Diabetes Mellitus Case Study

Diabetes Mellitus Case Study

Pathophysiology

Diabetes mellitus is a common condition of the endocrine system responsible for delivering insulin to body cells. Type 1 diabetes mellitus develops due to the absence of insulin in the blood due to inadequate insulin production in the pancreatic beta cells. Insulin, an anabolic hormone, regulates glucose in the blood, allowing its uptake into muscle and adipose tissue. Mineral metabolism, protein synthesis, and lipid breakdown all depend on the action of this crucial hormone, which also regulates the formation of fats and glycogen (Lucier & Weinstock, 2018). The development of the condition begins when patients are mostly healthy and progresses via an asymptomatic stage when the patient’s body is yet to respond to the insulin deficit already present. With time, the patient develops diabetic ketoacidosis due to reduced amounts of insulin.

Diabetes type 1 is also associated with altered adrenal and thyroid function. Glycemic control reverses these effects; however, it is challenging to correct endocrine function even with rigorous insulin therapy. Through affecting the release of pituitary thyrotropin and hypothalamic thyrotropin, diabetes affects the thyroid gland. In patients with a long term history of diabetes

, Diabetes may affect the patient’s reproductive system

The primary factor associated with type 1 diabetes is related to autoimmune diseases (Lucier & Weinstock, 2018). The autoimmune trigger may occur during a viral infection. In this case, the antibodies produced to attack the body’s beta cells molecules resulting in insulin deficiency. The immune-mediated subtype is, therefore, unavoidable, unlike type 2 diabetes.

Patient A.M has already been diagnosed with Type 1 DM and has failed in managing her food and sugars since she cannot eat well. The patient has not been taking the required dose of insulin and is, therefore, on an insulin deficiency. Since insulin deficiency has been going on for at least three days, the patient is already experiencing signs of diabetic ketoacidosis, which can lead to mortality if not carefully managed. These are the primary reason why the practitioner asks the patient to be rushed to the ED via an ambulance.

Clinical manifestations and etiology.

Insulin allows the utilization of glucose in body cells. The primary effect of lack of insulin is an almost pathological lack of energy in the patient since body cells cannot function in the utter absence of glucose. The patient is unsteady as she is walking towards the examining room, even with help. The patient has a challenge answering questions, which also indicates an absence of glucose in the brain leading to confusion and drowsiness. The lack of energy also explains why the patient is sleeping a lot.  Lack of glucose cell utilization and glucose conversion to glycogen by the enzyme results in poor regulation of potassium in the patient, and this resulted in mild hyperkalemia.

An increase of serum potassium levels in the blood due to low insulin concentrations is also affecting the patient’s ability to eat. The patient’s nausea and vomiting are also as a result of the increased potassium serum concentration.which make it difficult to digest food properly. The elevated amounts of glucose in the blood also need to be excreted from A. M’s body. For this to happen, the kidneys have to expel most of the glucose through urine. The high glucose levels lead to frequent urination in the patient, as reported earlier. Since the patient vomits when she drinks anything, she is already dehydrated. The patient also had an incidence of diarrhea, and this resulted in dehydration. Poor regulation of ketones leads to ketoacidosis and fast breathing due to acidosis, which produces acetone responsible for the sweet odor (Fazeli et al., 2017).

Treatment of the condition

Diabetes treatment aims to achieve an average range of glucose levels in the patient’s blood. The estimated normal glucose range is <154mg/dl; Insulin therapy attains this without causing unacceptable hypoglycemia. Almost all the orders that the patient is given are appropriate for their condition. LR’s are more useful for restoring electrolyte imbalances in patients with ketoacidosis. The patient also requires insulin doses to balance glucose concentrations. There is no need, however, to do blood cultures, stool and ova parasite tests, or testing of C. difficile. These tests are unnecessary because the patient has an established case of ketoacidosis which accounts for all the symptoms.,

Treatment of insulin deficiency is through the constant administration of insulin.  Administration of insulin is done through an injection or using a special insulin pen (Silver et al., 2018) that simplifies the dosing and administration process. Insulin pumps also enable the fast administration of insulin. Such insulin can be short or long-acting, depending on its half-life in the patient’s body (Deeb et al., 2018). Regular use of insulin, as instructed by the physician, helps to maintain glucose and potassium levels.

Treatment continues through exercising and proper diet intake to regulate the amount of sugar in the blood. A diabetic nurse may be consulted in this case to assist in appropriate meal planning. A PCOT (point of care) management system may also be incorporated in the patient self-care management plan to enable fast decision making in case of a future emergency.

References

Deeb A, Akle M, Al Ozairi A, Cameron F. (2018). Common Issues Seen in Pediatric Diabetes      Clinics, Psychological Formulations, and Related Approaches to Management. J     Diabetes Res.2018:1684175.

Fazeli, Brodovicz K, Soleymanlou N, Marquard J, Wissinger E, Maiese BA.(2017). Incidence and prevalence of diabetic ketoacidosis (DKA) among adults with type 1 diabetes mellitus (T1D): a systematic literature review. BMJ Open.7(7):e016587.

Lucier J, Weinstock RS. (2018). Diabetes Mellitus Type 1. In: StatPearls StatPearls            Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507713/

Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K,         Makhoba A.(2018). EADSG Guidelines: Insulin Therapy in Diabetes. Diabetes Ther.            Apr;9(2):449-492.