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Stages of Type I Diabetes Mellitus

Type I Diabetes Mellitus (TDM-I) is the effective culmination of the total "lymphatic infiltration" which causes the destruction of the pancreatic beta cells of the islets of Langerhans that secretes insulin. The rapid declination of beta cells reduces the insulin level in the body and this disrupts the normal balance of blood glucose levels in the body. The lack of insulin results in excess blood sugar in the body; a condition known as hyperglycemia. TDM-I occurs in three different stages.

Stage 1: This is usually asymptomatic and can be effectively diagnosed by the level of fasting glucose, level of glucose tolerance and the presence of two or more two autoimmune antibodies in the pancreas.

Stage 2: In this stage, dysglycemia (excess blood sugar level in the bloodstream) and two or higher numbers of pancreatic autoantibodies can be seen. The amount of fasting glucose becomes impaired which is the amount of “glucose to 100 to 125 mg/dl” and the amount of “glucose tolerance” also gets impaired (140 to 199 mg/dL). This stage also remains asymptomatic (Lucier et al., 2021).

Stage 3: This is the stage where the clinical symptoms of TDM-I can be seen and excess hyperglycemia occurs.

The main difference between type I and type II diabetes is in TDM-1, the insulin production stops due to the immune destruction of insulin-producing beta cells. On the other side, in TDM-II effective insulin resistance occurs as the pancreas becomes unable to produce "enough insulin" or is unable to "use insulin" for maintaining proper blood glucose levels. The clinical tablets for diabetes management influence insulin production and this work when the pancreas is still producing insulin (Eizirik, Pasquali & Cnop, 2020). In Jarrah's case, he has been diagnosed with TDM-I and therefore his body is unable to produce insulin due to this reason he requires a constant supply of external insulin to maintain the blood glucose level in his body.

Optisulin is effective external insulin that helps in managing the blood glucose level for 24 hours. The medicine should be taken once a day and can be taken any time of the day; however, regular intake of the medicine should be done at the same time. Effective monitoring of blood glucose levels before and after the administration of optisulin should be done regularly.

NovoRapid should be taken just before meal consumption. As the blood sugar level in TDM-I increases approximately 30 minutes after food consumption, the insulin starts acting 10-15 minutes after consumption and the effect lasts for four to five hours. However, small snacks or food should be consumed after NovoRapid administration as this would prevent hypoglycemia.

The basal-bolus insulin regimen requires when an individual is required to take both "basal" and ''bolus" insulin in a day. The basal insulin effectively controls the increase of blood glucose level that occurs due to "glycogenolysis and gluconeogenesis". The basal insulin helps in the effective maintenance of total blood glucose level during all 24 hours of a day. The bolus insulin helps in restricting the enhancement of blood glucose levels after meal consumption. This is a "quick-acting" medicine that prevents sudden hyperglycemia (Bryant & Knights, 2014).

Differences between Type I and Type II Diabetes

NovoRapid is an effective insulin replacement that acts “faster than human insulin”. The effect can be seen after approximately 10-15 minutes of administration of the medicine and the effect effectively lasts approximately four to five hours. This “bolus insulin” effectively blunts the “postprandial blood glucose rise”. These insulins are created after changing the amino acid structure and this reduces the hexameric formation of insulin molecules after subcutaneous administration and generates a rapid bloodstream absorption (Donner & Sarkar, 2019).

Optisulin on the other side effectively stimulates the peripheral uptake of glucose and maintains the blood glucose level by inhibiting the total production of hepatic glucose. The stimulation of peripheral uptake is primarily done through "skeletal muscle and fat stimulation". The insulin effectively restricts the "lipolysis" in the adipocytes tissues and also enhances the level of protein synthesis by restricting the rate of proteolysis. This is an effective "long-acting insulin" that helps in maintaining the blood sugar level throughout the day.

According to the registered nursing standard of "The nursing and Midwifery Board of Australia (NMBA)" there are seven nursing standards available and these are as follows.

  1. Critical thinking and effective analysis of nursing practise
  2. Proper engagement in "therapeutic relationships" and "professional relationships"
  3. Effective maintenance of nursing capabilities
  4. Comprehensive conduction of assessments
  5. Effective nursing plan development
  6. Providing a quality nursing service that is “safe”, “appropriate” and “responsive”.
  7. Effective evaluation of nursing outcomes.

  Registered nursing standards

Figure 1: Registered nursing standards

(Source: Nursingmidwiferyboard.gov.au 2022)

The above figure shows the registered nursing standard. During an emergency of hypoglycemia, the nurses should follow standards 1, 4 and 6 and should inform doctors and start administration of "concentrated dextrose" solution (50% concentration D50W) (Paschou et al., 2018). This would help in stabilizing the blood sugar level during emergency hypoglycemia. The nurse should also effectively monitor the blood sugar level to avoid such incidents.

Two possible causes that could lead to hypoglycemia are "insulin overdose", and "postponing meals".

Insulin overdose: In the present case Jarrah has been given both bolus and basal insulin for glycemic control and this might have led to excessive insulin levels in his body. This has lowered the blood sugar level excessively and has resulted in hypoglycemia (Roep et al., 2021).

Postponing Meals: NovoRapid requires rapid consumption of meals or snacks as this rapidly decreases the blood sugar level (Lucier & Weinstock, 2018). On the condition that Jarrah has not had a proper meal or has postponed his snacks, it may lead to hypoglycemia.

A proper nursing action after measuring hypoglycemia is emergency administration of "glucose tablets" or carbohydrates pills that contain approximately "15/20 grams of carbohydrate" (Xiang et al., 2018). As the patient is conscious, hard candies, sweets, glucose water, fruit juices etcetera can also be provided. This intervention has been carried out to manage the sudden lowering of blood sugar levels of conscious patients with the external glucose administration.

On the condition that Jarrah is in altered consciousness, emergency administration of "glucagon emergency kit" or "glucagon nasal powder" should be given by the nurse. As the patient is unconscious this implies that inadequate glucose transport is occurring in the patient's brain. Therefore immediate dextrose IV should also be given to stabilize the situation. This intervention has been carried out to manage the sudden decrease in blood glucose of unconscious patients (Tornese et al., 2020).

Medications for Type I Diabetes Mellitus

Insulin is effective in maintaining the blood glucose levels of individuals. Apart from blood glucose maintenance, insulin also helps in reducing the effect of associated diabetes symptoms such as "fatigue", "excess urge of urination" etcetera and gives the patient effective control over his or her health (Verma et al., 2020). Proper monitoring of blood glucose levels helps the patient in understanding the negative impact of diabetes on the body.

The effective information on the symptoms of hypoglycemia that can be provided to the patient is "excessive sweating", "tiredness", "dizziness", "shaking body", "excessive hunger", "tingling of lips", "palpitations", "frequent mood swings" such as anxiety, depression, irritation etcetera (Tauschmann & Hovorka, 2018).

Symptoms of hypoglycemia

Figure 2: Symptoms of hypoglycemia

(Source: Created by the author)

The vial of insulin should be effectively "rolled" and should be rotated at 180 degrees 5 to 10 times to ensure effective mixing (Tornese et al., 2020). After that, the lid should be removed and the top should be disinfected with alcohol. After that, the cap should be removed from the syringe and insulin should be taken by pushing air into the bottle through the syringe. After that adequate dose of insulin should be taken from the bottle by pulling the syringe. After that injection site should be chosen and it can be the abdomen or lateral thigh and the skin of that area should be pinched before injecting the syringe to avoid intramuscular absorption. After pushing the contents of the syringe the skin should be pinched for 5 to 10 seconds for ensuring the effective insertion of insulin.

Major social justice programs are proper maintaining "Human rights", "access", "participation", and proper "equity". In the present case, "participation" social rights should be given to Jarrah. This would help the patient in understanding the disease, its impact and the need for taking insulin (Xiang et al., 2018).

The solution can be provided by educating Jarrah about the negative consequences of diabetes and making him participate in his treatment program of effective diabetes management.

a. Different factors can disrupt effective glycemic control for young adults. These include, "lack of proper monitoring", "lack of self-control", "different psychosocial factors", "insufficient family support", "lack of parental supervision", "inadequate adherence to treatment", and "effective puberty increase of resisting insulin" etcetera.

b. After discharge from the hospital, the patient Jarrah has to take additional measurements before engaging in sports. Excessive exercise or sports activity can cause hyperglycemia or can cause hypoglycemia and this can affect glycemic control (Tornese et al., 2020).

Reference

Bryant, B., & Knights, K. (2014). Pharmacology for Health Professionals ebook. Elsevier Health Sciences. Retrieved on 23rd April, 2022 from: 

https://books.google.co.in/books?hl=en&lr=&id=Uo6bBgAAQBAJ&oi=fnd&pg=PP1&dq=Pharmacology+for+Health+Professionals,+5th+Edition&ots=PsDZ0AoSpD&sig=_wwUaCNolfCvW6zM2NzVWmBESbg&redir_esc=y#v=onepage&q=Pharmacology%20for%20Health%20Professionals%2C%205th%20Edition&f=false

Donner, T., & Sarkar, S. (2019). Insulin—pharmacology, therapeutic regimens and principles of intensive insulin therapy. Endotext. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278938/

Eizirik, D. L., Pasquali, L., & Cnop, M. (2020). Pancreatic β-cells in type 1 and type 2 diabetes mellitus: different pathways to failure. Nature Reviews Endocrinology, 16(7), 349-362. https://www.nature.com/articles/s41574-020-0355-7

Lucier J, Weinstock RS. Diabetes Mellitus Type 1. [Updated 2021 Jul 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507713/

Lucier, J., & Weinstock, R. S. (2018). Diabetes mellitus type 1. https://europepmc.org/article/nbk/nbk507713

Nursingmidwiferyboard.gov.au. (2022). Nursing and Midwifery Board of Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au. Retrieved 23 April 2022, from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx.

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine connections, 7(1), R38-R46. DOI: https://doi.org/10.1530/EC-17-0347

Roep, B. O., Thomaidou, S., van Tienhoven, R., & Zaldumbide, A. (2021). Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nature Reviews Endocrinology, 17(3), 150-161. https://www.nature.com/articles/s41574-020-00443-4

Tauschmann, M., & Hovorka, R. (2018). Technology in the management of type 1 diabetes mellitus—current status and future prospects. Nature Reviews Endocrinology, 14(8), 464-475. https://www.nature.com/articles/s41574-018-0044-y

Tornese, G., Ceconi, V., Monasta, L., Carletti, C., Faleschini, E., & Barbi, E. (2020). Glycemic control in type 1 diabetes mellitus during COVID-19 quarantine and the role of in-home physical activity. Diabetes technology & therapeutics, 22(6), 462-467. https://doi.org/10.1089/dia.2020.0169

Verma, A., Rajput, R., Verma, S., Balania, V. K., & Jangra, B. (2020). Impact of lockdown in COVID 19 on glycemic control in patients with type 1 Diabetes Mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(5), 1213-1216. https://doi.org/10.1016/j.dsx.2020.07.016

Xiang, A. H., Wang, X., Martinez, M. P., Getahun, D., Page, K. A., Buchanan, T. A., & Feldman, K. (2018). Maternal gestational diabetes mellitus, type 1 diabetes, and type 2 diabetes during pregnancy and risk of ADHD in offspring. Diabetes Care, 41(12), 2502-2508. https://doi.org/10.2337/dc18-0733

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