Type 1 diabetes

   Type 1 diabetes

       Type 1 diabetes

Introduction

Type 1 diabetes or diabetes mellitus type 1 is a disease that is commonly found in children caused by failure of beta cells of islets of Langerhans in the pancreas to produce enough insulin. The beta cells may also fail to produce insulin hormone due to pathogenic infection where certain viruses destroy the beta cells in the pancreas (In Dyson &In Goff, 2016). It is characterized by persistent hyperglycemia accompanied by disrupted fat, protein and starch metabolism which is caused by inadequate secretion of insulin molecules. Diabetes mellitus type 1 is known to be caused by an autoimmune reaction that destroys the beta cells of islets of Langerhans leading to production of inadequate or no insulin.

High blood glucose level

Type 1 diabetes is an increase in the glucose level in the body of a child. The beta cells in the pancreas fail to secrete enough insulin and the glucose is prevented to enter the body tissues. The body breaks down fats and proteins to release energy instead of the glucose and therefore the glucose increases in the blood (Australian Institute of Health and Welfare, 2015). Beta cells of islets of Langerhans in Briana’s pancreas had been destroyed by autoimmune reaction hence insulin hormone was produced in low quantities. This made the cells to prevent glucose from entering the muscle and other tissues and it accumulated in her blood. The osmotic pressure of the blood raised and thus Briana felt thirsty and drunk water frequently. The blood sugar in Briana’s blood had risen beyond the normal levels, hence her body responded by a negative feedback to remove the excess glucose from the blood using the kidneys. In the process, her kidneys filtered out plenty of water hence Brianna passed out urine frequently and even wet the bed.  After being reviewed for two hours in the emergency department, Briana was diagnosed with diabetes mellitus type one which may have been passed on to her by the mother as the medical history showed. To raise the insulin level in the blood, Briana was prescribed an injection of Aspart insulin through a Flex pen.

Glucose in the urine

The glucose presence in the urine is known as glycosuria. When the blood glucose is high than normal levels in children, the condition is known as diabetes mellitus type 1. It occurs when the glomerular filters much glucose than the amount the distal and proximal tubules of the kidney can absorb. If the renal threshold for sugars is reached, then glucose is filtered out with urine (In Dyson &In Goff, 2016). The renal threshold for glucose is raised by conditions such as persistent hyperglycemia. Briana’s renal threshold for glucose and after the glycosuria test was done, the doctor found there were glucose molecules in her urine. The accelerated amount of glucose present in the renal tubules made her kidneys unable to prevent all the glucose from being excreted in the urine. The glucose level in Briana’s urine was high than it may be expected hence the doctor suspected she might be suffering from diabetes mellitus type 1 and was immediately sent to emergency department for an insulin molecule injection.

Increased urination

This condition is known as polyuria. Briana experienced frequent passing out urine to an extent of wetting the bed for two nights. The blood sugar level was high and caused a lot of dehydration to her body. (Bhansali, Aggarwal, Parthan, &Gogate, 2016). Briana was drinking large amounts of water as her parents had noticed. This urinary frequency was due to taking in a lot of fluids especially water and drinks that consisted of caffeine. Since Briana’s blood contained a lot of glucose molecules, the glucose molecules were forced to diffuse in the urine. As the urine contained glucose molecules, solvent, which is the water in the blood moved through osmosis into the urine and caused Briana’s urinary bladder to fill fast and urinated frequently.

Increased thirst

This condition is known as polydipsia. It is a primary symptom of diabetes. Briana’s parents noticed that she was becoming thirsty frequently. This condition was caused by hyper concentration of glucose molecules in Briana’s bloodstream. Her kidneys were unable to prevent glucose monomers from diffusing into the urine across the walls of the renal tubules. As a result, water was drained from the blood through osmosis and hence she felt thirsty faster than usual.

Increased appetite

This condition is known as polyphagia. It is used to refer to the increased feeling of hunger in diabetic people. It can be brought about by anxiety, bulimia, stress and depression. The sugar levels in Briana’s bloodstream were excessively high as the beta cells of the pancreas were unable to secrete enough insulin molecules due to autoimmune annihilation of the beta cells. Her cells prevented the glucose to enter them because of inadequate insulin hormone in the blood to make them permeable to glucose molecules (Greydanus& Merrick, 2016). The cells were deprived of a food substrate to break down to release energy hence she felt hunger as her body was weak as glucose monomers were not metabolized to release energy.

Ketones

Diabetic ketoacidosis is a condition where high levels of ketones are produced by the body. The beta cells in the pancreas of Briana had been damaged and hence they secreted no or inadequate insulin hormone which make the muscles and other tissues permeable to glucose molecules. Her tissues therefore produced acids called ketones which accumulated in the blood as they metabolized fats instead of glucose monomers to release energy in form of adenosine triphosphate. Due to hyper concentration of glucose solutes in Briana’s bloodstream, accumulation of high level of ketones was also established by her doctor.

Weight loss

This is a condition whereby the body loses weight drastically in a way that cannot be explained. It is one the symptoms that someone is developing diabetes. From the medical history, Briana had lost five kilograms since she was reviewed for a cold a month ago which was a symptom of Diabetes mellitus type 1. Secretion of inadequate insulin by the cells of the pancreas inhibited the glucose molecules from the digested food from entering the cells (Perry, Hockenberry, Lowdermilk, & Wilson, 2014). This caused her cells to be deprived of the source of energy. To generate energy, the body begun to breakdown the fat stored in tissues and muscles through respiration to release energy. This caused her body to use the reserved fats to produce energy and hence she lost weight drastically.

Discuss the nursing responsibilities and supporting rationales related to the administration of Aspart (Novo Rapid) insulin to Briana via a Flex Pen

Prior to administration

Before administering the insulin on Briana, the nurse carries out the five medication administration rights. He/she identifies the patient, that is, who is Briana (her age, gender and physical and physiological characteristics). The nurse ensures that the right drug is given (Australian Institute of Health and Welfare, 2015). The label of the insulin and its order are checked. The route of the administration is also considered. In Briana’s case, the effect of the drug was required instantly and hence injection of the insulin through the vein was the most appropriate route. The timing of the medication is also important. The nurse checks twice if the insulin given was the ordered one and is given at the right time. Correct documentation of the time, route and the devices used in the administration of the medication is kept (Australian Institute of Health and Welfare, 2015). The medical profile of the patient is very crucial to the nurse. The nurse determines if the Aspart insulin might result in unexpected results due to differences in specific drug metabolism caused by genetic variations in different people. The nurse examines the height and weight of Briana to calculate the doses of the insulin to be administered accurately.

During administration

The nurse carries out the dosage calculations accurately to avoid errors that may result in adverse effects on Briana. The nurse injects the insulin he/she has prepared or has been prepared by a pharmacist who is licensed. The nurse also injects the insulin appropriately and safely to ensure that it has been injected in the right site for it to be effective in its action and to cause little discomfort to the patient.

After administration

The nurse is to educate Briana and her family about the side effects of the insulin and also explain to them of the expectations after the administration of the medication. This would enable Briana and her family to adhere to correct medication and monitoring the effects of the medication. The nurse makes a follow up of Briana after administering the insulin. The nurse checks blood glucose level after administering the medication and keep a record. Any unwanted results from the insulin injected are checked and accounted for by the nurse. This enables the nurse to keep track of the progress of Briana’s condition.

Discuss the effects of diabetes type 1 on Briana and her family

Emotional impacts

Briana faces so many emotional issues due to her illness. She is scared as her condition makes her feel weak and unable to effectively concentrate on her work for instance studies, dancing classes and some house chores. She becomes shy as she wets the bed hence lowering her self-confidence. She feels sad as her lifestyle changes regarding having to take a special diet, and injecting of insulin to control the blood sugar level. She also may her friends as they may see her as having a special case hence lowering her self-esteem.

Her siblings may feel powerless as they cannot be able to help their sister to get well. Loss of joy due to the sickness of their sister and they cannot play well as they used to before Briana fell sick. The parents may become stressed due to financial constraints resulting from the cost of medication of their daughter.

Physical impacts

Briana develops physical problems in her body due to the illness. Some of the problems include: delayed healing of wounds, frequent urination, blurred vision and high appetite.

The parents may experience sleeplessness as they look after their daughter. The mother develops exhaustion as she looks after the sick daughter, the husband who has a mild intellectual disability and the rest of the family.

Explain how you would adapt your nursing care of Briana and her family to accommodate Tom’s intellectual disability

I would be visiting Tom’s home frequently to have closer contact with the family. While at their home I would sit with Tom and spend some hours talking to him as a friend and even make some jokes. Then little by a little talk with him the condition of his daughter and try to help him understand the kind of medication and care that their daughter requires. I would also provide Tom with some brochures giving information on diabetes. Since people with intellectual disability have low cognitive abilities, I would help him read through the information on the brochure and help him understand the condition of their daughter in a better way. I would help him understand that their daughter requires regular injections of insulin to lower blood sugar level, regular exercise and a special diet.

References

Australian Institute of Health and Welfare. (2015). Aboriginal and Torres Strait Islander Health Performance Framework 2014 report: New South Wales.

Australian Institute of Health and Welfare.(2015). Incidence of type 1 diabetes in Australian children 2000-2013.

Bhansali, A., Aggarwal, A., Parthan, G., &Gogate, Y. (2016). Clinical rounds in endocrinology: Volume II.

Greydanus, D. E., & Merrick, J. (2016). Diabetes Mellitus. Hauppauge: Nova Science Publishers, Inc.

In Dyson, P., & In Goff, L. (2016). Advanced nutrition and dietetics in diabetes.

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2014). Maternal child nursing care


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