Pathophysiology Of Type 1 Diabetes Discussion Paper

Introduction To Type 1 Diabetes And Insulin Deficiency

In response to a glucose stimulus, insulin synthesis occurs in the pancreas through beta cells. In the case of type 1 diabetes, which is an autoimmune disorder, the insulin generating cells gets destroyed (Camaya, Donnelly & O’Brien, 2022). Type 1 diabetes is also known as juvenile-onset diabetes mellitus. In their teenage years, young individuals get affected by type 1 diabetes. Insulin is a hormone, and hence when the beta cells get destroyed, insulin deficiency occurs, and hence patients have to depend on exogenous sources throughout their life. Autoimmune b-cell destruction is caused by environmental or infective stimulus in genetically predisposed people. The onset of the disease occurs at a rapid pace, but the development of the disease is a slower process, and it leads to progressive immunological damage Pathophysiology Of Type 1 Diabetes Discussion Paper.

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Various pills are available to treat diabetes (Ramli, Reddy & Oliver, 2019). Still, such pills are not beneficial for those affected with type 1 diabetes, as pills only work when insulin is produced from the pancreas. The drugs help in lowering the glucose levels in the blood. Insulin cannot be consumed orally as the acids and digestive juices present in the stomach break it down before entering the blood. The diabetic pills help produce more insulin, or the pills improve the efficacy of the insulin that already has been produced. Still, the pills cannot be insulin substitutes naturally synthesized by the body (Perkins, Sherr, & Mathieu, 2021). In type 2 diabetes certain amount of insulin is synthesized by the body, and the medications work as long as insulin is produced.

Codes of conduct, standards of practice and code of ethics are the NMBA nurses’ professional standards. Nurses must meet NMBA (Nursing and Midwifery Board of Australia) qualifications if they work in Australia (NMBA, 2022). According to the code of ethics, a nurse’s primary professional duty is to individuals who require medical aid and treatment. Nurses facilitate collaborative cooperation and choices between healthcare providers and the patient’s family by creating evidence-based, person-centered and safe practices, according to Principle 2 of the code of conduct. Informed consent is mentioned in Standard 2.3. It is a patient’s free choice whether or not to undergo therapy, recognizing the potential benefits and risks (NMBA, 2022). Nurses must recognize the right to informed consent by disclosing information about the patient’s care, providing the perfect opportunity for the client to pose questions, and behave following the consumer’s willingness for preference and consent, as when caring for children with varying levels of understanding. Before delivering treatment, it is critical to get informed consent. As a result, nurses must learn and obey the NMBA standards before delivering any medication (NMBA, 2022) Pathophysiology Of Type 1 Diabetes Discussion Paper

For controlling blood sugar levels in type 1 diabetes patients, medical practitioners suggest injecting insulin hormone under the skin or being taken subcutaneously to decrease blood sugar significantly. Insulin is normally produced in the human body, but it is altered in patients with type 1 diabetes. Several forms of insulin are available in the market, each with a different absorption and action rate. A different form of insulin protects for a certain amount of time because of its half-life. One of the available insulins is Insulin Aspart (NOVORAPID), fast-acting insulin (Senior & Hramiak, 2019). This hormone must be introduced with another medium or long-acting insulin hormone as it takes approximately 20 minutes to begin acting in the body when injected. The Peak effect of the hormone lasts for about 2 hours to 3hours, and it has been observed that the hormone stops working after approximately 5hours. Optisulin is a prime example of a long-acting insulin hormone because it protects for about 24 hours.

Limitations Of Oral Diabetic Medications

Taking several daily injections is a part of the basal-bolus injection technique (Cescon et al., 2020). A therapy called basal-bolus therapy encompasses an infusion after taking each meal which could simulate a situation in which how a non-diabetic body produces its insulin hormone. Long-acting insulin is required to regulate blood glucose levels in fasting, and a few short-acting insulin doses to regulate Blood sugar level surges during eating. This basal-bolus technique could help individuals with diabetes to regulate, measure and control their condition. Basal insulin, sometimes known as background insulin, is the key to maintaining steady blood sugar levels in the case of fasting. Bolus insulin hormone regulates BGL before or after a meal (Park & Yoon, 2021).

NovoRapid is an insulin supplement that swiftly absorbs and accurately replicates the body’s insulin hormone. Glucose from the bloodstream penetrates cells because of the insulin hormone substitute in the same way that naturally synthesized insulin does. It will permit it to start functioning much more quickly than the original human insulin.  Optisulin comprises insulin glargine, which is analogous to human insulin with a prolonged duration of action (Godman et al., 2021)Pathophysiology Of Type 1 Diabetes Discussion Paper. Insulin suppresses lipolysis, modulates proteolysis, and stimulates protein synthesis in adipose tissues. It decreases blood glucose levels by enhancing peripheral glucose absorption, especially in muscular tissues and skeletal fat, reducing hepatic glucose synthesis.

  • Registered nurses (RNs) deliver evidence-based, individual healthcare which incorporates rehabilitative, preventative, innovative, collaborative, empathetic, and therapeutic qualities. The nursing staff helps the people, community, groups, and families in various occupational and therapeutic interactions (NMBA, 2022). According to NMBA Standard 6, nursing professionals must provide individuals with effective, balanced, and timely treatment. RNs are responsible for carrying out ethical and goal-oriented activities, something they may delegate. These were all based on a comprehensive and well-organized assessment and, therefore, the most up-to-date research to attain the optimum consequences (NMBA, 2022). Therefore, treating Jarrah with the best medical care is imperative, as 3.0mmol/L BGL is a pressing concern because Jarrah is at risk of hypoglycemia.
  • Hypoglycemia, or low blood sugar, is a serious condition. It is a common complication associated with diabetes, and it is marked by an oversupply of insulin in the circulation or bloodstream. Insulin is the hormone that influences how the system functions. It stimulates the body’s use of glucose as sugar for energy (Liu et al., 2022). Postponing or skipping a meal is yet another reason for hypoglycemia in Jarrah.
  • RNs could use pharmacologic or non-pharmacologic nursing strategies to address Jarrah’s hypoglycemia symptoms. Due to fluctuating blood sugar or hypoglycemia symptoms, Jarrah requires quick and continuous glucose monitoring. The delivery of sugar pills (about three), sugar gel, or carbohydrates is a component of nursing care for conscious people. Jarrah has recovered from her hibernation. When the individual is conscious, 4 to 6 ounces of non-sugar-free sodas, gummy candy, fruit juice, or salt crackers could be provided as suitable carbohydrate sources (Mathew, Thoppil & McClinton, 2021). A dextrose infusion with intravenous dextrose can also be used to treat severe hypoglycemia.
  • Trauma, medications, special foods, or other practices can change one’s natural frame of consciousness. This change is known as altered consciousness. The individual is not unconscious in this scenario. Jarrah’s BGL plunged as he received insulin, demanding immediate medical attention. He’s experiencing an altered state of consciousness.
  • Consequently, oral sugar like sugar cubes must be supplied to improve Jarrah’s glucose level; alternatively, he might pass out (Imam, 2018). If oral glucose administration is inadequate, an intravenous glucose infusion must always be administered (25 percent glucose-100 ml). If it goes below 5 mmol, an additional 25 percent glucose IV bottle must be administered, and the individual will ultimately recover. Nurses should monitor his blood sugar levels.  It is important to look at the blood sugar levels from time to time, and insulin hormone should be administered when needed.
  • The central themes of quality medicine usage are finding alternative management choices, finding critical medications if treatment is required, and utilising medicines safely and efficiently (Department of Health, 2022)Pathophysiology Of Type 1 Diabetes Discussion Paper. The benefit of regularly monitoring Jarrah’s BGL is that it eliminates hyperglycemia or hypoglycemia. Insulin is beneficial in the long run since it lowers sugar levels and promotes general health. Maintaining normal glucose levels reduces the risk of long-term problems. It could also effectively deter the progression of any ongoing issues. It aids in beta cells preservation by preventing them from running out of insulin. Insulin lowers the chances of suffering a heart attack or developing chronic kidney disease. Diabetes has long-term consequences such as kidney difficulties, heart attacks, strokes, and nerve damage (Awuchi, Echeta & Igwe, 2020).

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  • Hypoglycemia causes anxiety, dizziness, rapid heartbeat, headache, agitation, and difficulties concentrating. Jarrah’s hypoglycemia indications should be reported to him and his father. If hypoglycemia is not treated, it can prove fatal. During the night, certain clinical signs appear. Nightmares, sweatiness, weariness, bewilderment, and other symptoms may be present. Other signs and symptoms of acute hypoglycemia include difficulties conversing, sleepiness, tiredness, and so on.
  • Service users and their relatives must be taught how to self-administer insulin (Easa et al., 2019). The patients are advised to remain with the same brand if possible. The insulin syringe has to match with the insulin, and the ideal temperature for insulin administration is room temperature. The site for injecting insulin must be cleaned with alcohol, and it has to be dry. The syringe and the insulin have to be prepared before the administration. Rotating the injection sites from time to time is important. Insulin is commonly injected under the skin into the thigh, belly, and other body areas. The insulin has to be given in a gentle yet firm manner. Once the insulin has been injected, the used needle and syringe must be thrown away (Bahendeka et al., 2019).
  • Insulin therapy and blood glucose monitoring are essential for type 1 diabetes. The belief that everyone gets equal opportunities, like the right to health, is social justice. While allocating resources or healthcare access, nurses work to ensure equity and social justice (NMBA, 2022)Pathophysiology Of Type 1 Diabetes Discussion Paper. Treatment for type 1 diabetes in teenagers is difficult, influenced by interactions with important people in their lives. Jarrah always has to keep himself in proper physical shape as an athlete. He participates in sports activities, and therefore it is important that he maintains a balanced diet and eat at regular intervals.
  • It is important to address Jarrah’s health issues as negative thoughts should be harmful to his health.
  1. Jarrah will be absolutely fine if he gets appropriate treatment, as he is only 19 years. He should be pushed to perform physical activities to improve his health.
  2. After his discharge, Jarrah intends to participate in sports activities as a professional athlete. Jarrah has to be encouraged to eat while participating in sports activities (Cherubini et al., 2018). The insulin dose he will be taking before playing sports has to be lower than the usual dose as Jarrah will be physically active, and his glucose levels may plummet.

References

Awuchi, C. G., Echeta, C. K., & Igwe, V. S. (2020). Diabetes and the nutrition and diets for its prevention and treatment: a systematic review and dietetic perspective. Health Sciences Research, 6(1), 5-19. https://www.academia.edu/download/61997637/908084520200205-42671-lab2o8.pdf

Bahendeka, S., Kaushik, R., Swai, A. B., Otieno, F., Bajaj, S., Kalra, S., … & Karigire, C. (2019). EADSG guidelines: insulin storage and optimisation of injection technique in diabetes management. Diabetes Therapy, 10(2), 341-366. https://link.springer.com/article/10.1007/s13300-019-0574-x

Camaya, I., Donnelly, S., & O’Brien, B. (2022). Targeting the PI3K/Akt signaling pathway in pancreatic β?cells to enhance their survival and function: An emerging therapeutic strategy for type 1 diabetes. Journal of Diabetes. https://doi.org/10.1111/1753-0407.13252

Cescon, M., Deshpande, S., Nimri, R., Doyle III, F. J., & Dassau, E. (2020). Using iterative learning for insulin dosage optimization in multiple-daily-injections therapy for people with type 1 diabetes. IEEE Transactions on Biomedical Engineering, 68(2), 482-491. https://doi.org/10.1109/TBME.2020.3005622

Cherubini, V., Skrami, E., Iannilli, A., Cesaretti, A., Paparusso, A. M., Alessandrelli, M. C., … & Gesuita, R. (2018). Disordered eating behaviors in adolescents with type 1 diabetes: A cross?sectional population?based study in Italy. International Journal of Eating Disorders, 51(8), 890-898. https://doi.org/10.1002/eat.22889

Department of Health. (2022). Department of Health | Quality Use of Medicines (QUM). Www1.health.gov.au. Retrieved 21 April 2022, from https://www1.health.gov.au/internet/main/publishing.nsf/Content/nmp-quality.htm.

Easa, N., Alany, R. G., Carew, M., & Vangala, A. (2019). A review of non-invasive insulin delivery systems for diabetes therapy in clinical trials over the past decade. Drug Discovery Today, 24(2), 440-451. https://doi.org/10.1016/j.drudis.2018.11.010

Godman, B., Leong, T., Abubakar, A. R., Kurdi, A., Kalemeera, F., Rwegerera, G. M., … & Ogunleye, O. (2021). Availability and use of long-acting insulin analogues including their biosimilars across Africa; findings and implications. Internal Medicine, 11(4). https://strathprints.strath.ac.uk/77656/

Imam, S. Z. (2018). Proactive Initiatives of Dental Practitioners to Manage Emergency in the Dental Office. EC Dental Science, 17, 1086-1097. https://www.researchgate.net/profile/Syeda-Imam-3/publication/339747537_Proactive_Initiatives_of_Dental_Practitioners_to_Manage_Emergency_in_the_Dental_Office/links/5e62754f92851c7ce049cc36/Proactive-Initiatives-of-Dental-Practitioners-to-Manage-Emergency-in-the-Dental-Office.pdf

Liu, Y., Zeng, S., Ji, W., Yao, H., Lin, L., Cui, H., … & Pan, G. (2022). Emerging theranostic nanomaterials in diabetes and its complications. Advanced Science, 9(3), 2102466. https://doi.org/10.1002/advs.202102466

Mathew, P., Thoppil, D., & McClinton, T. (2021). Hypoglycemia (Nursing). https://europepmc.org/article/nbk/nbk568695

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Park, J. Y., & Yoon, K. H. (2021). Insulin Therapy. In Stroke Revisited: Diabetes in Stroke (pp. 117-129). Springer, Singapore. https://link.springer.com/chapter/10.1007/978-981-16-5123-6_10

Perkins, B. A., Sherr, J. L., & Mathieu, C. (2021). Type 1 diabetes glycemic management: Insulin therapy, glucose monitoring, and automation. Science, 373(6554), 522-527. https://doi.org/10.1126/science.abg4502

Ramli, R., Reddy, M., & Oliver, N. (2019). Artificial pancreas: current progress and future outlook in the treatment of type 1 diabetes. Drugs, 79(10), 1089-1101. https://link.springer.com/article/10.1007/s40265-019-01149-2

Senior, P., & Hramiak, I. (2019). Fast-acting insulin aspart and the need for new mealtime insulin analogues in adults with type 1 and type 2 diabetes: a Canadian perspective. Canadian Journal of Diabetes, 43(7), 515-523. https://doi.org/10.1016/j.jcjd.2019.01.004 Pathophysiology Of Type 1 Diabetes Discussion Paper