2808NRS Nursing

From the case study of Emilia, it is evident that family history of type 1 diabetes (T1D), celiac disease and tonsillectomy are the risk factors that accounted for her condition. T1D has an inherited susceptibility and if any of the parents has the disease, the likelihood increases of their child in developing the disorder. Research has stated that if father is having T1D, the risk of developing the condition is slightly higher than if any sibling or mother having the disease (Atkinson, 2012).

Moreover, the risk of T1D development increases by certain variants of HLA like HLA-DQB1, HLA-DQA1 and HLA-DRB1 genes that provide instructions for protein synthesis playing a critical role in the functioning of immune system considering it an autoimmune disorder. At the age of seven, Emilia was diagnosed with celiac disease and this also increases the development of T1D condition. According to a study conducted by Elfström, Sundström and Ludvigsson, (2014) celiac disease is strongly associated with significant increased risk of subsequent T1D in children under 20 years.

It has been well-established that children with celiac disease are at high risk for T1D within 5 years after first celiac disease diagnosis (Smyth et al., 2008). This is evident in the case study where Emilia was diagnosed with celiac disease at the age of 7 years and within 5 years, at the age of 11 years, she was diagnosed with T1D. HLA-DQ2 is a risk factor that positively increases the risk of T1D expressing tissue transglutaminase auto-antibodies in celiac disease.

Therefore, there is increased risk of T1D in celiac disease patients attributable to HLA characteristics. Tonsillectomy procedure affects the functioning of immune system that increases the risk of T1D among children. An autoimmune reaction where the immune system attacks its own body cells may be activated and destroy the beta cells in pancreases interfering with inclusion production (Atkinson, Eisenbarth & Michels, 2014). Although, there is little evidence on risk of T1D in children after tonsillectomy, however, surgical removal of tonsils affect the normal functioning and early development of immune system making children prone to long-term risks and autoimmune diseases like T1D (Bluestone, Herold & Eisenbarth, 2010).

Answer two

The first signs of T1D when insulin is not being produced in the body with elevated blood glucose levels, the rapid symptoms that are observed are extreme thirst, increased urination, vomiting and extreme tiredness. These signs and symptoms are also witnessed in Emilia as a result of manifestation of T1D. Excessive thirst (polydipsia) and frequent urination (polyuria) are the classic T1D symptoms that occur when excess glucose builds up in the body as seen in Emilia. During this time, kidneys are unable to filter and absorb the excess glucose that results in excretion through urine triggering increased urination, dehydration and increased thirst (Cooke & Plotnick, 2008).

She was lethargic due to dehydration, increased urination and inability of body to function properly and utilize glucose for energy needs. Vomiting occurs when the blood glucose levels tend to rise and makes the body prone to ketone body production. Ketones are acids and its increased levels leads to Diabetic ketoacidosis (DKA) resulting in vomiting and deep rapid breathing as witnessed in Emilia. DKA is common in T1D, when advanced enough leads to unconsciousness and due to this reason; Emilia was unresponsive towards verbal commands resulting from a combination of severely elevated blood glucose levels, shock, dehydration and exhaustion (American Diabetes Association, 2015).

Answer three

For the diagnosis of T1D, Glycated hemoglobin (A1C) test is performed that indicates average blood glucose level in last three months and measures the blood sugar percentage attached to haemoglobin (Gallagher, Le Roith & Bloomgarden, 2009). Higher the levels, more haemoglobin attached where 6.5% or higher indicates T1D. C-peptide testing can also be done as peptide levels matches with insulin levels indicating its production in the body and low levels of insulin and C-peptide points to T1D. Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD) test detects antibodies that are against specific enzymes in beta cells of pancreas producing insulin (Bingley, 2010).

TD can be managed through right amount of insulin administration while working closely with the medical team. This can be delivered through pens or syringes or pumps. The type and frequency of insulin dosage vary on a daily basis and may be required multiple times in a day. Daily blood sugar monitoring is important for Emilia as it helps to estimate carbohydrate intake for lowering blood sugar levels. A balanced diet and physical exercise is important for her ensuring appropriate nutritional intake and healthy weight maintenance curbing the effects of diabetic wear on her body. Regular medical check-ups and meeting with diabetic care team is also important in managing Emilia’s T1D condition and in avoiding its effects on her body (Chiang, Kirkman, Laffel & Peters, 2014).

Reference list

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical   diabetes: a publication of the American Diabetes Association, 33(2), 97. DOI: 10.2337/diaclin.33.2.97

Atkinson, M. A. (2012). The pathogenesis and natural history of type 1 diabetes. Cold Spring Harbor perspectives in medicine, 2(11),   a007641. Doi: 10.1101/cshperspect.a007641

Atkinson, M. A., Eisenbarth, G. S., & Michels, A. W. (2014). Type 1 diabetes. The Lancet, 383(9911), 69-82. Doi:   

Bingley, P. J. (2010). Clinical applications of diabetes antibody testing. The Journal of Clinical Endocrinology & Metabolism, 95(1), 25-  33. Doi:

Bluestone, J. A., Herold, K., & Eisenbarth, G. (2010). Genetics, pathogenesis and clinical interventions in type 1   diabetes. Nature, 464(7293), 1293. Doi:

 Chiang, J. L., Kirkman, M. S., Laffel, L. M., & Peters, A. L. (2014). Type 1 diabetes through the life span: a position statement of the   American Diabetes Association. Diabetes care, 37(7), 2034-2054. Doi: 

Cooke, D. W., & Plotnick, L. (2008). Type 1 diabetes mellitus in pediatrics. Pediatr Rev, 29(11), 374-84. DOI: 10.1542/pir.29-11-374

Elfström, P., Sundström, J., & Ludvigsson, J. F. (2014). Systematic review with meta?analysis: associations between coeliac disease and   type 1 diabetes. Alimentary pharmacology & therapeutics, 40(10), 1123-1132. Doi: 

Gallagher, E. J., Le Roith, D., & Bloomgarden, Z. (2009). Review of hemoglobin A1c in the management of diabetes. Journal of   diabetes, 1(1), 9-17. Doi:

 Smyth, D. J., Plagnol, V., Walker, N. M., Cooper, J. D., Downes, K., Yang, J. H., ... & Heap, G. A. (2008). Shared and distinct genetic   variants in type 1 diabetes and celiac disease. New England Journal of Medicine, 359(26), 2767-2777. Doi:   10.1056/NEJMoa0807917