case study analysis for a 13-year-old Type 1 diabetes

Diabetes is a common health complication resulting from excessive glucose in the blood (Katsarou et al.,2017). According to the American Diabetes Association (2018), about 34.2 million Americans were diabetic in 2018. Out of this, 1.6 million of the population had type 1 diabetes, with about 187,000 children and young adults. The report also indicates that approximately 210,000 young adults have diabetes. According to statistics, diabetes ranked as the seventh leading contributor to mortality rates in the United States (US) as of 2017.

Diabetes occurs due to excessive glucose accumulation in the blood when the body cannot process glucose properly. The factors that impair glucose processing include; failure of the pancreas to produce insulin or insufficient insulin and insulin failure to function correctly. The two types of diabetes include; Type 1 diabetes that occurs due to disintegration of cells that produce insulin and Type 2 diabetes that is associated with insufficient production of insulin or failure of the body cells to react with insulin (Katsarou et al.,2017).

This report is a case study analysis for a 13-year-old adolescent girl admitted and diagnosed with Type 1 diabetes in the pediatric unit. Her mother is her primary caregiver.

Pathophysiology  case study analysis for a 13-year-old adolescent girl admitted and diagnosed with Type 1 diabetes

Type 1 diabetes occurs due to destruction of the cells that generate insulin, thus impairing insulin production. The process is triggered by an abnormal reaction in the cells due to a virus or an infection. The condition occurs at any age and is common in childhood, as identified in the case study—destruction of beta-cells causes insulin deficiency. Loss of the islet cell occurs due to genetic susceptibility, environmental factors, and autoimmunity. Autoimmunity is associated with cell and cytokine injury of the beta cells. The autoantibodies, antibodies, and glutamic acid decarboxylase destroy the islet cells. The environmental factors that stimulate the autoimmune reaction include; medication like pentamidine, streptozocin, and alloxan. High consumption of bovine milk and foods with nitrosamines also trigger autoimmune injury and even viruses. The most commonly affected beta cells include the cytomegalovirus, mumps, and rubella.

Additionally, type 1 diabetes may be stimulated by pancreatitis (Zaccardi et al.,2016). Patients present rapid symptoms when the cells stop producing insulin, including polydipsia, polyphagia, and polyuria. Polydipsia increases blood sugar level, which causes an increase in the body cells’ osmotic pressure, thus resulting in intracellular dehydration and thirst, which is stimulated by the hypothalamus. Polyuria occurs when the blood glucose increase, therefore, acting as an osmotic diuretic. Glucose filtration in the glomeruli is higher than glucose level for reabsorption in the renal tubules thus causing glycosuria. At this point, the patient losses excessive water and electrolytes through urine. Polyphagia occurs due to the cells’ reduced capacity to store proteins, carbohydrates, and fats, resulting in starvation. The patient losses weight and develops fatigue due to loss of body fluids, and they utilize fats and proteins as a source of energy (Katsarou et al.,2017).

Lab abnormalities

Upon assessing the patient’s health history, subjective data include; The patient may have a viral infection like rubella, mumps, coxsackievirus, or any condition—a history of trauma or surgery. The patient might have used medications or regime. Functional health indicates metabolic health patterns like weight loss, thirst, nausea, vomiting, wound healing difficulties, and diet compliance. The patient’s activity and exercise level show fatigue and muscle weakness. The patient may express a blurred vision, abdominal pain, headache, and numbness in the extremities. Objective data include; Kussmaul respiration, confusion, tachycardia, and hypotension. Additionally, the client may have impaired skin integrity, low blood pressure, and increased heartbeat rate. The patient may have a history and risk factors for type 1 diabetes, including insulin resistance, pancreatitis, and infection (American Diabetes Association,2018).

Diagnosis

There are several tests for type 1 diabetes, including a random blood sugar test, a preliminary screening for type 1 diabetes taken at any time. A positive diagnosis for diabetes is indicated by the blood sugar level of 200mg/dL or 11mmol/L and above. Glycated hemoglobin (A1C) test is used to determine the average of the client’s blood sugar level in the previous three months. The presence of diabetes is confirmed if the A1C level is 6.5% and above upon repeating the test. A fasting blood sugar test after fasting overnight. A positive test for type 1 diabetes occurs if the fasting blood sugar level is 126mg/dl or 7,0 mmol/L or higher. Additional tests are also necessary to rule out type 2 diabetes and develop an effective care plan. They include; A blood test to determine the common antibodies present in type 1 diabetes patients. A urine test to determine if ketones are present since they suggest type 1 diabetes (American Diabetes Association,2018).

Implications for Self-Care

Self-care is the patient’s ability to sustain healthy lifestyle behaviors critical to coping with health conditions. Self-care demands that individuals use their resources to promote their health and consider the patients and the caregivers’ actions to maintain good health (Hartweg, 2015). For diabetic patients, as in the case of a 13-year old girl, positive self-care entails; healthy eating habits, physical exercises, regular monitoring of the blood sugar level, adherence to medication, development of healthy coping mechanisms, and refraining from the risk factors for diabetes.

Abraham Maslow’s hierarchy of needs has five levels, which include;(1) physiological conditions, (2) safety, (3) sense of belonging, (4) self-esteem needs, and (5) self-actualization. The hierarchy is critical for prioritizing the needs of the patients. Kenowitz et al. (2020) present the hierarchy needs for type 1 diabetes patients as follows;(1)The survival needs include; insulin, administration of insulin, and control; they also need close monitoring by the healthcare workers, education, and information needs. (2)The patient’s safety needs include; family, peer, community support, and increased knowledge and coping skills. (3)A sense of belonging is rooted in the family and peer support and the patient’s ability to adapt and participate in everyday activities like any other teenager. (4)The 13-year-old patient’s self-esteem needs include; a desire for strength, independence, achievement, and confidence. (5) Lastly is the self-actualization level where a patient would desire to accept themselves for who they are and to continue pursuing her dreams in school, the desire to convince herself that type 1 diabetes is not a death note and she can live with it and continue to pursue her dreams Kenowitz et al. (2020)

Orem’s theory of self-care demands that individuals be capable of taking care of their needs (Hartweg, 2015). However, the 13-year old girl described in the case study is a minor; she solely depends on her mother for survival. The case study describes her mother as her caregiver and seats at the bedside during the period the client is in the hospital; thus, it might be difficult for a single mother to raise income to cater to her child’s health needs. Additionally, the mother spends time by the bedside, making it difficult for her to work and make a living.

Patient Education Strategies

Treatment of type 1 diabetes is critical to avoid further complications. The treatment goal for the condition is to keep the blood glucose level in a normal state as much as possible to protect the patient from any difficulties. The interventions focus on keeping the glucose level in the blood between 80 and 130 mg/dl before eating and below 180mg/dl after food consumption. Treatment for type 1 diabetes includes; administering insulin, close monitoring of the patient’s dietary intake and blood sugar level, healthy nutrition intake, and regular exercise to maintain healthy body weight. Insulin is administered through an insulin pump or an injection (Phelan et al., 2018).

Education is critical for the successful management of diabetes. According to Phelan et al. (2018), childhood and adolescent diabetes helps control glycemia and promotes the patient’s psychological well-being. Diabetes education also aims to help the patient develop a self-management attitude against the disease. Education strategies include; informing the patient and the caregiver to remain committed to managing diabetes; this entails adhering to medication, adopting healthy eating practices, participating in physical activity programs, and establishing a healthy relationship with the health care provider. Secondly, inform the patient to identify herself by wearing a tag or bracelets, indicating she has diabetes. The patient should always carry the glucagon kit so that friends and loved ones can help with a low blood sugar emergency. Thirdly, advise the patient to schedule an annual physical and eye exam so the doctor can assess for any complications and any medical issues—the eye specialist checks for any damage to the retina, glaucoma, or cataracts. Fourthly, inform the patient and caregiver to update the vaccination dates; type 1 diabetes weakens the immune system. Therefore, the physician may recommend vaccination against pneumonia. Fifth, inform the patient to care for her feet by washing the feet with lukewarm water and gently drying them, particularly between the toes. The patient should also moisturize the feet with lotion and check for any injuries in the feet. Again, inform the patient to consult the doctor if she has a sore. Sixth, educate the patient and the caregiver to control the blood pressure and cholesterol through healthy dietary intake, regular exercises, and adhering to the recommended medication.

Interdisciplinary Collaboration

Successful management of type 1 diabetes for the 13-year-old patient requires collaboration between health care providers. Upon diagnosis, the patient needs a close medical follow-up to stabilize the blood sugar levels. An endocrinologist, a hormonal disorder specialist, coordinates the diabetes care team. Additionally, the healthcare team includes; a diabetologist, a doctor whose specialty is type 1 diabetes. The patient should visit the diabetologist every three months until the condition is under control. Secondly, a diabetes specialist nurse (DSN) helps in the treatment and management of type 1 diabetes. The nurse supports the patient’s independence and promotes self-management approaches to reduce the risk of complications and extended hospital stays. Thirdly, a general practitioner (GP) monitors the client’s overall well-being and refers the patient to appropriate specialists. Fourthly, a dietician to guide the patient on healthy nutritional choices, food one should take, and planning the meal menu. Fifth, a psychologist to provide patient support as she adjusts to living with diabetes. Sixth, an optometrist manages eye damage, a common problem among diabetic patients (Katsarou et al. 2017).

Conclusion

From the literature, diabetes is a common health complication caused by high blood sugar levels. Type 1 diabetes is most common in childhood, as in the case of a 13-year-old patient. Diabetes is a chronic illness, thus negatively impacting the economy, the healthcare system, the patient, and the caregivers. The paper has explored the pathophysiology of the disease, including the lab abnormalities and the diagnosis. Nursing interventions for type 1 diabetes aim to keep the blood sugar level in check and take insulin a priority for a patient with type 1 diabetes. Additionally, education for type 1 diabetes should aim at enhancing the self-management ability of the patient. Consequently, successful management of the condition requires a multidisciplinary approach and collaboration between healthcare providers.

References

American Diabetes Association. (, 2018). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care, 41(Supplement 1), S13-S27.

Hartweg, D. L. (2015). Dorothea Orem’s self-care deficit nursing theory. Nursing theories and nursing practice, 105-132.

Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., Dabelea, D., Bonifacio, E., Anderson, B. J., … & Lernmark, Å. (2017). Type 1 diabetes mellitus. Nature reviews Disease primers, 3(1), 1-17.

Kenowitz, J. R., Hoogendoorn, C. J., Commissariat, P. V., & Gonzalez, J. S. (2020). Diabetes‐specific self‐esteem, self‐care, and glycaemic control among adolescents with Type 1 diabetes. Diabetic Medicine, 37(5), 760-767.

Phelan, H., Lange, K., Cengiz, E., Gallego, P., Majaliwa, E., Pelicand, J., … & Hofer, S. E. (2018). ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatric diabetes, 19, 75-83.

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.