Case Study Analysis: Type 1 Diabetes, Insulin, and Hypoglycemia

This case study examines a scenario involving Sarah, a patient diagnosed with Type 1 Diabetes due to insufficient insulin production. The case study explores the function of insulin, the impact of its deficiency, and the need for insulin injections to regulate blood glucose levels. It covers the use of NovoRapid insulin, including its onset, duration, and optimal timing relative to meals. The study delves into the causes, symptoms, and treatment of hypoglycemia, as well as the appropriate needle length for insulin pens. It emphasizes the importance of blood glucose monitoring before insulin administration and discusses the potential physiological and emotional challenges associated with daily insulin therapy, including diet restrictions, and the risk of complications such as retinopathy. The case study also highlights the need for emotional support for patients. The provided references support the findings and recommendations made throughout the analysis.

Running head: CASE STUDY
CASE STUDY: TYPE 1 DIABETES
Name of Student:
Name of University:
Author’s Note:

1CASE STUDY
Answer number 1:
As per the given case study, Sarah is diagnosed with type1 diabetes due to inefficient
production of hormone known as insulin inside the body. As lymphocytic cell is functionless, it
damages the beta cell of the islets of Langerhans of pancreases. It is very difficult to produce
insulin. The function of insulin transports it into the cell, which would be helpful to generate
ATP (Folli et al., 2018). If insulin is not available, the glucose level in the blood is enhanced and
lead to hyperglycemia and body would get enough glucose for production of energy. Hence, it is
concluded that for normal concentration of glucose in the blood it is recommended to take
insulin for type1 diabetes.
Answer number 2:
a) The novoRapid insulin start to function around 10-20 minutes of time interval after it is
applied. Its effect is optimum within 1-3 hours of administration. It lasts till 4-5 hours
after it is injected (Jacob et al. 2016).
b) NovoRapid injection should be taken 10 min prior of meal. Moreover one can take this
injection after meal too but under 5 mins. The main reason behind this is due to
consumption of food, it gets breakdown into glucose and if there if inefficiency of
insulin, the glucose level get enhance in blood (Tauni & Golubic, 2019). Hence, it is
concluded that it would be better to take this injection immediately before or after meal.
Answer number 3:
a) The inefficiency of glucose in the blood is referred as Hypoglycemia (Adamkin, 2019).
b) Hypoglycemia is caused by over secretion or excessive intake of insulin hormone or any
other effect of malnourishment.

2CASE STUDY
c) Starvation, sweating, tremor, place face, irregular heart rate, faintness, blurred vision are
the warning sign of Hypoglycemia (Lipska, 2017).
d) It can be treated instantaneously by taking glucose rich diet just after the indication of
symptoms. Glucose tablet is best suited for this (Thornton et al., 2015).
Answer number 4:
a) 4mm needle for insulin pen is most appropriate length for Sarah (Lim et al., 2018).
a) Since the thickness of skin for children is 1.6mm to 2.4mm hence it is recommended to
use 4mm needle for injection to subcutaneous tissue (Frid, Hirsch & Strauss, 2018).
Answer number 5.
To save Sarah from risk of lethal consequence it is recommended to take glucose level
test just before insulin injection which lead to the rise of glucose level in the blood. As per
review of RCT paper by Calvo-Marín et al (2017), coma, heart failure or dizziness can be caused
by taking insulin injection at the time when concentration of glucose is either low or moderate in
the blood because it would more decrease the level of glucose from the normal level. According
to Muller et al. (2018), the correct measure of insulin to be taken should be between 0.5 to 1.0
units kg per day. Hence it is suggested to get regular check-up for blood glucose level before
getting insulin injection to save from bad health.
Answer number 6:
a) For better diffusion of insulin inside body, it is recommended for Sarah to take
injection on buttock which is high in fatty acid concentration.
b) It is recommended to insert insulin injection at angle approx. 450

3CASE STUDY
c) To escape any intramuscular injection and rise of any air bubble, it should be applied
in subcutaneous layer. It has been seen that for children the intramuscular
administration of insulin should be avoided as it may enhance the insulin absorption.
Farrar et al. (2016) suggested that insulin should be injected subcutaneously which is
similar to fat layer inside the skin. For long duration effect it is suggested to get
injection into fatty tissue as compared to deeper muscle. As per the study of Hua et al.
(2017) the fatty acid concentration near buttock area is 5.8% and that is why it is
recommended for Sarah to take insulin injection to the same place(Lim et al., 2018).
Answer number 7:
a) There is the need to test the blood glucose level of Sarah after the in time period of 10 to
20 min after administration of NovoRapid insulin. It is evident from the study of Jia et al.
(2017) that NovoRapid starts to function at the soon after it is injected into the body and
lowers the concentration of glucose level in the bloods and transport it into the cell of the
body. Hence, it is important to be check the whether the medication has started to work or
not in order to avoid adverse condition to the health. Therefore, blood glucose level need
to be tested.
b) There is the need to have blood glucose level at the time of administration, to inject
correct dose of NovoRapid insulin into the body. It is also noted that if the blood glucose
level is at the optimum range, injection of insulin can lead to decrease of glucose level in
the blood and consequently cause coma.

4CASE STUDY
Answer number 8.
The physiological obstacle that Sarah can face due to daily administration of insulin is
low immune system and restricted diet plan. She can be potent to bacterial infection as
defence system of the body become weak. Due to diet restriction, she can also be of poor
fatigue. Additionally the incidence of retinopathy and sensitivity to insulin is drug can be
high in Sarah (Heise & Mathieu, 2017). This can also have issue in daily curriculum and
physical activity which has the potential to weaken the body metabolism.
Answer number 9.
Sarah due to type 1 diabetes, can undergo emotional challenges and which can hamper
their quality of life. Due to her restriction regarding diet and daily intake of insulin injection
can end up with rising anxiety, depression and stress because she will not be able to live a
liberal life like other children of her age. Hence, this requires assistance by the parents to
support her emotionally (Young-Hyman et al., 2016).

5CASE STUDY
Reference
Adamkin, D. H. (2019). Neonatal hypoglycemia. In Common Problems in the Newborn
Nursery (pp. 99-108). Springer, Cham. Retrieved from https://doi.org/10.1007/978-3-
319-95672-5_10
Calvo-Marín, J., Torrealba-Acosta, G., Campbell, M., Gaboury, J., Ali, A., & Chen-Ku, C. H.
(2017). Effect of insulin therapy and dietary adjustments on safety and performance
during simulated soccer tests in people with type 1 diabetes: study protocol for a
randomized controlled trial. Trials, 18(1), 338. Retrieved from
https://doi.org/10.1186/s13063-017-2078-1
Farrar, D., Tuffnell, D. J., West, J., & West, H. M. (2016). Continuous subcutaneous insulin
infusion versus multiple daily injections of insulin for pregnant women with
diabetes. Cochrane Database of Systematic Reviews, (6). Retrieved from
https://doi.org/10.1002/14651858.CD005542.pub3
Frid, A., Hirsch, L., & Strauss, K. (2018). Optimal Insulin Delivery. In Ultimate Guide to
Insulin. IntechOpen. Retrieved from DOI 10.5772/intechopen.76232.
Heise, T., & Mathieu, C. (2017). Impact of the mode of protraction of basal insulin therapies on
their pharmacokinetic and pharmacodynamic properties and resulting clinical
outcomes. Diabetes, Obesity and Metabolism, 19(1), 3-12. Retrieved from
https://doi.org/10.1111/dom.12782
Hua, M. C., Su, H. M., Yao, T. C., Kuo, M. L., Lai, M. W., Tsai, M. H., & Huang, J. L. (2017).
Alternation of plasma fatty acids composition and desaturase activities in children with

6CASE STUDY
liver steatosis. PloS one, 12(7), e0182277. Retrieved from
https://doi.org/10.1371/journal.pone.0182277
Jacob, D., Taylor, M. J., Tomlins, P., & Sahota, T. S. (2016). Synthesis and identification of
FITC-insulin conjugates produced using human insulin and insulin analogues for
biomedical applications. Journal of fluorescence, 26(2), 617-629. Retrieved from
https://doi.org/10.1007/s10895-015-1748-1
Jia, J., Wu, J., Wu, Y., & Hu, L. J. B. R. (2017). Clinical efficacy and safety of novorapid
flexpen in treatment of gestational diabetes mellitus. Biomedical Research, 28(19), 8553-
8556. Retrieved from
https://pdfs.semanticscholar.org/3862/72727108b3152da712ae4be61b5e01c299fd.pdf
Lim, S. T. J., Hui, Y. C. A., Lim, P. K., Lim, C. C. E., Chia, Y. Y., & Vasanwala, R. F. (2018).
Ultrasound-guided measurement of skin and subcutaneous tissue thickness in children
with diabetes and recommendations for giving insulin injections. Journal of clinical &
translational endocrinology, 12, 26-35. Retrieved from
https://doi.org/10.1016/j.jcte.2018.04.004
Lipska, K. J., Yao, X., Herrin, J., McCoy, R. G., Ross, J. S., Steinman, M. A., ... & Shah, N. D.
(2017). Trends in drug utilization, glycemic control, and rates of severe hypoglycemia,
2006–2013. Diabetes care, 40(4), 468-475. Retrieved from https://doi.org/10.2337/dc16-
0985
Muller, M., Wheeler, B. J., Blackwell, M., Colas, M., Reith, D. M., Medlicott, N. J., & Al-
Sallami, H. S. (2018). The influence of patient variables on insulin total daily dose in
paediatric inpatients with new onset type 1 diabetes mellitus. Journal of Diabetes &

7CASE STUDY
Metabolic Disorders, 17(2), 159-163. Retrieved from Retrieved from
https://doi.org/10.1007/s40200-018-0355-5
Tauni, R., & Golubic, R. (2019, May). Challenges in managing patients with type 1 diabetes and
hypersensitivity reaction to insulin. In 21st European Congress of Endocrinology (Vol.
63). BioScientifica. Retrieved from https://doi.org/10.1530/endoabs.63.P168
Thornton, P. S., Stanley, C. A., De Leon, D. D., Harris, D., Haymond, M. W., Hussain, K., ... &
Sperling, M. A. (2015). Recommendations from the Pediatric Endocrine Society for
evaluation and management of persistent hypoglycemia in neonates, infants, and
children. The Journal of pediatrics, 167(2), 238-245. Retrieved from
https://doi.org/10.1016/j.jpeds.2015.03.057
Young-Hyman, D. L., Peterson, C. M., Fischer, S., Markowitz, J. T., Muir, A. B., & Laffel, L.
M. (2016). Depressive symptoms, emotion dysregulation, and bulimic symptoms in youth
with type 1 diabetes: Varying interactions at diagnosis and during transition to insulin
pump therapy. Journal of diabetes science and technology, 10(4), 845-851. Retrieved
from https://doi.org/10.1177%2F1932296816645118