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Insulin Types and Their Uses

Discuss about the Professional Development and Capability.

Type 1 Diabetes is a type of high blood sugar that is mostly leads to the destruction of cells that produce insulin in the pancreas, the beta cells (Johnston, Mitchell, Haythorne, Pessoa, Semplici, Ferrer, Piemonti, Marchetti, Bugliani, Bosco and Berishvili, 2016). This disturbance is mostly found in young adults and children. Once the cells are destroyed, insulin production is affected and less or no insulin is produced. This affects the uptake of glucose by the cells from blood, hence glucose accumulates in blood leading to high blood sugar finding during a random blood sugar test. This glucose can sip into the urine leading to presence of glucose in urine. Since the cells and tissues do not get enough glucose for metabolism processes, this leads to breakdown of muscle to provide protein energy as a substitute for metabolism processes, this is the reason for weight loss for people with type 1 diabetes (Zaccardi, Webb, Yates and Davies, 2015). Type 1 diabetes presents with symptoms of polyphagia, increased urination and polydipsia. Since the tissues do not receive get enough glucose, one is always hungry, a hunger that does not go away after eating. The hypothalamus is stimulated to perceive hunger continuously due to the tissues deprived of energy, a condition referred to as polyphagia. Due to the increased concentration of glucose in urine, the osmotic gradient in the urine is high and water follows a concentration gradient, therefore a lot of urine is excreted leaving a person dehydrated, this is called polyuria. This triggers an excessive feeling of thirst and the person drinks a lot of water. A condition referred to as polydipsia. Type one can be stabilized with insulin. The person can lead a normal life as long as he gets insulin solution.

Tony has been prescribed with insulin Aspart a fast acting insulin and insulin glargine flexipen a long acting insulin. Tony and his family should be educated on the following; Time-course formulation include; fast, intermediate and long-acting insulin (Lamalle, Servais, Radermecker, Crommen, J. and Fillet, M., 2015).  Fast acting insulin gets assimilated very fast from the fatty tissue of the skin into the blood and controls blood glucose during meals and when taking snacks. It comprises of rapid acting insulin that is absorbed and initial action is after 5-15 minutes of inoculation and duration of action pinnacles at two hours and lasts up to six hours. The other type is Rapid human insulin that has an initial action after two hours which peaks after 2-4 hours and the duration of action can last up to eight hours. Long acting insulin is assimilated slowly, peaks, and stabilizes over a long period of time. it comprises of analogs insulin Detemir and Glargine. Onset of action is after two hours and the duration of action levels for about 24 hours.

Self-Administration of Insulin

Rapid and short acting insulin appears clear in colour and placed in containers. Intermediate acting insulin, NPH is cloudy in appearance while long acting types are clear. Basal insulin is the one needed maintain normal blood glucose during fasting in between meals, bolus insulin is taken before or immediately after meals to prevent hyperglycemic episodes. The principles underpinning the basal-bolus regime include the facts that insulin Aspart is taken before meals because its fast acting nd maintains normal blood glucose after meals while the insulin glargine controls the level of glucose released to blood when one is fasting thus mimicking normal body function. This regime ensures an individual is close to normal function.

Tony is required to have practical skills and knowledge on self-administration of insulin. This will encourage independency (Daniel, Takatori, Fiore, Neto, Pavin, Minicucci and Parisi, 2015). Tony ought to be educated on the nature of his condition, the reason for the symptoms and the importance of insulin to his body, having understood why he needs insulin, he then should be educated on the procedure, precautions and monitoring of progress. Tony needs insulin to relieve the symptoms and lead a normal life. The insulin administered mimics the body insulin. Insulin is administered subcutaneously using a needle. He should be able to monitor the blood sugar oftenly and document the findings for reference and consult. In case of any fluctuations of blood sugar, he should be able to visit a physician. Tony should be aware of the safety measures of proper disposal of the needle after use. He should have a sharps bin nearby for proper disposal. Tony should be aware of the injection skills, the measurement of blood glucose and the dosage to administer.

Insulin is a hormone produced by the islets of Langerhans in the pancreas. Its main function is to lower blood glucose levels to normal ranges. It works antagonizing effects of glucagon. In conditions where the cells are destroyed and cannot produce insulin, artificial insulin formulations are administered to an individual. Once administered, the insulin is absorbed to the blood stream (Czech, Wang and Seki, 2018). Once in the blood stream, the action begins. Insulin attaches itself to call receptors and enhances facilitated diffusion of glucose into the cells where it is immediately converted to gluvose-6-phosphate hence maintaining a concentration gradient for glucose influx. This will in turn reduce blood glucose level. Insulin facilitates the storage of glucose as glycogen in the cells or its conversion to fatty acids hence the ultimate effect of lowering blood glucose.

Monitoring of Blood Glucose Levels

Taking objective tests is necessary to assess the prognosis and stability of the patient. The objective tests to assess if Tony is stable are; Glycated hemoglobin levels, fasting and random blood sugar levels. Glycated hemoglobin reveals the level of glucose for up to the past twelve weeks, this can show the fluctuation of the glucose levels hence point out the stability of patient (Amreen, Suneel, Shetty, Vasudeva and Kumar, 2018). Random blood sugar testing helps determine if the dosage is sufficient and can help adjust and it also points out how the body responds after meals to assess the condition of the patient. Fasting blood sugar is taken after a patient has fasted, mainly in the morning after whole night fast. It helps determine how the body is managing the blood glucose hence gives light on whether the patients metabolism is stable or not (Khandouzi, Shidfar, Rajab, Rahideh, Hosseini and Taheri, 2015).


Hypoglycemia possibly due to inadequate carbohydrate intake- Tony had a hypoglycemic attack immediately after taking a glass of juice, this shows that the juice had inadequate intake of the carbohydrate as compared to the insulin dose he is taking (Smith, Wilson,  Karl, Austin, Bukhari,  Pasiakos ... & Lieberman, 2016)

Hyperglycemia possibly related to excessive carbohydrate intake- Tony is a teenager and mostly takes junk food. Due to the condition, Tony has polyphagia this leads to lots of consumption of carbohydrates leading to hyperglycemia.

My goal towards Tony’s blood sugar level is to ensure that the level of blood sugar is maintained within normal ranges.

In addressing his knowledge deficit, my goals will be; to ensure Tony demonstrates understanding of the nature of disease, to ensure tony is educated on the treatment options and why they are important, to ensure patient demonstrates understanding on how to administer the treatment regime and adhere to it stating the importance of adherence, to ensure Tony demonstrates understanding and willingness towards the adjustment in diet and is ware of the danger signs and complications of the disease (Luke and Richards, 2018).

In an event where Tony’s blood sugar is less than 3.5mmol/L but he is conscious, my intervention will be giving him a fast acting oral carbohydrate such as glucose or fresh juice. After a period of 15 minutes, I will repeat a glucose test to assess the levels, if still low I will give a snack again three times whereby in case where it fails, I consult physician to consider IV glucose infusion (Cryer, 2016). The rationale of giving a snack is; the snack will be digested, converted to glucose and absorbed to the bloodstream to correct the low blood sugar levels to be absorbed to tissues for metabolism. Repeating of the blood glucose test is to evaluate and re plan in case the intervention fails.

Objective Tests to Assess Patient Stability

In an event where Tony’s blood sugar is below 3.5mmol/L and he has lost consciousness, I will position him on the lateral side, administer 10% of IV glucose and consult a physician. Positioning a patient who is unconscious in necessary so as to enable maintain an open airway for proper gaseous exchange (Patti, Li and Goldfine, 2015). IV glucose is fast acting and is infused into the blood raising blood sugar levels, it is readily absorbed by tissues for metabolism purposes. Consultation with physician is necessary in order to assess any complication and collaboratively work towards best patient care.

Ethical values are; maintaining privacy and confidentiality, fairness and just in patient care. the standards of practice are; the standards of practice are; therapeutic and professional relationship and developing a plan for nursing practice. In taking care of Tony, privacy and confidentiality is necessary. This boosts patients trust in the nurse and may lead to Tony to be cooperative in the management hence positive prognosis. Patients should be treated fairly regardless of the social status. Fair and just treatment boosts the patient trust in the facility and promotes openness of the patient in giving history which is a key factor in the management and adherence to treatment.  This promotes smooth stay with the patient and collaboration from relatives through the hospital stay till discharge (Skela-Savi? and Kiger, 2015).


In nursing the standards of practice are important to ensure quality and professional standards of care. Therapeutic and professional relationship between the nurse and Tony is necessary. This will build trust and smooth stay during hospitalization. During the discharge the nurse establishes a plan of referral to the nearby facility for followup. In the case of Tony, the nurse will ensure Tony receives the best care and is comfortable (Harper, and Maloney, 2016). The nurse is responsible in the daily care, education, investigation and planning of discharge. Patient care requires the nurse to plan for the nursing practice. The nurse plans on the patients medication, discharge and clearance from the hospital and explains the procedures to the patient.This is necessary to promote quick recovery of Tony and discharge home and refer to nearby clinic for blood sugar monitoring.

Psychosocial factors refer to the psychological factors and the social factors that affects one’s ability to function (Walker, Gebregziabher, Martin-Harris and Egede, 2015). Psychological factors include stress, hostility, depression and hopelessness. Social factors include, income, social status, culture, customs and beliefs. There are factors that can directly or indirectly affect the participation of Tony in his care and his interaction. in a case where Tony is under normal life stressors, the blood glucose spikes and he might be preoccupied to remember to maintain his diet or consult clinicians. Depressed teenagers pick the introvert nature (Asmat, Abad and Ismail, 2016).This is a stage where they may lose hope in life and he may not adhere to the insulin regime as per the doctor’s instructions. In this state, the interaction between Tony and medical team is affected as he may not be willing to communicate or express his feelings. A calm mind and stress free situation encourages Tony to adhere to self-care and adherence to drugs and promotes good patient-professional relationship (Capoccia, Degaru and Letassy, 2016).

Addressing Knowledge Deficit

Socially, a low family income of Tony may affect his hospital visitation and he might lack the resources required in the management of diabetes. As they struggle to curb the condition, they may not be able to cater for the insulin required regularly and the regular hospital checks required. This affects his adherence no matter how willing he is to adhere. The lack of resources affects the interaction with professionals since he won’t be able to visit the hospital (Silverman, Krieger, Kiefer, Hebert, Robinson and Nelson, 2015). A good family income is a source of motivation towards good health.  Sufficient family income will enable them afford all doses and adhere to hospital visits. The family social status is key when it comes to treatment. A low social status is subject to discrimination in terms of care in the society at large. If Tony feels discriminated, he may be discouraged and withdrawn. This demotivates him and the drive for self-care is reduced (Walker et al., 2015). A high social status attracts respect and better handling and interaction from the society including medical practitioners. culture, customs and beliefs affects one’s health seeking behaviour (Patel, Stone, McDonough, Davies, Khunti and Eborall, 2015).


Some communities may look down on people with chronic conditions and in this setting, Tony may feel alienated and this leads to depression and withdrawal from the people who suit assistance. In the isolated sector, Tony may not stand up and seek medication or visit and interact with medical professionals as it feels shame (Gonzalez, Tanenbaum and Commissariat, 2016). Favourable cultures and beliefs act as source of encouragement to health seeking and medical consultations this fosters interactions. Family relations affect the health seeking behaviour as family is the source of support and income. After the diagnosis of chronic condition, family enters a grieving process (Rebolledo and Arellano, 2016). A family that accepts and sticks together will help Tony with the resources and emotional support to adhere to treatment, a family that scatters due to depression ill affect negatively the adherence and interaction between Tony and medical professionals.

In my future practice, I will take various actions I have learnt from the case of Tony. I will handle a patient holistically; emotional, psychologically, socially, physically and mentally. This will give me a clear understanding of my patient in order to address issues that may affect treatment directly or indirectly. I will educate my patients widely on the condition they have creating trust and understanding to promote openness and adherence. I will involve the relatives of the patient actively in the care to promote emotional support. I will ensure patient centered care since each patient is unique.

Interventions in Case of Hypoglycemia

References

Amreen, S., Suneel, A., Shetty, A., Vasudeva, A. and Kumar, P., 2018. Use of glycosylated HbA1c and random blood sugar as a screening tool for gestational diabetes mellitus in first trimester. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 7(2), pp.524-528.

Asmat, U., Abad, K. and Ismail, K., 2016. Diabetes mellitus and oxidative stress—a concise review. Saudi Pharmaceutical Journal, 24(5), pp.547-553.

Capoccia, K., Odegard, P.S. and Letassy, N., 2016. Medication adherence with diabetes medication: a systematic review of the literature. The Diabetes Educator, 42(1), pp.34-71.

Cryer, P.E., 2016. Management of hypoglycemia during treatment of diabetes mellitus. UpToDate, Waltham, MA.(Accessed on March 25th, 2014.) Retrieved from https://www. uptodate. com/contents/management-of-hypoglycemia-during-treatment-of-diabetes-mellitus.

Czech, T.Y., Wang, Q. and Seki, E., 2018. A new mechanism of action of glucagon?like peptide?1 agonist in hepatic steatosis: Promotion of hepatic insulin clearance through induction of carcinoembryonic antigen?related cell adhesion molecule 1. Hepatology Communications, 2(1), pp.9-12.

Daniel, K.B., Takatori, K.S., Fiore, A.R., Neto, A.M., Pavin, E.J., Minicucci, W.J. and Parisi, M.C.R., 2015, December. Evaluation of the insulin administration technique in a tertiary hospital. In Diabetology & metabolic syndrome (Vol. 7, No. 1, p. A176). BioMed Central.

Gonzalez, J.S., Tanenbaum, M.L. and Commissariat, P.V., 2016. Psychosocial factors in medication adherence and diabetes self-management: implications for research and practice. American Psychologist, 71(7), p.539.

Harper, M.G. and Maloney, P. eds., 2016. Nursing professional development: Scope and standards of practice. Association for Nursing Professional Development

Johnston, N.R., Mitchell, R.K., Haythorne, E., Pessoa, M.P., Semplici, F., Ferrer, J., Piemonti, L., Marchetti, P., Bugliani, M., Bosco, D. and Berishvili, E., 2016. Beta cell hubs dictate pancreatic islet responses to glucose. Cell metabolism, 24(3), pp.389-401.

Khandouzi, N., Shidfar, F., Rajab, A., Rahideh, T., Hosseini, P. and Taheri, M.M., 2015. The effects of ginger on fasting blood sugar, hemoglobin A1c, apolipoprotein B, apolipoprotein AI and malondialdehyde in type 2 diabetic patients. Iranian journal of pharmaceutical research: IJPR, 14(1), p.131.

Lamalle, C., Servais, A.C., Radermecker, R.P., Crommen, J. and Fillet, M., 2015. Simultaneous determination of insulin and its analogues in pharmaceutical formulations by micellar electrokinetic chromatography. Journal of pharmaceutical and biomedical analysis, 111, pp.344-350.

Luke, S.L. and Richards, L., 2018. Motivational Interviewing: A Tool to Open Dialogue With Teens With Type 1 Diabetes Mellitus. Journal of pediatric nursing.

Patel, N., Stone, M.A., McDonough, C., Davies, M.J., Khunti, K. and Eborall, H., 2015. Concerns and perceptions about necessity in relation to insulin therapy in an ethnically diverse UK population with type 2 diabetes: a qualitative study focusing mainly on people of South Asian origin. Diabetic Medicine, 32(5), pp.635-644.

Patti, M.E., Li, P. and Goldfine, A.B., 2015. Insulin response to oral stimuli and glucose      effectiveness increased in neuroglycopenia following gastric bypass. Obesity, 23(4), pp.798-807.

Raziani, F., Tholstrup, T., Kristensen, M. D., Svanegaard, M. L., Ritz, C., Astrup, A., & Raben, A. (2016). High intake of regular-fat cheese compared with reduced-fat cheese does not affect LDL cholesterol or risk markers of the metabolic syndrome: a randomized controlled trial, 2. The American journal of clinical nutrition, 104(4), 973-981.

Rebolledo, J.A. and Arellano, R., 2016. Cultural Differences and Considerations When Initiating Insulin. Diabetes Spectrum, 29(3), pp.185-190.

Silverman, J., Krieger, J., Kiefer, M., Hebert, P., Robinson, J. and Nelson, K., 2015. The relationship between food insecurity and depression, diabetes distress and medication adherence among low-income patients with poorly-controlled diabetes. Journal of general internal medicine, 30(10), pp.1476-1480.

Skela-Savi?, B. and Kiger, A., 2015. Self-assessment of clinical nurse mentors as dimensions of professional development and the capability of developing ethical values at nursing students: A correlational research study. Nurse education today, 35(10), pp.1044-1051.

Smith, T. J., Wilson, M. A., Karl, J. P., Austin, K., Bukhari, A., Pasiakos, S. M., ... & Lieberman, H. R. (2016). Interstitial glucose concentrations and hypoglycemia during 2 days of caloric deficit and sustained exercise: a double-blind, placebo-controlled trial. Journal of Applied Physiology, 121(5), 1208-1216.

Walker, R.J., Gebregziabher, M., Martin-Harris, B. and Egede, L.E., 2015. Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling. Patient education and counseling, 98(1), pp.34-40.

Walker, R.J., Gebregziabher, M., Martin-Harris, B. and Egede, L.E., 2015. Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes. Diabetes technology & therapeutics, 17(2), pp.80-87.

Zaccardi, F., Webb, D.R., Yates, T. and Davies, M.J., 2015. Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal, pp.postgradmedj-2015.

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