Case Study: Diabetes Mellitus and Chronic Kidney Disease

This case study focuses on Mrs. Mallacoota, a patient suffering from type 1 diabetes mellitus and chronic kidney disease (CKD). The analysis highlights the importance of managing blood glucose levels to slow down the progression of CKD, with a non-fasting blood glucose level of 14 mmol/L indicating poorly controlled diabetes. The assignment explores the pathophysiology of type 1 diabetes, the impact of diabetes on kidney function, and the critical role of self-management in preventing further deterioration. Additionally, the case study addresses the second nursing problem: high blood pressure (150/100), which is also a risk factor for CKD, emphasizing the need for effective hypertension management through relaxation techniques, guided imagery, and medication. The document references key studies supporting the relationship between diabetes, hypertension, and CKD, underscoring the cyclical nature of these conditions and the importance of comprehensive patient care.

Diabetes Mellitus

1.
In the present case, Mrs Mallacoota is suffering from Chronic Kidney Disease (CKD) and
type 1 diabetes mellitus. Non- fasting Blood Glucose levels were observed to be 14 mmol/ L.
This indicated poorly controlled diabetes mellitus. The prime goal of the care provided to Mrs
Mallacoota is to adopt secondary prevention strategies so that the progression of CKD could be
slowed down. In this regard, the first step to be taken is to encourage effective self- management
of the blood glucose levels by Mrs Mallacoota. Diabetes type 1 is characterized by destruction of
beta cells in the pancreas. This condition occurs in individuals who are genetically susceptible
(Van Belle, Coppieters and Von Herrath, 2011). Type 1 diabetes is a catabolic disorder in which
very low level of circulating insulin in present in the body. This leads to elevation of plasma
glucagon. Destruction of insulin secreting cells further leads to insulin deficiency (Maahs and
et.al., 2010). Type 1 diabetes is a major risk factor for chronic kidney disease. Diabetes leads to
injury of small blood vessels in the body. When the blood vessels of kidneys are injured, it
affects the functioning of kidneys leading to retention of more water and salt in the body
(Shurraw and et.al., 2011). Hence, if the type 1 diabetes is not self- managed by Mrs Mallacoota,
it will eventually worsen the condition of her kidneys.
2.
The second nursing problem with Mrs Mallacoota is high blood pressure. Her BP was
recorded to be 150/ 100 which is much above the normal range. Hence, the second goal of care is
effective management of hypertension. The reason behind this goal is that hypertension is a risk
factor for development of chronic Kidney disease. Further, it also leads to more rapid
progression of CKD. It is even more important to manage Mrs Mallacoota’s hypertension
because the relationship between this condition and CKD is cyclic (Thomas and et.al., 2011).
Progressive CKD can also exacerbate uncontrolled hypertension (Jha and et.al., 2013). In this
regard, Mrs Mallacoota can be instructed to undertake relaxation techniques and guided imagery.
This will help in reducing stressful stimuli thereby producing a calming effect. Along with this,
medications can be administered for managing the problem of high blood pressure.
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REFERENCES
Jha, V. and et.al., 2013. Chronic kidney disease: global dimension and perspectives. The
Lancet. 382(9888). pp.260-272.
Maahs, D. M., and et.al., 2010. Epidemiology of type 1 diabetes. Endocrinology and metabolism
clinics of North America. 39(3). pp.481-497.
Shurraw, S. and et.al., 2011. Association between glycemic control and adverse outcomes in
people with diabetes mellitus and chronic kidney disease: a population-based cohort
study. Archives of internal medicine. 171(21). pp.1920-1927.
Thomas, M. C. and et.al., 2011. The association between dietary sodium intake, ESRD, and all-
cause mortality in patients with type 1 diabetes. Diabetes care. 34(4). pp.861-866.
Van Belle, T. L., Coppieters, K. T. and Von Herrath, M. G., 2011. Type 1 diabetes: etiology,
immunology, and therapeutic strategies. Physiological reviews. 91(1). pp.79-118.
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