Case Study: Drug Therapy Management of Type 1 Diabetes Mellitus

This case study delves into the intricacies of managing Type 1 Diabetes Mellitus, focusing on a patient named Tony and his prescribed insulin regimen, which includes both fast-acting insulin aspart and long-acting insulin glargine. It emphasizes the importance of educating Tony and his family about the different types of insulin, their time course formulations, and the principles underpinning the basal-bolus regime. The study highlights the need for Tony to develop practical skills in self-administration of insulin, monitor his blood sugar levels, and understand safety measures for proper needle disposal. It further explores the role of insulin in lowering blood glucose levels, objective tests for assessing patient stability, potential complications like hypoglycemia and hyperglycemia, and the significance of maintaining normal blood sugar levels. The study also addresses psychosocial factors that can affect Tony's participation in his care and the ethical considerations and standards of practice in nursing, emphasizing patient privacy, fairness, and the importance of a therapeutic nurse-patient relationship. Desklib provides access to similar case studies and solved assignments for students.

Running head: TYPE 1 DIABBETES MELLITUS.
Type 1 Diabetes Mellitus
Name of student
Institutional affiliation

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Question one
Type 1 Diabetes is a type of high blood sugar that is mostly leads to the destruction of
cells that produce insulin in the pancreas, the beta cells (Johnston, Mitchell, Haythorne, Pessoa,
Semplici, Ferrer, Piemonti, Marchetti, Bugliani, Bosco and Berishvili, 2016). This disturbance is
mostly found in young adults and children. Once the cells are destroyed, insulin production is
affected and less or no insulin is produced. This affects the uptake of glucose by the cells from
blood, hence glucose accumulates in blood leading to high blood sugar finding during a random
blood sugar test. This glucose can sip into the urine leading to presence of glucose in urine. Since
the cells and tissues do not get enough glucose for metabolism processes, this leads to
breakdown of muscle to provide protein energy as a substitute for metabolism processes, this is
the reason for weight loss for people with type 1 diabetes (Zaccardi, Webb, Yates and Davies,
2015). Type 1 diabetes presents with symptoms of polyphagia, increased urination and
polydipsia. Since the tissues do not receive get enough glucose, one is always hungry, a hunger
that does not go away after eating. The hypothalamus is stimulated to perceive hunger
continuously due to the tissues deprived of energy, a condition referred to as polyphagia. Due to
the increased concentration of glucose in urine, the osmotic gradient in the urine is high and
water follows a concentration gradient, therefore a lot of urine is excreted leaving a person
dehydrated, this is called polyuria. This triggers an excessive feeling of thirst and the person
drinks a lot of water. A condition referred to as polydipsia. Type one can be stabilized with
insulin. The person can lead a normal life as long as he gets insulin solution.
Question two

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Tony has been prescribed with insulin Aspart a fast acting insulin and insulin glargine
flexipen a long acting insulin. Tony and his family should be educated on the following; Time-
course formulation include; fast, intermediate and long-acting insulin (Lamalle, Servais,
Radermecker, Crommen, J. and Fillet, M., 2015). Fast acting insulin gets assimilated very fast
from the fatty tissue of the skin into the blood and controls blood glucose during meals and when
taking snacks. It comprises of rapid acting insulin that is absorbed and initial action is after 5-15
minutes of inoculation and duration of action pinnacles at two hours and lasts up to six hours.
The other type is Rapid human insulin that has an initial action after two hours which peaks after
2-4 hours and the duration of action can last up to eight hours. Long acting insulin is assimilated
slowly, peaks, and stabilizes over a long period of time. it comprises of analogs insulin Detemir
and Glargine. Onset of action is after two hours and the duration of action levels for about 24
hours.
Rapid and short acting insulin appears clear in colour and placed in containers.
Intermediate acting insulin, NPH is cloudy in appearance while long acting types are clear. Basal
insulin is the one needed maintain normal blood glucose during fasting in between meals, bolus
insulin is taken before or immediately after meals to prevent hyperglycemic episodes. The
principles underpinning the basal-bolus regime include the facts that insulin Aspart is taken
before meals because its fast acting nd maintains normal blood glucose after meals while the
insulin glargine controls the level of glucose released to blood when one is fasting thus
mimicking normal body function. This regime ensures an individual is close to normal function.
Tony is required to have practical skills and knowledge on self-administration of insulin.
This will encourage independency (Daniel, Takatori, Fiore, Neto, Pavin, Minicucci and Parisi,
2015). Tony ought to be educated on the nature of his condition, the reason for the symptoms

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and the importance of insulin to his body, having understood why he needs insulin, he then
should be educated on the procedure, precautions and monitoring of progress. Tony needs insulin
to relieve the symptoms and lead a normal life. The insulin administered mimics the body
insulin. Insulin is administered subcutaneously using a needle. He should be able to monitor the
blood sugar oftenly and document the findings for reference and consult. In case of any
fluctuations of blood sugar, he should be able to visit a physician. Tony should be aware of the
safety measures of proper disposal of the needle after use. He should have a sharps bin nearby
for proper disposal. Tony should be aware of the injection skills, the measurement of blood
glucose and the dosage to administer.
Question three
Insulin is a hormone produced by the islets of Langerhans in the pancreas. Its main
function is to lower blood glucose levels to normal ranges. It works antagonizing effects of
glucagon. In conditions where the cells are destroyed and cannot produce insulin, artificial
insulin formulations are administered to an individual. Once administered, the insulin is absorbed
to the blood stream (Czech, Wang and Seki, 2018). Once in the blood stream, the action begins.
Insulin attaches itself to call receptors and enhances facilitated diffusion of glucose into the cells
where it is immediately converted to gluvose-6-phosphate hence maintaining a concentration
gradient for glucose influx. This will in turn reduce blood glucose level. Insulin facilitates the
storage of glucose as glycogen in the cells or its conversion to fatty acids hence the ultimate
effect of lowering blood glucose.
Question four

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Taking objective tests is necessary to assess the prognosis and stability of the patient. The
objective tests to assess if Tony is stable are; Glycated hemoglobin levels, fasting and random
blood sugar levels. Glycated hemoglobin reveals the level of glucose for up to the past twelve
weeks, this can show the fluctuation of the glucose levels hence point out the stability of patient
(Amreen, Suneel, Shetty, Vasudeva and Kumar, 2018). Random blood sugar testing helps
determine if the dosage is sufficient and can help adjust and it also points out how the body
responds after meals to assess the condition of the patient. Fasting blood sugar is taken after a
patient has fasted, mainly in the morning after whole night fast. It helps determine how the body
is managing the blood glucose hence gives light on whether the patients metabolism is stable or
not (Khandouzi, Shidfar, Rajab, Rahideh, Hosseini and Taheri, 2015).
Question five
Hypoglycemia possibly due to inadequate carbohydrate intake- Tony had a hypoglycemic attack
immediately after taking a glass of juice, this shows that the juice had inadequate intake of the
carbohydrate as compared to the insulin dose he is taking (Smith, Wilson, Karl, Austin, Bukhari,
Pasiakos ... & Lieberman, 2016)
Hyperglycemia possibly related to excessive carbohydrate intake- Tony is a teenager and mostly
takes junk food. Due to the condition, Tony has polyphagia this leads to lots of consumption of
carbohydrates leading to hyperglycemia.
Question six
My goal towards Tony’s blood sugar level is to ensure that the level of blood sugar is
maintained within normal ranges.

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In addressing his knowledge deficit, my goals will be; to ensure Tony demonstrates
understanding of the nature of disease, to ensure tony is educated on the treatment options and
why they are important, to ensure patient demonstrates understanding on how to administer the
treatment regime and adhere to it stating the importance of adherence, to ensure Tony
demonstrates understanding and willingness towards the adjustment in diet and is ware of the
danger signs and complications of the disease (Luke and Richards, 2018).
Question seven
In an event where Tony’s blood sugar is less than 3.5mmol/L but he is conscious, my
intervention will be giving him a fast acting oral carbohydrate such as glucose or fresh juice.
After a period of 15 minutes, I will repeat a glucose test to assess the levels, if still low I will
give a snack again three times whereby in case where it fails, I consult physician to consider IV
glucose infusion (Cryer, 2016). The rationale of giving a snack is; the snack will be digested,
converted to glucose and absorbed to the bloodstream to correct the low blood sugar levels to be
absorbed to tissues for metabolism. Repeating of the blood glucose test is to evaluate and re plan
in case the intervention fails.
In an event where Tony’s blood sugar is below 3.5mmol/L and he has lost consciousness,
I will position him on the lateral side, administer 10% of IV glucose and consult a physician.
Positioning a patient who is unconscious in necessary so as to enable maintain an open airway
for proper gaseous exchange (Patti, Li and Goldfine, 2015). IV glucose is fast acting and is
infused into the blood raising blood sugar levels, it is readily absorbed by tissues for metabolism
purposes. Consultation with physician is necessary in order to assess any complication and
collaboratively work towards best patient care.

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Question eight
Ethical values are; maintaining privacy and confidentiality, fairness and just in patient
care. the standards of practice are; the standards of practice are; therapeutic and professional
relationship and developing a plan for nursing practice. In taking care of Tony, privacy and
confidentiality is necessary. This boosts patients trust in the nurse and may lead to Tony to be
cooperative in the management hence positive prognosis. Patients should be treated fairly
regardless of the social status. Fair and just treatment boosts the patient trust in the facility and
promotes openness of the patient in giving history which is a key factor in the management and
adherence to treatment. This promotes smooth stay with the patient and collaboration from
relatives through the hospital stay till discharge (Skela-Savič and Kiger, 2015).
In nursing the standards of practice are important to ensure quality and professional
standards of care. Therapeutic and professional relationship between the nurse and Tony is
necessary. This will build trust and smooth stay during hospitalization. During the discharge the
nurse establishes a plan of referral to the nearby facility for followup. In the case of Tony, the
nurse will ensure Tony receives the best care and is comfortable (Harper, and Maloney, 2016).
The nurse is responsible in the daily care, education, investigation and planning of discharge.
Patient care requires the nurse to plan for the nursing practice. The nurse plans on the patients
medication, discharge and clearance from the hospital and explains the procedures to the
patient.This is necessary to promote quick recovery of Tony and discharge home and refer to
nearby clinic for blood sugar monitoring.
Question nine

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Psychosocial factors refer to the psychological factors and the social factors that affects
one’s ability to function (Walker, Gebregziabher, Martin-Harris and Egede, 2015). Psychological
factors include stress, hostility, depression and hopelessness. Social factors include, income,
social status, culture, customs and beliefs. There are factors that can directly or indirectly affect
the participation of Tony in his care and his interaction. in a case where Tony is under normal
life stressors, the blood glucose spikes and he might be preoccupied to remember to maintain his
diet or consult clinicians. Depressed teenagers pick the introvert nature (Asmat, Abad and Ismail,
2016).This is a stage where they may lose hope in life and he may not adhere to the insulin
regime as per the doctor’s instructions. In this state, the interaction between Tony and medical
team is affected as he may not be willing to communicate or express his feelings. A calm mind
and stress free situation encourages Tony to adhere to self-care and adherence to drugs and
promotes good patient-professional relationship (Capoccia, Degaru and Letassy, 2016).
Socially, a low family income of Tony may affect his hospital visitation and he might
lack the resources required in the management of diabetes. As they struggle to curb the
condition, they may not be able to cater for the insulin required regularly and the regular hospital
checks required. This affects his adherence no matter how willing he is to adhere. The lack of
resources affects the interaction with professionals since he won’t be able to visit the hospital
(Silverman, Krieger, Kiefer, Hebert, Robinson and Nelson, 2015). A good family income is a
source of motivation towards good health. Sufficient family income will enable them afford all
doses and adhere to hospital visits. The family social status is key when it comes to treatment. A
low social status is subject to discrimination in terms of care in the society at large. If Tony feels
discriminated, he may be discouraged and withdrawn. This demotivates him and the drive for
self-care is reduced (Walker et al., 2015). A high social status attracts respect and better handling

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and interaction from the society including medical practitioners. culture, customs and beliefs
affects one’s health seeking behaviour (Patel, Stone, McDonough, Davies, Khunti and Eborall,
2015). Some communities may look down on people with chronic conditions and in this setting,
Tony may feel alienated and this leads to depression and withdrawal from the people who suit
assistance. In the isolated sector, Tony may not stand up and seek medication or visit and interact
with medical professionals as it feels shame (Gonzalez, Tanenbaum and Commissariat, 2016).
Favourable cultures and beliefs act as source of encouragement to health seeking and medical
consultations this fosters interactions. Family relations affect the health seeking behaviour as
family is the source of support and income. After the diagnosis of chronic condition, family
enters a grieving process (Rebolledo and Arellano, 2016). A family that accepts and sticks
together will help Tony with the resources and emotional support to adhere to treatment, a family
that scatters due to depression ill affect negatively the adherence and interaction between Tony
and medical professionals.
Question ten
In my future practice, I will take various actions I have learnt from the case of Tony. I
will handle a patient holistically; emotional, psychologically, socially, physically and mentally.
This will give me a clear understanding of my patient in order to address issues that may affect
treatment directly or indirectly. I will educate my patients widely on the condition they have
creating trust and understanding to promote openness and adherence. I will involve the relatives
of the patient actively in the care to promote emotional support. I will ensure patient centered
care since each patient is unique.

TYPE 1 DIABBETES MELLITUS.
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