence takes place until the available insulin is no longer found to be
appropriate for maintaining normal blood glucose levels (Farsani et al., 2017). The condition of
hyperglycemia results when almost about 80 to 90% of the beta cells undergo destruction. In
such situations, patients are seen to require exogenous insulin for reversing the catabolic
conditions as well as prevention of the ketosis and even for the decrease of the hyperglycemia
along with normalization of lipid and protein metabolism. This disorder is actually a chronic
autoimmune disorder which is seen to take place in mainly genetically susceptible individuals
which might be precipitated by the number of environmental factors. Studies are of the opinion
that in susceptible individuals, the immune system gets triggered to develop an auto-immune

2
TYPE 1 DIABETES MANAGEMENT
response against that of the altered pancreatic beta cell antigens or the molecule in the beta cells
which resemble to that of the viral proteins. It has been found that about 85% of the affected
patients have exhibited circulating islets cell antibodies. It has been found that the majority
numbers of affected individuals are also found to have detectable anti-insulin antibodies. Burns
et al. (2018) had clearly stated that most of these islet cells antibodies are seen to get directed
against that of the glutamic acid decarboxylase (GAD) within pancreatic beta cells. Another
model had been also put forward by many studies. It states that environmental triggers can result
in inducing islet autoimmunity and beta-cell death in the different susceptible and vulnerable
individuals. This actually results in initiating a series of pre-diabetic stages that ultimately sets
forth the clinical onset of that of the disorder.
Diabetic ketoacidosis can be described as the life-threatening problem that can affect
people with diabetes. This situation is seen to take place when the body starts to break own fat at
a rate that is much faster. The liver in this situation is seen to process the fat in ways that it gets
turned to fuel called the ketones that ultimately make the blood acidic in nature (Duca et al.,
2017). This situation is mainly seen to happen when signal from that of the insulin in the body
becomes so low that glucose cannot get into the cells to be used as the fuel source, when the liver
makes huge amount of the blood sugar level and when the fat gets broken down much faster than
for the body to process. It is seen that these fat gets broken down in the liver into the fuels and
this is often called ketones which are actually produced when the body breaks down fat after a
longer period of time between the meals (Peters et al., 2016). It has been found that when
ketones are produced quickly and are built up in the blood as well as the urine, they can be found
to become toxic by making the blood acidic. Researchers have termed this condition is known to
be ketoacidosis.

3
TYPE 1 DIABETES MANAGEMENT
Tachypnea or deep, rapid breathing is one of the symptom of DKA which was also
observed in the patient called Bill. It has been found that when the body is seen to produce or
ingest a much higher amount of acid or when the kidneys and lings are seen to fail, blood acid
levels rises. In cases of type-1 diabetes, ketones become higher in amount in the blood resulting
in the increase of the blood acid level. When the blood is seen to become too acidic, acidosis is
seen to take place and therefore, the body tries its best in restoring the imbalance (Robinson et
al., 2016). The body tries to take deeper as well as longer breaths where the lungs try to expel
more acidic carbon disoxide than that of the normal. Hence, rapid breathing s seen in this
disorder often called the Kussmaul breathing which was also observed in Bill. Another symptom
is the fruity smell in the breath of the patient which was also observed in Bill which comprised of
acetone smell in the breath. As the lungs try to expel more acetone-containing carbon dioxide,
the smell of his breath can also be found to be fruity. Another symptom that is also observed is
the flushed face which was also observed in Bill. Decrease in alertness and increase of confusion
is another symptom that was also observed when patient named Bill was admitted. This can be
contributed to a number of reasons (Gard et al., 2017). Because of the increased concentration of
the acids in the blood from that of the breakdown of the fats, the body is seen to urinate in excess
for removing these compounds from that of the blood. Excessive of the urination in the setting of
the continuous production of the keto acids can result in dehydration resulting in a general
feeling of illness, fatigue. Headache and slowed mental capacity. Excessive urination can also
result in huge loss of the potassium causing symptoms of nauseas and vomiting, fainting and
drowsiness, muscle cramps and others which were also seen in the patient (Semenkovich et al.,
2019).

4
TYPE 1 DIABETES MANAGEMENT
Nursing and medication management:
In order to manage diabetes ketoacidosis, the nurses need to undertake interventions so as
to help the patient named bill get over the symptoms. The first intervention would be fluid
replacement where the patient would be provided fluids either by the mouth or by the vein in an
intravenous manner unless they become rehydrated. The main rationale of doing so is that the
fluids would replace those which have been lost though excessive urination as well as also help
in diluting the excess sugar present in the blood (Henry et al., 2015). The second intervention
that the nurse should be undertaking is the electrolyte replacement. Studies are of the opinion
that electrolytes are mainly the minerals in the blood that can carry an electric charge like that of
sodium, potassium as well as chloride. It has been found that the absence of insulin can help in
lowering the level of electrolytes in the blood. The patient named Bill would be given the
electrolytes through a vein (Lennerz et al., 2018). This would help in keeping the heart muscles
as well as the nerve cells and the muscles function properly. Another intervention is the insulin
therapy. Insulin would mainly help in reversing the process that causes diabetic ketoacidosis. In
addition to that of the fluids as well as the electrolytes, the nurses should provide Bill with
insulin therapy that would be mainly given though the vein. When the blood sugar level would
fall to about 200mg/dL or below 11.1 mmol/L and the blood of the patient is no longer acidic,
the nursing professionals can stop the intravenous insulin therapy and thereby initiate the normal
subcutaneous therapy. Studies are of the opinion that having type-1 diabetes would require
significant lifestyle change for better maintenance of the symptoms and to avoid any form of
threatening situations (Nyenwe t al., 2016). People with that of diabetes type1should be educated
about a number of aspects like frequent testing of the blood sugar levels as well as initiate careful

5
TYPE 1 DIABETES MANAGEMENT
meal planning after consultation with the dietician. Bill should be also advised to undertake daily
exercises and take insulin and other medications in a disciplined manner to avoid any form of
threatening conditions in the body.
Medication management:
In order to treat diabetic ketoacidosis, the medication that can be provided is the short-
acting insulin which would help in correcting the hyperglycemia in case of DKA. Studies are of
the opinion that rapid acting insulin mainly helps by suppressing the hepatic glucose output
thereby enhancing glucose uptake by the peripheral tissues (Foster et al., 2019). This insulin can
also seen to be suppressing the ketogenesis as well as lipolysis thereby helping n the stimulation
of the proper use of glucose by the different cells along with the reduction of the blood sugar
levels. Studies are of the opinion that rapid acting insulin mainly help in the correction of
hyperglycemia. The normal blood glucose level should be 7.8 mmol/L but it has been found to
be quite high for about 38.5 which show treatment of short acting insulin is important for the
patient to tackle hyperglycemia (Bergenstal et al., 2016). The nurse can use the insulin namely
Aspart also called Novolog which is found to be helpful in Glycemic control in the adults. For
type 1 diabetes, professionals might administer 0.2-0.6 unit/kg/day in the form of divided doses.
Studies are of the opinion that conservative doses of that of 0.2-0.4 unit/kg/day are advised to be
followed for reduction of the risk of hypoglycemia. This medication might come as a solution or
as a suspension and can be injected subcutaneously. It should be injected about 5 to 10 minutes
before the meal (Umpierrez et al., 2016). The suspension is used for treating type-1 diabetes and
should be injected for 15 minutes before meal. The nurses need to be careful about changes in
the blood sugar level and might cause side effects like the redness or swelling as well as itching
found to be occurring at the site of injection, along with various changes in the feel of the skin,

6
TYPE 1 DIABETES MANAGEMENT
thickening of skin, constipation and weight gain. Nurses should monitor these signs and
immediately take interventions if they occur.
The next set of medication that should be also advised for the patient would be long
acting insulin which can be used in combination with that of the rapid acting insulin. This mainly
helps in lowering the blood glucose levels when the rapid acting insulin would stop working. It
should be taken once or twice a day. Isophane is actually human-made insulin which lowers the
amount of sugar in the blood. It is seen to start working after 30 minutes and can be found to be
working for as long as the 12 to 24 hours. This medication is mainly used as an injection
provided under the skin. Some of the side effects that might be seen to result from this
medication is allergic reactions like skin rash, breathing problems and others, itching, burning as
well as swelling or rash at the site where the patients are injected (Umpierrez et al., 2016). There
might be also increase as well as decrease in the fatty tissue that are present under the skin
because of the overuse of particular injection site. This insulin us seen to provide basal
requirement of a basal-bolus regimen called the Multiple Daily Insulin (MDI) injections where 3
to 4 insulin injections per day are provided with combination of long acting and rapid acting
insulin. It may act with medications like clonidine, reserpine, albuterol and other and hence,
nurse should be very careful while administering the medication to the patient.
Another medication that can be also suggested for the patient is called the Pramlintide.
This is an inject-able drug which actually results in lowering the level of sugar in the blood. This
medication is a synthetic hormone that is found to resemble similar to human amylin. This si a
hormone that is produced from the pancreas and then gets released in the blood after meals. This
hormone actually helps the body in regulation of glucose level in the blood. Amylin is found to
work in several ways for controlling blood glucose like slowing the rate at which good is

7
TYPE 1 DIABETES MANAGEMENT
absorbed from the intestine. It also helps in the reduction of the production of the glucose by the
liver by inhibition of the action of glucagon which is a hormone that causes stimulation of the
production of glucose by the liver (Goldenberg et al., 2016). Amylin also causes reduction in the
appetite. In different studies, pramline-treated patients are seen to achieve lower blood glucose
level and experienced weight loss. This medication can be also prescribed for Bill to control his
blood glucose levels successfully. The nursing professional should initiate this medication by the
dosage of 15 mcg SC immediately before major meals and should increase it by 15 mcg q3Days.
Some of the side effects that the nurse should consider and monitor in the patient when treated
with this medication are the nausea, hypoglycemia, headache, weight loss and headache and
fatigue (Henriksson et al., 2016). Nurse should undertake proper precautionary measure when
administering the medication
Conclusion:
From the above discussion, it can be seen that people suffering from type-1 diabetes like
Bill can suffer from worsening health conditions if the glucose level in the blood is not managed
successfully within the safe limits. Destruction of the beta cells results in prevention of the
release of insulin that causes increase in blood glucose level and affecting the health condition of
the patient. Diabetic ketoacidosis might also take place when acid level in the blood increases.
Nursing professionals would need to ensure providing the right interventions like fluid balance,
electrolyte balance and insulin therapies to help patient overcome DKA. They also need to
initiate rapid acting and long acting insulin followed by pramline to ensure safety of the patient
helping him to live better quality life.

8
TYPE 1 DIABETES MANAGEMENT
References:
Bergenstal, R. M., Garg, S., Weinzimer, S. A., Buckingham, B. A., Bode, B. W., Tamborlane,
W. V., & Kaufman, F. R. (2016). Safety of a hybrid closed-loop insulin delivery system
in patients with type 1 diabetes. Jama, 316(13), 1407-1408.
Burns, K., Farrell, K., Myszka, R., Park, K., & Holmes‐Walker, D. J. (2018). Access to a youth‐
specific service for young adults with type 1 diabetes mellitus is associated with
decreased hospital length of stay for diabetic ketoacidosis. Internal medicine
journal, 48(4), 396-402.
Danne, T., Garg, S., Peters, A. L., Buse, J. B., Mathieu, C., Pettus, J. H., ... & Cariou, B. (2019).
International Consensus on Risk Management of Diabetic Ketoacidosis in Patients with
Type 1 Diabetes Treated with Sodium-Glucose Cotransporter (SGLT)
Inhibitors. Diabetes care.
Duca, L. M., Wang, B., Rewers, M., & Rewers, A. (2017). Diabetic ketoacidosis at diagnosis of
type 1 diabetes predicts poor long-term glycemic control. Diabetes Care, 40(9), 1249-
1255.
Farsani, S. F., Brodovicz, K., Soleymanlou, N., Marquard, J., Wissinger, E., & Maiese, B. A.
(2017). Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type
1 diabetes mellitus (T1D): a systematic literature review. BMJ open, 7(7), e016587.
Foster, N. C., Beck, R. W., Miller, K. M., Clements, M. A., Rickels, M. R., DiMeglio, L. A., ...
& Olson, B. A. (2019). State of type 1 diabetes management and outcomes from the T1D
Exchange in 2016–2018. Diabetes technology & therapeutics, 21(2), 66-72.

9
TYPE 1 DIABETES MANAGEMENT
Garg, S. K., Henry, R. R., Banks, P., Buse, J. B., Davies, M. J., Fulcher, G. R., ... & Danne, T.
(2017). Effects of sotagliflozin added to insulin in patients with type 1 diabetes. New
England Journal of Medicine, 377(24), 2337-2348.
Goldenberg, R. M., Berard, L. D., Cheng, A. Y., Gilbert, J. D., Verma, S., Woo, V. C., & Yale, J.
F. (2016). SGLT2 inhibitor–associated diabetic ketoacidosis: clinical review and
recommendations for prevention and diagnosis. Clinical Therapeutics, 38(12), 2654-
2664.
Henriksson, M., Jindal, R., Sternhufvud, C., Bergenheim, K., Sörstadius, E., & Willis, M.
(2016). A systematic review of cost-effectiveness models in type 1 diabetes
mellitus. Pharmacoeconomics, 34(6), 569-585.
Henry, R. R., Thakkar, P., Tong, C., Polidori, D., & Alba, M. (2015). Efficacy and safety of
canagliflozin, a sodium–glucose cotransporter 2 inhibitor, as add-on to insulin in patients
with type 1 diabetes. Diabetes Care, 38(12), 2258-2265.
Lennerz, B. S., Barton, A., Bernstein, R. K., Dikeman, R. D., Diulus, C., Hallberg, S., ... &
Ludwig, D. S. (2018). Management of type 1 diabetes with a very low–carbohydrate
diet. Pediatrics, 141(6), e20173349.
Nyenwe, E. A., & Kitabchi, A. E. (2016). The evolution of diabetic ketoacidosis: an update of its
etiology, pathogenesis and management. Metabolism, 65(4), 507-521.
Peters, A. L., Henry, R. R., Thakkar, P., Tong, C., & Alba, M. (2016). Diabetic ketoacidosis with
canagliflozin, a sodium–glucose cotransporter 2 inhibitor, in patients with type 1
diabetes. Diabetes Care, 39(4), 532-538.

10
TYPE 1 DIABETES MANAGEMENT
Robinson, C., Cochran, E., Gorden, P., & Brown, R. J. (2016). Management of Diabetic
Ketoacidosis in Severe Insulin Resistance. Diabetes care, 39(8), e116-e118.
Semenkovich, K., Berlin, K. S., Ankney, R. L., Klages, K. L., Keenan, M. E., Rybak, T. M., ... &
Eddington, A. (2019). Predictors of diabetic ketoacidosis hospitalizations and
hemoglobin A1c among youth with Type 1 diabetes. Health Psychology.
Umpierrez, G., & Korytkowski, M. (2016). Diabetic emergencies—ketoacidosis,
hyperglycaemic hyperosmolar state and hypoglycaemia. Nature reviews
Endocrinology, 12(4), 222.