The Management For Diabetes Type 1 Discussion
| Situation | The patient is a 23-year-old male with type 1 diabetes. He presented 2 hours ago with confusion, deep labored breathing, chest pain, tachycardia, nausea, and vomiting. He has acetone breathing. He is being managed for diabetic ketoacidosis. His blood glucose level was 640 but has now reduced to 340 after initiating insulin and intravenous fluids in the intensive care unit. His vitals are s follows: BP 110/68 mmHg, HR 110, Oxygen saturation at 96% on room air. Arterial blood gasses test results indicate features of metabolic acidosis. He is lying in the propped-up position to prevent aspiration of food contents that could result in aspiration pneumonia. The Management For Diabetes Type 1 Discussion
Don't use plagiarized sources. Get Your Custom Essay on
The Management For Diabetes Type 1 Discussion
Just from $12/Page
PLACE YOUR ORDER HERE NOW
|
| Background | The patient has been on management for diabetes type 1 using insulin injections for the last 10 years. He is a student in the second year of his studies. He has had four previous admissions due to pneumonia and urinary tract infections. However, there is no history of blood transfusion or a surgical procedure. He drinks alcohol but denies smoking cigarettes. He lives with his supportive parents. His mother is worried about his health and would like to be given an hourly update about his progress. He reported having forgotten to use his medication as he was feeling sick. He also was invited to a party last night where he drank heavily. He was having deep acidotic breathing, was confused, and appeared anxious. His vitals at admission were as follows: P 121b/min, BP 98/66 mmHg, T 98.8 F, oxygen saturation 94% on room air. The Management For Diabetes Type 1 Discussion
|
| Assessment | The patient was confused, sick-looking, in respiratory distress, and well-groomed. He was oriented to person but lost orientation to place, time, and situation. However, he has now recovered his full orientation. The pupils were equal and bilaterally reactive to light and accommodation. No fever. On chest examination, the chest is moving with respiration; he has deep acidotic breathing and uses accessory muscles for breathing. Air entry is reduced bilaterally, with fine basal lung crackles. Percussion is resonant. All other systems are essentially normal.
Laboratory and imaging tests were requested with the following findings: urinalysis showed glucosuria and ketonuria. Arterial blood gas analysis HCO3– 14, PH 7.30, PCO2 40. Full blood count results showed neutrophilia. Chest radiography showed features of lobar pneumonia. His blood sugars were 640 but have since reduced to 340. Urea and electrolytes showed hyperkalemia. After a complete assessment of the patient using both subjective and objective features, it was unanimously evident that he had diabetic ketoacidosis. It is likely aggravated by pneumonia and failure to take insulin injections. Furthermore, heavy alcohol drinking precipitated the events. He had uncompensated metabolic acidosis and required ICU admission for stabilization and continuous monitoring. Stabilization would include oxygen, fluid therapy, ECG monitoring, and cardiac stabilization (Evans, 2019)The Management For Diabetes Type 1 Discussion. He was started on oxygen therapy via a face mask at 6 liters per minute. Intravenous fluids were calculated according to his body deficit. He has since received 3 liters of normal saline. Insulin injection was started with a concurrent infusion of glucose to prevent hypoglycemia. Sugar monitoring has been scheduled hourly and should continue until they are stabilized. Fluid infusion to continue for the next hours while assessing for features of fluid overload, including periorbital bleeding and difficulty in breathing. The patient will continue being nil per oral while blood glucose monitoring continues. Zofran should be administered when needed to alleviate nausea. Antibiotics to manage pneumonia were started and administered as indicated. He also requires review by a cardiologist and respiratory physician for further management.
|
| Recommendation | Upon stabilizing blood sugars between 140 to 160 g/dl and alleviating symptoms, the patient should be discharged home. However, he will require basic education regarding his condition. Education should focus on the disease process, signs and symptoms, complications, follow-up, treatment, and lifestyle modifications. To begin with, the patient should be educated about type 1 diabetes. The discussion should emphasize that diabetes is a chronic condition resulting from dysfunction of the pancreas leading to insulin insufficiency (Elzouki & Eledrisi, 2020). As a result, people with diabetes can not control their sugars, leading to a hyperglycemic state presenting with features such as polyuria, polyphagia, polydipsia, and weight loss. Therefore, the body depends on injectable insulin to control blood sugars. For optimal control, the patient should understand that they will be dependent on insulin in their lifetime (Hermanns et al., 2020)The Management For Diabetes Type 1 Discussion. Therefore, the patient must be ready to adhere to inject insulin as directed without failure. Furthermore, the patient should be educated about the correct ways of using insulin.
First, insulin should be stored in cool and dry places, preferably in the refrigerator at 4-80 C or room temperature if there is no refrigerator. Furthermore, insulin should not be exposed to direct sunlight or frozen (Evans, 2019). Any opened vial should be discarded after 4 weeks of use. Finally, the patient should understand the injection sites for insulin. These sites include arm, lower back, butt fat, belly fat, and anterior thigh fat. Daily use is recommended. Consequently, diabetes ketoacidosis (DKA) may develop with any failure in treatment. DKA is a life-threatening complication characterized by acidosis, hyperglycemia, and ketonemia/ketonuria. It is a common complication in type 1 diabetes. It is precipitated by several factors, including failure to use insulin, use of inappropriate doses of insulin, stressful event, alcohol intake, smoking, and infections such as pneumonia and urinary tract infection. Therefore, the patient should understand all these factors. For instance, the patient should be educated to stop drinking alcohol as this could potentially lead to more attacks. Furthermore, he should be watchful for signs of infections such as fever, malaise, abdominal pain, chest pain, and chills. Any of these should warrant a prompt visit to the hospital for early management. In addition, the patient should be advised about lifestyle modifications to help in preventing complications. Such include moderate regular 30 minutes exercise for at least five days a week; cessation of smoking; reduction of alcohol intake; stress management strategies; daily monitoring of blood glucose using a glucometer; healthy eating; and regular medical check-ups (Papatheodorou et al., 2018)The Management For Diabetes Type 1 Discussion. About feeding, the patient should be encouraged to have frequent snacking between major meals to prevent hypoglycemia that may result from using insulin. However, the patient should understand that no food is contraindicated but should watch his eating habit and eat according to body demands. He should eat a lot of fruits, vegetables, and nonfat dairy meat while being watchful of his carbohydrate intake. Finally, the patient must be encouraged to have regular hospital visits. Blood sugar will be checked during visits, and appropriate adjustments made to insulin dosing (Hermanns et al., 2020). He should also visit a podiatrist regularly to have his feet checked to prevent leg ulcers. A cardiologist review will also be mandatory to identify and treat any cardiac-related complications. His hemoglobin A1C level should be checked regularly.
|
| References | References
Elzouki, A.-N., & Eledrisi, M. (2020). Management of diabetic ketoacidosis in adults: A narrative review. Saudi Journal of Medicine and Medical Sciences, 8(3), 165. https://doi.org/10.4103/sjmms.sjmms_478_19 Evans, K. (2019). Diabetic ketoacidosis: update on management. Clinical Medicine (London, England), 19(5), 396–398. https://doi.org/10.7861/clinmed.2019-0284 Hermanns, N., Ehrmann, D., Finke-Groene, K., & Kulzer, B. (2020). Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review. Diabetic Medicine: A Journal of the British Diabetic Association, 37(3), 436–447. https://doi.org/10.1111/dme.14256 Papatheodorou, K., Banach, M., Bekiari, E., Rizzo, M., & Edmonds, M. (2018). Complications of diabetes 2017. Journal of Diabetes Research, 2018, 3086167. https://doi.org/10.1155/2018/3086167 The Management For Diabetes Type 1 Discussion
|
