Diabetes type 1 - Nursing Case Study

Pathophysiology

• Primary mechanism: Type 1 Diabetes results from an autoimmune destruction of the insulin-producing beta cells in the pancreas. This leads to an absolute deficiency of insulin, a hormone crucial for glucose uptake into cells for energy production.

• Secondary mechanism: Without insulin, glucose cannot enter cells and remains in the bloodstream, causing high blood sugar levels (hyperglycemia). The body then starts breaking down fats for energy, leading to the production of harmful ketones.

• Key complication: Prolonged hyperglycemia can damage blood vessels, leading to long-term complications such as retinopathy, nephropathy, and neuropathy. Additionally, the production of ketones can lead to a potentially life-threatening condition called diabetic ketoacidosis.

Patient Profile

Demographics:

45-year-old female, primary school teacher

History:

• Key past medical history: Recently diagnosed with Type 1 diabetes, no other significant health issues.

• Current medications: Insulin injections as prescribed, multivitamin supplements.

• Allergies: No known allergies.

Current Presentation:

• Chief complaint: Regular feelings of tiredness and increased thirst.

• Key symptoms: Frequent urination, sudden weight loss, constant hunger.

• Vital signs: Blood pressure 120/80 mmHg, heart rate 78 bpm, respiratory rate 16 bpm, body temperature 98.6 F, Blood sugar level 130 mg/dL.

Section 1

Initial Assessment Findings:

During the patient's first nursing assessment, the nurse notes that the patient is experiencing polyuria (excessive urination) and polydipsia (increased thirst), both common symptoms of hyperglycemia. In addition, the patient reports unexplained weight loss and constant hunger, despite a normal or increased food intake. These symptoms are consistent with the patient's recent diagnosis of Type 1 Diabetes.

The nurse also conducts a thorough physical examination, which reveals no immediate complications such as skin changes, ulcers, or signs of infection, which can be common in diabetes. However, the patient did report experiencing occasional numbness and tingling in her lower extremities. This could be an early sign of peripheral neuropathy, one of the potential complications of long-term hyperglycemia. The nurse documents this finding and plans to inform the healthcare provider. In the next session, the nurse will educate the patient about the importance of regular foot care and will discuss strategies to manage her blood sugar levels effectively.

Section 2

In their second meeting, the nurse finds that the patient's fasting blood glucose level is 190 mg/dL, significantly above the normal range of 70-99 mg/dL. Also, the patient's hemoglobin A1C, used to measure the average blood sugar levels over the past two to three months, is 8.1%, which is higher than the recommended level of 7% for most adults with diabetes. These results confirm that the patient's blood sugar levels are poorly controlled.

The nurse takes this opportunity to provide education to the patient about the importance of regular blood glucose monitoring and insulin administration. She explains that insulin therapy is crucial in managing Type 1 Diabetes as the body can't produce insulin on its own. She also emphasizes the need to balance insulin doses with food intake and physical activity to prevent hypoglycemia. The nurse also advises the patient to maintain a healthy diet and engage in regular physical activity.

In addition to this, the nurse schedules a follow-up appointment for the patient to evaluate the effectiveness of the interventions and to monitor for any new complications. The patient is also instructed to report any changes in her symptoms, particularly any worsening of the numbness and tingling in her lower extremities, as it may indicate a progression of peripheral neuropathy.

Section 3

At the follow-up appointment, the patient reports that she has been diligently monitoring her blood glucose levels and administering insulin as advised. She shares that her recent fasting blood glucose levels have ranged between 130-150 mg/dL, showing an improvement from the previous level. However, she also mentions that she occasionally feels lightheaded and shaky, especially when she misses a meal or exercises more than usual.

During the physical assessment, the nurse observes that the patient's skin is dry and she has a slight tremor in her hands. The nurse suspects these symptoms may be a result of hypoglycemia, a condition that can occur if the patient's blood sugar level drops below 70 mg/dL. The nurse advises the patient to consume a quick source of sugar like fruit juice or glucose tablets whenever she feels these symptoms. She also explains the importance of regular meals and snacks to prevent fluctuations in blood sugar levels. She adjusts the patient's insulin regimen to better balance with her meal and exercise schedule. The nurse schedules another follow-up appointment in two weeks to reassess the patient's blood glucose levels and response to the adjusted insulin regimen.

Section 4

At the two-week follow-up appointment, the patient reported feeling less lightheaded and shaky since her last visit. She shared that she has been following the nurse's advice on regular meals and snacks, and promptly taking a quick source of sugar when she feels the onset of hypoglycemic symptoms. However, she mentioned that she still feels fatigued throughout the day. The nurse took her vital signs, which were within normal limits: blood pressure 120/80 mmHg, pulse 72 bpm, respiration 16 breaths per minute, and temperature 98.6°F.

The nurse decided to review her recent blood glucose readings and noted that her fasting blood glucose levels had improved, now ranging between 100-120 mg/dL, closer to the desired level. However, her postprandial (after meal) blood glucose levels were higher than expected at 180-200 mg/dL, which could explain her fatigue. The nurse explained to the patient that while managing fasting blood glucose is important, it's also crucial to manage postprandial blood glucose levels to prevent energy slumps and long-term complications. The nurse suggested the patient to manage her carbohydrate intake during meals and continue monitoring her blood glucose levels after meals. Furthermore, the nurse recommended slight adjustments to her insulin regimen to accommodate for the high postprandial blood glucose levels. They scheduled another follow-up appointment in one month to reassess the patient's condition.

Section 5

At the one-month follow-up appointment, the patient expressed slight improvement in her energy levels. However, she admitted to struggling with managing her carbohydrate intake during meals and was not always diligent about monitoring her blood glucose levels after meals. She reported that her fasting blood glucose levels remained stable, but postprandial levels were still high at times, fluctuating between 150-200 mg/dL. The nurse reminded her of the importance of adhering to the recommended diet and closely monitoring her blood glucose levels to prevent complications and manage her symptoms more effectively.

The nurse decided to reassess the patient's understanding of diabetes management and provided further education on the importance of carbohydrate counting, meal planning, and the consequences of uncontrolled postprandial blood sugars. The patient's insulin regimen was adjusted again, with the addition of a short-acting insulin before meals to better manage her postprandial blood sugars. The nurse also suggested the use of a continuous glucose monitoring system (CGMS) to help with more accurate blood glucose tracking. The patient agreed to try these changes and they scheduled another follow-up appointment in two weeks to evaluate the effectiveness of the new interventions.