Case Study Analysis: Type 1 Diabetes Diagnosis and Management

This case study presents the diagnosis and management of Type 1 diabetes in a young patient named Briana. The assignment analyzes the patient's symptoms, including high blood glucose, glucose in urine, increased urination, thirst, appetite, ketones, and weight loss, and explains the underlying physiological mechanisms. It details the process of insulin administration, including pre-, during-, and post-administration considerations for nurses. The case study also explores the emotional and physical impacts of the diagnosis on Briana and her family, including the mother's coeliac disease history and the father's disability. Finally, it outlines recommendations for healthcare professionals, including consultation with senior doctors, adherence to statutory laws and NMBA guidelines, and the involvement of a specialized team to support the family. The case study references relevant medical literature and provides illustrations to support the analysis.

CASE STUDY

Table of Contents
Question 1........................................................................................................................................1
1. High blood glucose level.........................................................................................................1
2. Glucose in the urine................................................................................................................1
3. Increased urination..................................................................................................................2
4. Increased thirst........................................................................................................................3
5. Increased appetite....................................................................................................................3
6. Ketones in the urine and blood................................................................................................3
7. Weight Loss............................................................................................................................4
Question 2........................................................................................................................................4
Prior to administration.................................................................................................................4
Question 3........................................................................................................................................4
Emotional impact........................................................................................................................4
Physical Impact...........................................................................................................................4
Question 4........................................................................................................................................4
REFERENCES................................................................................................................................6

Question 1
The insulin producing beta-cells are destructed in an autoimmune way that too within
Langerhans islets. This entire process is responsible for causing type 1 diabetes that is mellitus.
Furthermore, the role of genetics herein is also very important. Diseases like diabetes are highly
at risk of getting transferred through genes. Since Briana's mom was suffering from disease
called coelia, her genes were likely to be passed to Briana.
Further contextualising upon hypothalamus, it is a part present within brain and crucially
plays the role of determining whether diabetes would be developed or not. It is responsible for
controlling thirst, hunger and temperature of body. Any disturbances in these system is likely to
pose the threat of diabetes. Having diet involving high-fats triggers the pathway of hypothalamus
thereby causing hunger and thirst in excessive terms. Gradually the [erson is made prone towads
having diabetes.
1. High blood glucose level
Type 1 diabetes mainly occurs due to presence of higher blood-glucose levels since the
body is not able to produce insulin in appropriate amount. If the level is higher than 7 mmol/L
then the diabetes is diagnosed. In case of Briana it was 25.0mmol/L (A to Z: Diabetic
Ketoacidosis, 2017). As per this, beta cells present in pancreas are responsible for production of
insulin, are killed by the body's immune system.
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Within the bloodstream building up of glucose occurs instead of going through the cells.
So, the entire body gets restricted from using glucose necessary for energy thereby causing type-
1 diabetes.
2. Glucose in the urine
The presence of glucose in urine higher than 0.8mmol/L tends to be the significant
outcomes of diabetes. Excreting of glucose in urine is often termed as glycosuria. The enhanced
blood glucose level is responsible for causing it as an outcome of type-1 diabetes. Millions of
nephrons are responsible for filtering blood. Within it, flow of blood is usually from arteriole to
glomerulus. Each of the glomerulus is surrounded by Bowman's-capsule which is responsible
for collecting filtrate usually consisting of waste-materials. This is passed by the aid of renal-
tubules present in kidney (Chang & Johnson, 2014). The renal-tubule's 1st part that is proximal-
tubule, reabsorbs glucose from filtrate. Only a limited quantity of glucose gets absorbed and rest
is passed into urine. And since type-1 diabetes cause high blood-glucose levels, presence of
glucose in urine gradually increases.
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Illustration 1: Destroying insulin producing cells
(Source: Type 1 diabetes, 2017)

3. Increased urination
The type-1 diabetes is responsible for causing osmotic-diuresis. In this, the levels of
glucose becomes very high such that amount of it gets excreted in the urine as well (Diabetes
Mellitus and Polyuria, 2017). When an individual is found to drink excessive quantity of fluid
having caffeine or alcohol in them, this condition usually occurs.
When blood is filtered by kidney to produce urine, all sugar gets absorbed moving back
to blood flow. The abnormally-high level of glucose makes it impossible to absorb entire glucose
from blood and hence diffuses into urine. Henceforth, volume of urine is increased. So, Briana
has been showing an signs of this because from past 2 nights she had been wetting the bed.
Also, her excessive drinking has resulted in this as well.
4. Increased thirst
The glucose getting hyper concentrated within the bloodstream, as such the kidney fails
in pulling out glucose from water. Since, glucose can no longer be pulled out from water in the
kidney,forming of osmotic pressure increases (Dempsey, Hillege & Hill, 2014). This is increased
to such an extreme level that water does not gets absorbed within the blood stream. It is rather
absorbed out.
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Illustration 2: Increased urination by type-1 diabetes
(Source: Diabetes Mellitus and Polyuria, 2017)

5. Increased appetite
Because of the extremely high glucose-levels due to type-1 diabetes, glucose present in
blood gets restricted to enter the cell. This happens because of lacking insulin and as an outcome
food eaten couldn't be converted into energy. So, this gradually leads to increased appetite which
is also termed as ‘polyphagia’. As noticed by Briana's parents, she was consistently found to eat
a lot.
6. Ketones in the urine and blood
The building up of ketones is usually because the body cells do not get fuelled up due to
inadequate insulin (Type 1 diabetes, 2017). So, people having type-1 diabetes are likely to be
more prone towards high ketone levels. Because of diabetes, there is often insufficient amount of
insulin.
Because of this, appropriate levels of glucose couldn't be delivered into body-cells to be
used as energy and as a result fat burning starts. Then, liver converts fatty-acids into ketones to
be released in stream of blood in order for obtain energy. People having type 1 diabetes have
high levels of ketones due to very low insulin thereby causing ketoacidosis which might possibly
lead to death of person.
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Illustration 3: Kitoacidosis
(Source: A to Z: Diabetic Ketoacidosis, 2017)

7. Weight Loss
Within the type-1 diabetes, improper use of glucose causes lack of insulin. If it does not
get diagnosed, usually weight-loss begins to occur. Within the bloodstream, glucose starts to
build up due to lack of insulin. In such situations, through urine, kidney gets rid of excess
glucose. As a result, dehydration occurs, which further leads to loss in weight. In case of Briana
nearly 5 Kg loss was observed. Calories are lost as well due to the sugar that was unable to be
used as energy-source.
Question 2
1. Prior to administration
1. Before providing insulin via Flex Pen, nurse has some responsibility to take care of. It
must be ensured that insulin is injected before 5-10 minutes before taking any meal.
2. The nurse should take care that insulin is first drawn when it is mixed with NPH-insulin.
The injection needs to be given immediately after the mixing. It is also the nurse's role to
store it in a refrigerated temperature (2 degree to 8 degrees). Care has to be taken so that
that excessive sunlight is not exposed upon it and also prevent it from freezing (LeMone
& et.al., 2015).
3. The patient who is being diagnosed with insulin needs, to have a proper diet plan so that
no further amounts of glucose are generated thereby making the process of insulin
injection far more complicated.
2. During administration
5. At the time of administration, it is the responsibility of the nurse that proper dosage is being
provided to Briana. The right amount is 2 units as set by the doctors of Emergency
Department. So, this has to be taken care of.
6. Moreover, during the intake, the behaviour of the patient in taking it has to be monitored as
well. This is to be taken in extreme observation so that no difficulty is faced by her during
intake.
7. The injecting of insulin should not be done upon swollen areas.
3. After the administration
8. Herein, the nurse plays the most significant part. Although there is a very less probability
of getting adversely affected.
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9. Still, nurse has to monitor Briana in case of any type of allergic-reactions are found to
occur. Also, the initial response usually begins to show within 15 minutes after the
injection and peaks out within 45 to 90 minutes.
10. Also, senior doctor has to be consulted by the nurse in case, any signs of trauma, fever,
nausea are indicated by Briana after being diagnosed. This stage basically requires full
involvement from the side of nurse.
11. She has to do the monitor the patient that is ‘Briana’ and observe her actions withjin
every few hours during the whole day. Also, the diet which is taken by Briana after the
injection, needs to be properly taken care of so that no type of side effects are observed.
12. And, if any complications are occurring then it is the responsibility of the nurse to
immediately inform the authorities of the Emergency Department to take the necessary
actions.
Question 3
1. Emotional impact
Since Briana mother had already suffered from coleiac disease so she is likely to remain
in a state of stress that her child is suffering from such adverse affects (Bullock & Manias, 2013).
Briana's brother is also likely to get affected since she is his sister and being emotionally
connected levels of anxiety are supposed to rise. Also, her father will majorly going under a state
of depression since she has to undergo through the complications of type-1 diabetes. Also he
would be feel guilty since he is not able to help Briana as he is already suffering from disability.
2. Physical Impact
Since Briana has been diagnosed with type-1 diabetes, she needs to be taken to the
hospital on timely basis. But since her mother, father and brother are themselves undergoing
through their complications so, additionally taking care of Briana and themselves is likely to be
the major physical-impact upon their individual bodies. Furthermore, Briana's diet also needs to
be maintained accordingly by her parents because Briana being so little would not be able to take
care. So, they had to take care about their diet as well as hers too which is physically going to
affect their bodies.
Question 4
In order to positively impact Briana and her family, first of all I would consult all the
senior doctors. Since knowing that her mother is suffering from coeliac disease immediate action
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has to be taken. As per the statuary laws, I would accordingly formulate the required procedures.
I would also take in consideration coping strategies provided from the NMBA, Briana, and her
mother, father, brother are likely to carry their day to day activities under my strict supervision,
Specifically Briana's father would be provided physical training from me to make him fit enough
to cope with disability. I would also be involving a specialised team to train him with special
exercises on daily basis. This team would be under the certification of NMBA guidelines.
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REFERENCES
Books and Journals
Bullock, S. & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education
AU.
Chang, E. & Johnson, A. (Eds.). (2014). Chronic illness and disability: Principles for nursing
practice. Elsevier Health Sciences.
Dempsey, J., Hillege, S. & Hill, R. (Eds.). (2014). Fundamentals of nursing and midwifery: A
person-centred approach to care. Lippincott Williams & Wilkins.
LeMone, P. & et.al., (2015). Medical-surgical nursing. Pearson Higher Education AU.
Online
A to Z: Diabetic Ketoacidosis, 2017. [Online]. Available Through :
<http://kidshealth.org/RadyChildrens/en/parents/az-ketoacidosis.html>. [Accessed
On: 29th July 2017].
Diabetes Mellitus and Polyuria, 2017. [Online]. Available Through:
<https://courses.washington.edu/conj/bess/polyuria/polyuria.htm>. [Accessed On: 29th
July 2017].
Type 1 diabetes, 2017. [Online]. Available Through:
<https://medlineplus.gov/ency/article/000305.htm>. [Accessed On: 29th July 2017].
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