Case Study Analysis: Health Variation 2 - Sarah's Type 1 Diabetes

This case study focuses on the nursing care of Sarah Burns, a 5-year-old diagnosed with type 1 diabetes. It examines the pathophysiology of the disease, the use of NovoRapid insulin, and the importance of monitoring blood glucose levels. The assignment addresses questions about insulin onset, peak, duration, administration, and the management of hypoglycemia. Additionally, it explores appropriate insulin pen needle lengths, injection sites, and the potential physical and emotional challenges Sarah may face. The case study emphasizes the need for balancing energy expenditure, insulin dosage, and nutrition, as well as the importance of psychological support for the patient and her family. It also includes references to relevant literature supporting the pharmacological and nursing management of a person with type 1 diabetes.

Running Head: Leisure and Health 1
HEALTH VARIATION 2
by Student’s Name
Class/Course/Code
Professor’s Name
University/School
City, State
Date

Running Head: Leisure and Health 2
Health Variation 2
Question 1:
Because of the diagnosis of type 1 diabetes (T1D), Sarah has been prescribed insulin. It is
considered a chronic autoimmune disease, and in the susceptible individuals, the immune
mechanism is elicited for developing an autoimmune response alongside changed beta-cell
antigens of the pancreas or the molecules of beta cells resembling pathological proteins.
(Agoons, Balti, & Kaze, 2016) Ecological triggering makes the islet autoimmunity also beta-cell
death in persons, causing sequences of the pre-diabetic phases in addition, ultimately cause
clinical commencement of T1D (Zaccardi et al., 2016). The patient then needs the exogenous
insulin for reversing this catabolic illness, prevent ketosis, reduce hyperglycemia, and regularize
lipid as well as protein metabolism. Insulin acts by the binding to the glycoprotein receptors
(Chaplin, S. (2017). A growth-stimulating effect of the insulin seems to occur by triggering
receptors of relevant insulin-alike growth factors (Petersen & Shulman, 2018).
Question 2.
a) What is the onset, peak and duration of action for NovoRapid insulin?
NovoRapid insulin begins its action 10 to 20 minutes subsequent to injection; its extreme
duration of the action ("peak") is 1 to 3 hours, as well as period of the action, is about 3 to 5
hours (Bullock, & Manias, 2017). Each person responds slightly differently to different insulins,
although they are always within a given range (Galbraith et al., 2015).
b) When should Novo-Rapid be administered in relation to food and why?
NovoRapid should be administered with the relation of food immediately before meals, but
can be taken after meals if necessary. As when used with a meal, especially in children, care
should be taken to match the insulin dose (especially the basic bolus) with food intake, physical

Running Head: Leisure and Health 3
activity and current blood glucose levels in order to minimize the risk of hypoglycemia.
Hypoglycemia can occur if the insulin dose is too high relative to insulin demand. No
NovoRapid should be injected if hypoglycemia or suspected hypoglycemia occurs. After
adjusting the patient's blood sugar, the dose adjustment should be considered (Bullock, &
Manias, 2017).
Question 3.
a) Define hypoglycemia
Hypoglycemia is a condition caused by extremely small levels of the blood sugar (glucose),
which is the body's chief source of energy (American Diabetes Association, 2013).
b) What causes hypoglycemia?
Hypoglycemia can be caused by one or more events, such as excessive insulin or other
glucose-reducing diabetes tablets, delaying or losing a meal, not eating enough carbohydrates,
unplanned physical activity, more intense than usual Exercise and drinking (Chang, 2017).
c) What are the symptoms of hypoglycemia?
Symptoms may vary depending on the degree of hypoglycemia (Cryer, 2016). The symptoms
include hunger, shaking, anxiety and sweating, pale skin, rapid or irregular heartbeat, lethargy,
dizziness, and coughing. As hypoglycemia worsens, symptoms may include blurred
consciousness, blurred vision, loss of consciousness, and seizures (Bullock, & Manias, 2017).
d) How is hypoglycemia treated?
Treatment of hypoglycemia involves immediate initial treatment to increase blood glucose
levels and treat potential conditions that cause hypoglycemia to prevent it from recurring (Cryer,
2016).
Question 4.

Running Head: Leisure and Health 4
a) What is the most appropriate insulin pen needle length for Sarah?
Mostly smaller pen needles (4mm, 5mm or 6mm) are utilized for all children who start
insulin treatment. Although 4mm needles are considered the safest option, especially to 2-6 years
old (O'Neal et al., 2015). Consequently, for Sarah, this will be the most suitable insulin needle of
pen length with lifted skin fold.
b) Why is this length appropriate?
Shorter pen needles are favored over lengthier pen needles because the shorter needle is more
advantageous in terms of ease of usage, perceived pain as well as glycemic control (Kalra et al.,
2017), so this length is suitable for Sarah.
Question 5:
Checking blood glucose levels before injecting insulin is important for Sarah because
frequent testing is the only way to keep child's blood sugar levels within the target range, which
may change as Sarah raises (Agoons et al., 2016). In addition, in this way, parents can better
understand and control the youngster's diabetes. Monitoring can avoid short-term symptoms of
diabetes, as well as future health complications. Parents can solve issues in a timely plus
effective manner and create changes to diabetes controlling plan (Czenczek-Lewandowska et al.,
2019).
Question 6.
a) What is an appropriate site on Sarah’s body to inject the Novo-Rapid insulin?
The favoured site for Sarah of Novo-Rapid insulin injection is the abdomen; two mature
fingers extend away from the umbilicus, the superior third and lateral side of the two thighs and
the posterior and lateral side of the superior buttocks and flank (American Diabetes Association,
2015).

Running Head: Leisure and Health 5
b) What injection angle is appropriate for Sarah?
Children like Sarah or very thin adults may need to be injected on the 45-degree angle for
avoiding injection going intramuscular (Klonoff et al., 2017).
c) Why are these appropriate for Sarah?
Abdominal absorption is the fastest, followed by arms, thighs and buttocks. In addition, the
45-degree angle prevents pain caused by intramuscular injection, so these are suitable for Sarah
(Klonoff et al., 2017).
Question 7.
a) When would Sarah’s BGL need to be tested after administration of NovoRapid?
Sarah’s blood glucose level (BGL) needed to be tested at 1 to 3 hours after administration of
NovoRapid insulin subcutaneously (DiMeglio et al., 2018).
b) Why would a BGL be required at that time?
Blood glucose levels is required in order to minimize the risk of hypoglycemia at the peak
hour for the mechanism of action of Novorapid. Hypoglycemia can occur if the insulin dose is
too high relative to insulin demand. No NovoRapid should be injected if hypoglycemia or
suspected hypoglycemia occurs. After adjusting the patient's blood sugar, the dose adjustment
should be considered (Bullock, & Manias, 2017).
Question 8:
The most vital everyday physical challenge that Sarah may face in type 1 diabetes is the
necessity for balancing energy expenditure with insulin dose/nutrition intake. According to
Iversen, Graue, Haugstvedt, & Råheim, (2018) children with the T1D were observed to have
lesser overall activity, and a few minutes of the moderate-intensity physical activity equated to
their peers not having T1D. Moreover, normal growth, as well as development, disturbs all

Running Head: Leisure and Health 6
aspects of diabetes care plus forms the framework for handling care at diverse ages (Petrak,
Röhrig, & Ismail, 2018). Hypoglycemia is the chief problem of Sarah's condition, especially
because it is associated with potential side effects on intellect. Her objective blood sugar level
may be upper to offset low blood sugar Klonoff et al., (2017) suggested that hypoglycemia is
predominantly harmful to brain development in youngsters.
Question 9:
Potential emotional effects of type 1 diabetes that Sarah may face include adjustments
depression, anxiety, as well as eating disorders affecting diabetes management that is needed to
be discovered. Delamater (2018) concluded that after primary adjustment, children suffering
from diabetes had the same psychosocial standing as children without diabetes. Though, two
years subsequently, the diagnosis, children as well as adolescents with diabetes experienced
double as much depression and modification problems as their age fellows. The family history of
diabetic complications might have a negative impact on adjustment. Jones et al. (2016) evaluated
school-age youngsters in the initial six years of the diagnosis and examined a slight increase in
the depressive symptoms subsequently the first year. Boys' anxiety decreases; however, girls'
anxiety increases by time. So Sarah may face these emotional impacts in the near future.

Running Head: Leisure and Health 7
References
American Diabetes Association. (2016). Stress. [Online] Available at:
http://www.diabetes.org/living-with-diabetes/complications/mental-health/stress.html
[Accessed 24 Mar. 2016].
Agoons, D. D., Balti, E. V., & Kaze, F. F. (2016). From the Journals. African Journal of
Diabetes Medicine Vol, 24(2). ISSN 2053-4787 What is the title of the article
(title is African journal of diabetes medicine), attaching article
with it you can check
Kalra, S., Mithal, A., Sahay, R., John, M., Unnikrishnan, A. G., Saboo, B., & Strauss, K. W.
(2017). Indian injection technique study: population characteristics and injection
practices. Diabetes Therapy, 8(3), 637-657. (June 2017, Volume 8, Issue 3, pp 637–657
(no DOI)
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology (8th ed). Melbourn, Pearson:
Australia.
Klonoff, D. C., Nayberg, I., Stauder, U., Oualali, H., & Domenger, C. (2017). Half-unit insulin
pens: disease management in patients with diabetes who are sensitive to insulin. Journal
of diabetes science and technology, 11(3), 623-630. (First Published November 28, 2016
Review Article https://doi.org/10.1177/1932296816679180)
Chang, E. (2017). Living with Chronic Illness and Disability-EBook: Principles for Nursing
Practice. Elsevier Health Sciences. 3rd edition ISBN: 9780729542616
Cryer, P. (2016). Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention.
American Diabetes Association. (3rd edition DOI: 10.2337/9781580406499)

Running Head: Leisure and Health 8
Czenczek-Lewandowska, E., Leszczak, J., Weres, A., Baran, J., Wyszyńska, J., Grzegorczyk, J.,
… Mazur, A. (2019). Sedentary behaviors in children and adolescents with type 1
diabetes, depending on the insulin therapy used. Medicine, 98(19), e15625.
doi:10.1097/MD.0000000000015625
Delamater, A. M., de Wit, M., McDarby, V., Malik, J. A., Hilliard, M. E., Northam, E., &
Acerini, C. L. (2018). ISPAD Clinical Practice Consensus Guidelines 2018:
psychological care of children and adolescents with type 1 diabetes. Pediatric Diabetes,
19 (Supply 27), 237-249. (DOI: 10.1111/pedi.12736)
DiMeglio, L. A., Acerini, C. L., Codner, E., Craig, M. E., Hofer, S. E., Pillay, K., & Maahs, D.
M. (2018). Glycemic control targets and glucose monitoring for children, adolescents,
and young adults with diabetes. Pediatric diabetes, 19, 105-114. DOI/ISSN
https://doi.org/10.1111/pedi.12737)
Galbraith, A., Bullock, S., Manias, E., Hunt, B., & Richards, A. (2015). Fundamentals of
Pharmacology: An applied approach for nursing and health. Routledge. ( location,
city???) Pub. Location: London
Iversen, A. S., Graue, M., Haugstvedt, A., & Råheim, M. (2018). Being mothers and fathers of a
child with type 1 diabetes aged 1 to 7 years: a phenomenological study of parents'
experiences. International journal of qualitative studies on health and well-being, 13(1),
1487758. doi:10.1080/17482631.2018.1487758
Jones, A., Olsen, M. Z., Perrild, H. J., & Willaing, I. (2016). The psychological impact of living
with diabetes: descriptive findings from the DAWN2 study in Denmark. Primary care
diabetes, 10(1), 83-86. https://doi.org/10.1016/j.pcd.2015.03.008

Running Head: Leisure and Health 9
National Institutes of Health. (2015). National Institute of Diabetes and Digestive and Kidney
Diseases. Diabetes in America, 2nd Edition. NIH Publication, (95-1468).
(https://www.niddk.nih.gov/-/media/Files/Strategic-Plans/Diabetes-in-America-3rd-
Edition/DIA_Ch22.pdf?la=en&hash=B36A992469526A5C4C240263AB81E0BC)
O’Neal, K. S., Johnson, J., & Swar, S. (2015). Nontraditional considerations with insulin needle
length selection. Diabetes Spectrum, 28(4), 264-267.
https://doi.org/10.2337/diaspect.28.4.264
Petersen, M. C., & Shulman, G. I. (2018). Mechanisms of insulin action and insulin resistance.
Physiological reviews, 98(4), 2133-2223. https://doi.org/10.1152/physrev.00063.2017
Petrak, F., Röhrig, B., Ismail, K. (2018). Depression and Diabetes. South Dartmouth (MA):
MDText.com, Inc.; 2000-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK498652/
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2016). Pathophysiology of type 1 and type
2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, 92(1084), 63-
69. Medical Journal 2016; 92:63-69.