NSG 2290 Fall 2018: Endocrine System and Diabetes Presentation

This presentation provides a comprehensive analysis of a case study involving an 8-year-old girl diagnosed with Type-1 Diabetes. It begins by outlining the prescribed medications, including NPH insulin and Novolin, detailing their rationales and mechanisms of action. The presentation further explores the nursing process associated with Type-1 Diabetes management, covering pre- and post-medication assessments, and alternative interventions like diet management. Adverse effects of insulin and interactions with other medications are also addressed. Additionally, the presentation emphasizes the importance of patient and family education, including indicators of diabetes, genetic predispositions, and proper disease management strategies. The expected outcomes and evaluations, such as blood glucose level reduction and body mass index improvements, are discussed, providing a holistic view of diabetes care.

ENDOCRINE SYSTEM AND
DIABETES
Presented by

• The following presentation aims to analyze a
case study of a 8-year old girl suffering from
Type-1 Diabetes.
• The presentation will initiate medication
management of Daisy followed by nursing
process associated with Type 1 Diabetes
Management and Family Education

Medications prescribed to Daisy Miller
• 8u NPH (neutral protamine Hagedorn) Insulin
BID
• Novolin Regular BID

Rational of Medication
• NPH is intermediate acting insulin. It helps in decrease in the
blood glucose level of patients with type 1Diabetes Mellitus. Daisy
was administered with NPH insulin as her HbA1c is at margin
(5.2%). It will help to reduce the level of insulin in blood at the
normal range (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in
terms of its mode on diabetes mellitus. Journal of Traditional
Chinese Medicine, 34(2), 234-237.

Rational of Medication
• According to Ahmad (2014), NPH insulin works best when it is
administered with rapid-acting monomeric analogue insulin.
• Novolin regular is rapid-acting monomeric analogue insulin. It
will help to reduce the random blood glucose level of Daisy
(22.3 mmol/L while the normal range is 4.4 to 7.8 mmol/L)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin
in terms of its mode on diabetes mellitus. Journal of
Traditional Chinese Medicine, 34(2), 234-237.

Mode of Action of Insulin
• Insulin once in blood binds to alpha subunit of glycoprotein receptor on
the surface of the cell
• Insulin bound glyco-protein receptor is stimulated by insulin at the beta
subunit of the receptor
• This lead to receptor activation followed by receptor tyrosine kinase
activity at the downstream
• The activation of receptor leads to uptake of glucose molecule in blood
inside the cells (Pernicova & Korbonits, 2014)
References
Pernicova, I., & Korbonits, M. (2014). Metformin—mode of action and
clinical implications for diabetes and cancer. Nature Reviews
Endocrinology, 10(3), 143.

Details of Insulin Mechanism
Hall, J. E. (2015). Guyton and Hall textbook of medical physiology e-
Book. Elsevier Health Sciences.

Mode of Action of NPH Insulin and Novoline
• NPH insulin is crystalline insulin suspension with protamine and since
which act as intermediate acting insulin.
• The onset of action occurs during 1 to 3 hours with duration up to 24 hours
• The peak action time is 6 to 8 hours
• Novolin binds to insulin receptors on muscle and adipocytes
• It immediately lowers the blood glucose level by facilitating the cellular
uptake of glucose (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in terms of its
mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2),
234-237.

Desired Effects over the Patients
• Action of NPH insulin and Novoline helps in the reduction of
blood glucose level of Daisy
• It will mainly work in reducing the random blood glucose level
which will help in reduction in the appearance of glucose in
the urine (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin
in terms of its mode on diabetes mellitus. Journal of
Traditional Chinese Medicine, 34(2), 234-237.

Steps of Preparing NPH Insulin
• NPH is given through subcutaneous (SC) injection
• It is prepared through mixing with regular insulin
• Both the NPH insulin (8u) and regular insulin (7u) is combined with the help of
same syringe
• NPH and normal insulin bind when mixed thus mixing should be done only
before the time of medicine administration (Ahmad, 2014)
References
Ahmad, K. (2014). Insulin sources and types: a review of insulin in terms of its
mode on diabetes mellitus. Journal of Traditional Chinese Medicine, 34(2), 234-
237.

Adverse Effects of Insulin
The common side effects of insulin administrations include
• Sudden drop in the blood glucose level (hypoglycemia) leading to nausea,
dizziness, lightheadedness, sweating and fast heart rate. (Pedersen-Bjergaard et
al., 2014)
• This is the reason why doctors recommended for periodic monitoring of the
blood glucose level of Daisy
References
Pedersen-Bjergaard, U., Kristensen, P. L., Beck-Nielsen, H., Nørgaard, K., Perrild, H.,
Christiansen, J. S., ... & Tarnow, L. (2014). Effect of insulin analogues on risk of
severe hypoglycaemia in patients with type 1 diabetes prone to recurrent severe
hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-
endpoint crossover trial. The lancet Diabetes & endocrinology, 2(7), 553-561.

Other adverse effects of insulin
• Swelling of arms and legs
• Weight gain
• Confused state
• Difficulty in communicating
• At the site of injection there can be irritability, swelling and itching
(Pedersen-Bjergaard et al., 2014)
References
Pedersen-Bjergaard, U., Kristensen, P. L., Beck-Nielsen, H., Nørgaard, K., Perrild, H., Christiansen, J. S., ... & Tarnow, L.
(2014). Effect of insulin analogues on risk of severe hypoglycaemia in patients with type 1 diabetes prone to
recurrent severe hypoglycaemia (HypoAna trial): a prospective, randomised, open-label, blinded-endpoint
crossover trial. The lancet Diabetes & endocrinology, 2(7), 553-561.

Interaction of Insulin with other Medication
• Externally supplied insulin can interact with other medications like
• Other anti-diabetic agent
• Anti-bacterial and antiviral agent
• Agent affecting growth hormone
(American Diabetes Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80.

Nursing Process

Pre-Medication Assessment
• Pre-medication assessment will mainly include proper assessment of
the blood glucose level along with monitoring of the weight. This will
help to determine dosage
• Other pre-medication assessment include
• Checking the sterilization of the needle
• Injection site selection
(American Diabetes Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in
diabetes—2014. Diabetes care, 37(Supplement 1), S14-S80.

Post Medication Assessment
• Post Medication Assessment will be done mainly by checking the blood glucose level by random
blood glucose test and HbA1c test.
• Checking blood glucose level can be done by the use of glucometer
• The level of extra blood glucose will also be tested by the urine test (American Diabetes
Association, 2014)
Reference
American Diabetes Association. (2014). Standards of medical care in diabetes—2014. Diabetes
care, 37(Supplement 1), S14-S80

Alternative Intervention
• Diet management
• Diet plan of daisy will mainly include regular small meals at frequent interval
• Meal will be rich in protein, fruits and vegetables
• Meal will avoid deserts, chocolates and aerated drinks and other junk food
(Atkinson, Eisenbarth & Michels, 2014)
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1
diabetes. The Lancet, 383(9911), 69-82.

Expected Outcome and Evaluation
• Expected outcome will be reduction in the blood glucose level
• Reduction in the blood glucose level can be monitored by
conducting blood test like random blood glucose test and
HbA1c test (Atkinson, Eisenbarth & Michels, 2014)
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1
diabetes. The Lancet, 383(9911), 69-82

Expected Outcome and Evaluation
• Improvement in the body mass index of Daisy
• This will be monitored by measurement of the body
weight and the body mass index
• Monitoring of the level of ketone bodies in blood.
• Decrease in the level of ketone bodies will indicate
positive outcome
(Atkinson, Eisenbarth & Michels, 2014).
References
Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014).
Type 1 diabetes. The Lancet, 383(9911), 69-82

Patient/Family Education

Family Education
Three important factors contributing Type 1 Diabetes
among Children are
Genetic Predisposition
Lack of physical activity
Increased consumption of calorific food
(Hilliard et al., 2013)
References
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood,
K. K. (2013). Predictors of deteriorations in diabetes
management and control in adolescents with type 1
diabetes. Journal of Adolescent Health, 52(1), 28-34.

Indicators of type 1 Diabetes
Sudden loss of weight
Increase in appetite
Fatigue
Nausea
Appearance of glucose in blood
Increase level of thrust
(Hilliard et al., 2013)
References
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K.
(2013). Predictors of deteriorations in diabetes management and
control in adolescents with type 1 diabetes. Journal of Adolescent
Health, 52(1), 28-34.

Path physiology of Diabetes
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K.
(2013). Predictors of deteriorations in diabetes management and
control in adolescents with type 1 diabetes. Journal of Adolescent
Health, 52(1), 28-34.

Proper Management of Diabetes
Hilliard, M. E., Wu, Y. P., Rausch, J., Dolan, L. M., & Hood, K. K. (2013).
Predictors of deteriorations in diabetes management and control in
adolescents with type 1 diabetes. Journal of Adolescent Health, 52(1), 28-

Special Education To Daisy’s Mother
Importance of immunization
A detailed feedback of the ideal body weight
and body mass index of Daisy

Conclusion
Proper medication management and proper
regulation of diet and physical activity helps
in effective management of type 1 diabetes
mellitus
For effective dosage modulation (insulin
dose) periodic monitoring of blood glucose
level is important