Health Variations 2: Nursing Case Study on Type 1 Diabetes Management

This nursing assignment presents a case study of a 5-year-old patient, Sarah Burns, diagnosed with Type 1 diabetes. The assignment addresses key aspects of diabetes management, including the role of insulin, its mechanism of action, and the pathophysiology of the disease. It explores the properties of NovoRapid insulin, including its onset, peak, and duration, and discusses the importance of its timing in relation to meals. The case study also defines and analyzes hypoglycemia, covering its causes, symptoms, and treatment strategies. Furthermore, it delves into the appropriate insulin pen needle length for pediatric patients, the rationale behind it, and the necessity of blood glucose level testing before insulin administration. The assignment also highlights the physical and emotional challenges faced by patients with Type 1 diabetes and references relevant literature to support the understanding of pharmacological and nursing management of the disease.

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Nursing assignment
Nursing Assignment

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Nursing assignment
Table of Contents
Question 1:..................................................................................................................................................2
Question 2:..................................................................................................................................................2
Question 3:..................................................................................................................................................3
Question 4:..................................................................................................................................................4
Question 5:..................................................................................................................................................4
Question 6:..................................................................................................................................................4
Question 7:..................................................................................................................................................5
References...................................................................................................................................................6

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Nursing assignment
Question 1:
The hormone Insulin is secreted by the beta cells of the Islets of Langerhans of the pancreas in
the human body. Glucose then triggers the beta cells of the pancreas to release insulin hormone
immediately after taking food. The role of the insulin hormone is to decrease the blood glucose
level by converting it into energy. It also stores the excess glucose level into liver, muscle, and
fat cells for future purpose ("How Insulin Works with Glucose | Kaiser Permanente
Washington", 2019). The immune system destroys the beta cells of the pancreas in type 1
diabetes. As a result, insulin is not produced in the human body which facilitates the rising
amount of glucose levels in the blood and without insulin, glucose cannot convert into energy.
Thus, Sarah needs to inject insulin from outside into the subcutaneous layer of skin to maintain
her blood glucose level ("Diabetes Overview - Symptoms, Causes, Treatment", 2019).
Question 2:
a. The onset action of NovoRapid is faster than any other soluble insulin as it starts
lowering the glucose level within 10 to 20 minutes. The maximum effect is observed
within 1-3 hours which is called peak time. The effect of this insulin may last for a
maximum of 5 hours. Though it may vary based on body temperature, physical
activity, insight blood flow, etc.
b. Novo Rapid should be given 10 minutes before having a carbohydrate meal. Because it
starts action within 10 to 20 minutes and if someone not taking meals within this period
he or she may encounter the extreme lower level of blood glucose. It should be noted
that the lower level of blood glucose would be responsible for hypoglycemia in the
human body ("Diabetes Overview - Symptoms, Causes, Treatment", 2019).

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Nursing assignment
Question 3:
a) The term hypoglycemia is associated with the decrease of blood glucose level than the
normal level in the human body. In the hypoglycemia condition, brain cells starve
glucose energy that may have fatal effects on brain function.
b) Hypoglycemia is mainly observed as the side effects of medication for diabetes.
Hypoglycemia is also observed in non-diabetic patients though it is a very rare condition
("Hypoglycemia - Symptoms and causes", 2019).
Some causes of hypoglycemia are:
 Excess amount of insulin uptake is responsible for the hypoglycemia condition as it
lowers the glucose level in the bloodstream.
 Overproduction of insulin hormone in the body
 Problem in metabolism in children
 Insulin autoimmune syndrome
 Incorrect insulin uptake dose for diabetic patients
c) When blood sugar levels become low due to hypoglycemia condition the following symptoms
are observed:
 Headache
 Anxiety
 Sweating
 Pale skin
 Fatigue
 Dizziness
 Loss of consciousness, confusion, behavioral and visual disturbances are observed
when excess amount of hypoglycemia is occurred ("Hypoglycemia - Symptoms and
causes", 2019).
d) It is important to take care of the medicinal uptake regularly. Diabetic patients must check
their blood glucose level in a regular interval. Sometimes doctors prescribe glucagon hormone to
the patient because it breaks the glycogen into glucose molecules and increase the glucose level

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Nursing assignment
in the blood stream. Diabetic patients should carry candies always with them to avoid
hypoglycemia condition ("Glucagon", 2018).
Question 4:
1. As Sarah is an infant thus she need fine needles for injecting insulin to minimize the pain.
The length of the pen needle for Sarah should be 4 mm in size. The thickness should be
31 gauges as it is considered the finest needle to apply insulin (Birkebaek et al., 2008).
2. Below the subcutaneous layer there is intramuscular layer in skin. Long length of needle
is used to inject insulin in the intramuscular layer of skin to increase the insulin
absorption rate within the body. But this may increase the risk of hyperglycemia. As
Sarah is an infant, her skin layer is thinner than adults. 4 mm needle size helps to inject
the insulin in the subcutaneous layer to reduce pain and risk of hypoglycemia (Birkebaek
et al., 2008).
Question 5:
Sarah needs to check blood glucose level (BGL) before injecting insulin to her body. It will
help to determine the dose of insulin to be injected to her. As Sarah is a newly diagnosed type 1
diabetic patient, regular check up of blood glucose level is important to determine the proper
dose of insulin. Because, as we all know excess amount of insulin injection may lead to
hypoglycemia condition. Points to be noted that patients newly diagnosed with type 1 diabetic
are more prone to hypoglycemia condition in the first 48 hours (Pacaud, Lemieux & Crawford,
2019).
Question 6:
a. It is important to pick a soft and fatty area to inject the NovoRapid insulin. For infant
thighs are the most softening area to be considered. Thus, thighs would be the best place
to inject insulin.
b. 90 degree angle without skin fold is appropriate for Sarah.

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Nursing assignment
c. As 4 mm length of needle is used for Sarah to inject the NovoRapid insulin, it is
important to maintain a 90 degree angle during administration ("Needle Length and
Injection Technique", 2019).
Question 7:
a) After 2 to 3 hours of NovoRapid insulin administration blood glucose level of Sarah need to
be tested.
b) BGL test is required at that time after insulin administration to assess the NovoRapid insulin
dose. It is important to verify whether the given dose is appropriate to control the glucose level in
blood stream (Vinagre et al., 2013).
Question 8:
Sarah may face daily physical challenges for her type 1 diabetes disease. These are:
 Frequent urination at night because kidney responds to the higher glucose level by
flushing out the extra glucose through pee.
 Loss of body water due to frequent urination.
 Tiredness and fatigue as body cannot use glucose to convert it into energy.
 Weight loss due to breakdown of stored fat to provide energy.
 Appetite increment
 Falling asleep
 Thirsty feeling ("Type 1 Diabetes: What Is It? (for Parents) - KidsHealth", 2019)
Question 9:
Due to the lack of proper glucose utilization brain cell could not act properly. As a result, mood
swings can be observed often to Sarah. Some other emotional effects are:
 Change in behavior
 Irritation, aggression
 Stubbornness
 Difficulty in making concentration
 Anxiety, nervousness ("Diabetes and mood swings: Effects on relationships and lifestyle
tips", 2019)

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Nursing assignment
References
Birkebaek, N., Solvig, J., Hansen, B., Jorgensen, C., Smedegaard, J., & Christiansen, J. (2008).
A 4-mm Needle Reduces the Risk of Intramuscular Injections Without Increasing
Backflow to Skin Surface in Lean Diabetic Children and Adults. Diabetes Care, 31(9),
e65-e65. doi: 10.2337/dc08-0977
Diabetes and mood swings: Effects on relationships and lifestyle tips. (2019). Retrieved 24
August 2019, from https://www.medicalnewstoday.com/articles/317458.php
Diabetes and mood swings: Effects on relationships and lifestyle tips. (2019). Retrieved 24
August 2019, from https://www.medicalnewstoday.com/articles/317458.php
Diabetes Overview - Symptoms, Causes, Treatment. (2019). Retrieved 24 August 2019, from
https://www.diabetes.org/diabetes
Diabetes Overview - Symptoms, Causes, Treatment. (2019). Retrieved 24 August 2019, from
https://www.diabetes.org/diabetes
Glucagon. (2018). Retrieved 24 August 2019, from https://www.diabete.qc.ca/en/living-with-
diabetes/care-and-treatment/hyper-hypo-glycemia/glucagon
How Insulin Works with Glucose | Kaiser Permanente Washington. (2019). Retrieved 24 August
2019, from https://wa.kaiserpermanente.org/healthAndWellness/index.jhtml?item=/
common/healthAndWellness/conditions/diabetes/insulinProcess.html
Hypoglycemia - Symptoms and causes. (2019). Retrieved 24 August 2019, from
https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-
20373685
Needle Length and Injection Technique. (2019). Retrieved 24 August 2019, from
https://www.bbraun.co.uk/en/products-and-therapies/diabetes-care/insulin-injection/
needle-length-injection-technique.html
Pacaud, D., Lemieux, L., & Crawford, S. (2019). Starting subcutaneous insulin doses in a
paediatric population with newly diagnosed type 1 diabetes. Retrieved 24 August 2019,
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921730/
Type 1 Diabetes: What Is It? (for Parents) - KidsHealth. (2019). Retrieved 24 August 2019, from
https://kidshealth.org/en/parents/type1.html

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Nursing assignment
Vinagre, I., Sánchez-Hernández, J., Sánchez-Quesada, J., María, M., de Leiva, A., & Pérez, A.
(2013). Switching to basal-bolus insulin therapy is effective and safe in long-term type 2
diabetes patients inadequately controlled with other insulin regimens. Endocrinología Y
Nutrición, 60(5), 249-253. doi: 10.1016/j.endonu.2012.11.009