Diabetes Mellitus

In today’s society, there are a number of chronic diseases and illnesses that affect the health and wellbeing of Australian’s each year. Diabetes Mellitus along with its complications create a significant impact on Australia’s health status as a whole (Australian Institute of Health and Welfare 2010). Diabetes Mellitus has proven to be one of the contributing factors to other causes of morbidity and mortality, resulting in being named one of Australia’s National Health Priority Areas in 1996 (Australian Institute of Health and Welfare 2010).

Diabetes Mellitus can be referred to as a chronic disease found in humans, identified by glucose intolerance (King et al. 2007). There are two main forms of the disease, type 1; insulin dependent diabetes mellitus and type 2; non-insulin dependant diabetes mellitus (King et al. 2007). A 14 year old girl by the name of Molly Manning has recently been admitted to hospital with a newly diagnosed diabetes mellitus type 1. Although Molly is not experiencing any signs of diabetic ketoacidosis, she has presented with symptoms of; polyuria, polydipsia and polyphagia.

The following essay will outline the normal control of blood glucose, the pathophysiology of how diabetes mellitus type one disrupts the normal process, and common presenting symptoms of an individual who has recently been diagnosed with the illness. As well as providing a rationale of the nursing care requirements in regards to molly’s case, while paying close attention to the five components of diabetes management. Blood glucose levels can be referred to as the amount of glucose found in the bloodstream, often between 3-6 millimoles/liter (mmol/L) (The Oxford Dictionary of Sports Science & Medicine 2007).

The normal control of an individuals blood glucose levels follow the digestion process, after an individual has eaten a meal (Marieb & Hoehn 2007). In a healthy person, blood glucose levels may rise following the digestion of a meal, as a result of nutrient molecules being absorbed and used (Wallymahmed 2007). When blood glucose levels are high, the Beta cells in the pancreas release insulin, stimulating most body cells to increase their levels of glucose uptake from the blood (Marieb & Hoehn 2007).

The amount of glucose used as an energy source increases, allowing glucose to be stored in the liver as glycogen, educing blood glucose levels back to a normal range (Marieb & Hoehn 2007). Blood glucose levels may fall below the normal limits, when the nutrients from a previous meal are no longer being absorbed into the blood (Wallymahmed 2007). During a period of fasting when an individual does not eat, or following the absorption stage, insulin levels are low, along with a declining amount of blood glucose (Wallymahmed 2007). The alpha cells in the pancreas react, through the secretion of glucagon (Wallymahmed 2007).

Consequently this stimulates the breakdown of the stored glycogen back into glucose, and releasing it into the blood (Wallymahmed 2007). As a result the blood glucose levels increase back within the normal range (Marieb & Hoehn 2007). Diabetes mellitus type 1 disrupts the normal control of blood glucose levels through the destruction of insulin producing beta cells in the pancreas (Farrell & Dempsey 2011). After an individual with diabetes mellitus type one digests a meal, glucose is unable to enter most tissue cells in the body, resulting in elevated blood glucose levels (Marieb & Hoehn 2007).

As blood glucose levels rise and glucagon is unable to be released, hyperglycemia is likely to occur (Marieb & Hoehn 2007). Excessive hyperglycemia can cause an individual to feel nauseated (Marieb & Hoehn 2007). If left untreated, hyperglycemia can worsen causing confusion, clumsiness, or even fainting. Severe cases can lead to seizures, coma and even death (Marieb & Hoehn 2007). During a hyperglycemic episode, in the absence of insulin, the body’s cells are unable to transform glucose into energy.

This causes the body to burn its own fats as a replacement (Diabetes Australia 2011). As a result of an insulin deficiency, the condition must be treated with an insulin injection in order to maintain life (Wallymahmed 2006). Insulin therapy uses short and long-acting insulin via subcutaneous injections in order to replace the body’s inability to release insulin (Wallymahmed 2006). The most common presenting symptoms of an individual who has been newly diagnosed with diabetes mellitus type 1 include; polyuria, polydipsia and polyphagia (Diabetes Australia 2011).

Under normal circumstances, glucose that has been filtered out of the blood is reabsorbed. Polyuria can be referred to as the production of abnormal amounts of diluted urine (Stevenson 2010). Elevated glucose levels in the kidney, prevents the kidney tubules to reabsorb water (Marieb & Hoehn 2007). Glucose has the ability to draw water into the urine through the process of Osmosis (Osterberg et al. 2010). Consequently resulting in polyuria, as the large amounts of glucose contaminating the urine are excreted, leading to deceased blood volume and dehydration (Marieb & Hoehn 2007).

Polydipsia can be referred to as abnormal excessive thirst, followed by drinking large quantities of fluid to overcome dehydration (Colman 2009). When an individual becomes dehydrated, this stimulates the hypothalamic thirst centers, causing polydipsia (excessive thirst) (Marieb & Hoehn 2007). The hypothalamus has the ability to respond to changes in the total amount of body water (Marieb & Hoehn 2007). The thirst centre is stimulated by dehydration, projecting information around the body of the need for water (Marieb & Hoehn 2007).

As a result, individuals feel thirsty, and therefore, drink more fluids (Marieb & Hoehn 2007). Polyphagia can be referred to as excessive or continuous eating (Bender 2009). Polyphagia in individuals who suffer from diabetes is caused by the lack of glucose in the body’s cells (Marieb & Hoehn 2007). Although there are large amounts of glucose available, it cannot be used, causing the body to make use of its fat and protein’s as a source of energy (Marieb & Hoehn 2007). When the body is lacking insulin, this causes a sugar build up in the body’s blood.

Consequently the body’s cells feel as though they are starving, causing the patient to feel hungry (Marieb & Hoehn 2007). When the individual begins to eat more, their sugar levels continue to elevate, with the sugar still unable to enter the cells (Diabetes Wellbeing 2010). The cycle continues and individuals may begin to loose weight, as they are unable to gain weight (Diabetes Wellbeing 2010). Due to the fact that the body is unable to gain access to the sugar, it responds by burning fat and muscle tissue as a replacement (Diabetes Wellbeing 2010).

Polydipsia can also lead to diabetes ketoacidosis (Marieb & Hoehn 2007). When an individual has elevated blood sugar levels, fluid may be taken from body tissues including the lenses of the eyes (Diabetes Australia 2011). Blurred vision may occur affecting an individual’s ability to clearly focus on objects (Diabetes Australia 2011). An individual presenting with diabetes may also be suffering from fatigue (Diabetes Australia 2011). The body is unable to use its blood sugar; therefore energy in the form of glycogen is not being dispersed throughout the body (Diabetes Wellbeing 2010).

This process can be both physically and mentally exhausting as the body struggles to locate an energy source (Diabetes Australia 2011). Diabetes Ketoacidosis is another complication of diabetes as a result of insufficient amounts of insulin (Palmer 2004). The lack of insulin leads to increased storage of glucose in the tissues, increasing the transformation of glucose into glycogen (Palmer 2004). As a result, hyperglycemia occurs and polyuria may take place (Palmer 2004). When the body begins to metabolize fats as a source of energy, the levels of fats found in the blood dramatically increases (Palmer 2004).

The fatty acids that have been metabolized, can be referred to as ketones (Marieb & Hoehn 2007). When ketones accumulate in the blood, the bloods pH levels drop causing ketoacidosis (Marieb & Hoehn 2007). Patient education is one of the earliest priorities of nursing care requirements in relation to diabetes management (Farrell & Dempsey 2011). It is essential that nursing staff provide Molly and her family with appropriate information in regards to her case, to ensure her safety and wellbeing (Farell & Dempsey 2011).

Due to the fact that Molly manning has been newly diagnosed with diabetes mellitus type 1, and is at a young age of 14, education is likely to take place with parents (Lowes 2008). Education should be directed at the child from around 12 years of age, through simple explanation or the use of visual aid (Lowes 2008). It is important that immediate education is provided to Molly’s parents, as they have a key role in assisting Molly to adjust to life with the new diagnosis and successfully carry out her individual diabetes management plan (Lowes 2008).

A follow up of Molly’s case will also be organized to ensure there is an improvement in Molly’s overall health and wellbeing (Farell & Dempsey 2011). The initial management of Molly’s diabetes will include information regarding Diabetes Mellitus (specifically type 1), what it is, risk factors (often modifiable), components of a management plan or program, practical skills of insulin administration and blood glucose monitoring (Lowes 2008).

Nutritional management in relation to Molly’s case involves choosing foods and being active, to assist in the management of her blood glucose levels (Diabetes Australia 2011). The management of blood glucose levels in individuals with diabetes type 1 involves matching the amount of insulin and carbohydrate found in the foods consumed (Diabetes Australia 2011). Molly will be provided with a dietitian experienced in working with people with diabetes type 1, to assist in developing an individualized meal plan (Diabetes Australia 2011).

Molly will need to be educated by nursing staff about how to monitor her blood glucose levels (Farell & Dempsey 2011). Blood glucose levels provide medical professionals with the information required to determine the best plan of action within her diabetes management plan (Farell & Dempsey 2011). Molly and her family will be educated regarding the importance of monitoring, as well as educational information regarding the skill (Farell & Dempsey 2011). Blood glucose monitoring is a self-management tool that will enable Molly to check her levels as often as she needs to (Farell & Dempsey 2011).

While in hospital, Molly’s blood glucose levels will be monitored hourly to determine her body’s response to insulin therapy (Palmer 2004). Testing Molly’s blood glucose levels will help her to better understand the relationship between her blood glucose levels and the exercise she does, the food she eats, medication taken, and other lifestyle influences such as travel, stress and illness (Diabetes Australia 2011). Nursing staff will advise Molly to keep a record diary of her blood glucose levels, so that if her blood glucose goals are not being met, she can seek medical advice (Diabetes Australia 2011).

Nursing staff will also provide Molly and her family with information is regards to the best blood glucose meter for her. As well as how to correctly use the meter to ensure accurate results (Diabetes Australia 2011). For those individuals with diabetes, regular exercise plays an important role in keeping the body healthy (Diabetes Australia 2011). Exercise helps individuals who are on insulin by assisting the insulin to work more effectively and maintain normal blood glucose levels (Diabetes Australia 2011).

Exercise is an important aspect of managing diabetes (Diabetes Australia 2011). However, Individuals whose diabetes is poorly managed, or with fasting blood glucose levels greater than 14mmol/L, it is best to avoid exercise until their blood glucose levels have settled (Diabetes Australia 2011). If exercise is undertaken during these circumstances, it can cause blood glucose levels to further increase, increasing ketone production (Diabetes Australia 2011). If Molly and her family have any further questions in regards to exercise (Diabetes Australia 2011).

They will have the opportunity to speak with a doctor or exercise physiologist to determine appropriate types of exercise; amounts of exercise, as well as intensity of exercise suitable for Molly to part take in (Diabetes Australia 2011). Individuals who suffer from diabetes mellitus type 1 use pharmacologic therapy (Diabetes Australia 2011). An insulin injection is used to replace the body’s inability to produce insulin (Farell & Dempsey 2011). Insulin therapy replacements are required through daily injections via a range of devices, from needles to insulin pumps (Diabetes Australia 2011).

Molly and her family will be provided with information regarding the number of options, to determine the best device for Molly (Diabetes Australia 2011). As Molly is only 14 years of age, her newly diagnosed diabetes may be very overwhelming and frightening for her. The registered nurse looking after Molly will organize an appointment for Molly to see a psychologist if it is in her best interests (Diabetes Australia 2011). Information will also be provided in regards to Molly being eligible to register with the National Diabetes Services Scheme (NDSS) (Diabetes Australia 2011).

Registration is required at no cost, providing subsidized products to Molly and her family (Diabetes Australia 2011). In Conclusion, as a result of the care provided to Molly Manning and her family. Together they have been made aware of Molly’s diagnosis, Diabetes Mellitus type 1, and the numerous amounts of nursing actions that need to be addressed when caring for Molly. The diabetes management and plan of care discussed in the previous essay, is essential in providing Molly with the optimum care needed to carry on a relatively normal lifestyle.

Without the education and assistance from health care professionals, Molly’s diagnosis may have brought unnecessary stress and anxiety to her and her family. Although there is currently not a cure for diabetes mellitus, Individuals of all ages who have been diagnosed with Diabetes Mellitus type 1, will continue to see improvements in their individual situations and quality of life (Diabetes Australia 2011). As a result of ensuring they effectively work alongside health care professional, family and friends to develop the best possible diabetes management plan for their individual case.

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