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Answer 1: Zach is suffering from a clinical condition called Type 1 Diabetes Mellitus. Type 1 Diabetes mellitus results from an autoimmune eradication of Beta cells of the endocrine organ called the Pancreas. The pancreas, is unable to manufacture insulin as the body's immune system destroys the insulin-producing cells (beta cells) in the (Herbert et al., 2017). This further damage the pancreas from producing insulin, which is consumed for getting energy from glucose. The pathogenesis of both types of diabetes mellitus i.e. type 1 and type 2 is entirely different. The process of destruction occurs in genetically vulnerable people under the provoking effect of one or more genetic, immunological, and environmental factors and mostly advances over many months to years, during which time patients are having no symptoms. The auto-immune response causes production and antibodies and T-cells which attack the beta cells causing non-production of insulin, increase in blood glucose and consequently increase in glucagon which results in significant hyperglycemia and direct diabetes manifestation after a long latency period. This indicates the significant number of β cells that need to be damaged before frankly diabetes becomes conspicuous. People with type 1 diabetes don't produce insulin. Thus, artificial Insulin has to be administered in the form of injections daily. Insulin administered in this way helps in controlling the displacement of glucose from the bloodstream into cells (Otto-Buczkowska& Janita, 2018). It also lowers the levels of glucose in the blood by increasing the utilization of glucose in the peripheries of the patient’s body mostly by skeletal muscle cells and adipose tissues and also decreasing the manufacture of glucose and thus the liberation of glucose by the liver. Therefore, it has a 3-way action in diabetic patients. It helps in increased glucose uptake by cells, the formation of glycogen from glucose, and also the metabolic formation of fat in the body. Consequently, insulin plays a major role in the treatment of type 1 diabetes mellitus.
Answer 2: Zach’s best timing for the administration of NovoRapid insulin is to be given immediately before a meal. Here FlexPen is a prefilled pen with the effective composition of insulin aspart. After Novo rapid is administered, it is rapidly acting and starts its work at a very fast pace to equalize blood sugar levels (Leelarathnaet al., 2018; Rubin & McIver, 2019). It generally starts its work after 10-20 minutes and stays till about 3 and 5 hours. As it is rapid-acting insulin it's also called mealtime insulin. The chances of hyperglycemia and hypoglycemia are relatively less with the medicine as it's a rapid-acting drug and gets faster metabolized and thus eliminated by the body (Ouzouni et al., 2019). Hypoglycemia is a dose-related side effect and can be averted with less dosage of insulin. After any unprecedented episode of hypoglycemia, insulin dosage, and food (glucose) intake has to be scrutinized to correct dosage and stop future mishaps (Thompson, 2015).
Answer 3: Zach’s blood glucose level (BGL) was tested before and after his first NovoRapid insulin injection in the hospital setting, for the simple reason that chances of hypoglycemia have to be taken into consideration when giving insulin injection for the first time to monitor the correct dosage of insulin and also to prevent any complications (Buckloh et al., 2016; Khandan et al., 2018). The action of insulin differs from fast-acting insulin's which can have an impact on glucose very rapidly after being given by injection, through to long-acting insulin's which can keep acting for up to a day. NovoRapid insulin being a fast-acting variant of insulin, will start acting rapidly. Thus, for patients using it for the very first time, both pre and post-drug administration values of blood glucose levels are very crucial for further management planning and execution. Hypoglycemia can be seen in the form of the patient having excess sweating, excessive hunger, feeling dizzy or shaky, having shivers, feeling low or fatigues, and a fast heartbeat.
Answer 4: Diabetes mellitus poses dangerous physical, mental, social, and emotional challenges in a patient's life and also to his or her family. In the case study of Zach,various physical challenges may include, fatigue and tiredness, certain complications such as forgetting a dose of insulin may exhibit symptoms like increased sweating, trembling, hunger, dizziness, light-headedness, mood disorders, due to hypoglycemia (Lasaite et al., 2016). Self-care can be quite challenging for a young adolescent boy such as Zach. Daily management of insulin intake through needle may cause injury to the nearby tissue until learnt to do aptly. Certain complications of type 1 diabetes mellitus may occur over a period of time and probably due to non-compliance to the treatment. These complications include, heart disease, disease of the nerves, stroke, foot ulcers, skin infections, retinopathy and high blood pressure (Gregg, Hora & Benoit, 2019). Symptoms of type I diabetes may cause hinderance in living a routine life for Zach. For instance, frequent urination, calorie counting for each meal, excessive thirst and sudden uncontrollable hunger.
Emotional challenges include, feelings offearfulnessrelated to the disease and depression by continuously having to care about keeping a check on their diet as compared to their fellow schoolmates. This causes mental distress and worry. Many kinds of research and scholars have found the features of depression and anxiousness in children and teenagers (Ouzouni et al., 2019).Other than this, various long-term issues associated with type I diabetes mellitus causes lack of self-confidence and feeling of inferiority among the peers.
Buckloh, L. M., Wysocki, T., Antal, H., Lochrie, A. S., &Bejarano, C. M. (2016). Learning about long-term complications of pediatric type 1 diabetes: parents’ preferences. Children's Health Care, 45(4), 399-413.
Gregg, E. W., Hora, I., & Benoit, S. R. (2019). Resurgence in diabetes-related complications. Jama, 321(19), 1867-1868.
Herbert, L. J., Wall, K., Monaghan, M., & Streisand, R. (2017). Parent employment and school/daycare decisions among parents of young children with type 1 diabetes. Children's Health Care, 46(2), 170-180.
Khandan, M., Abazari, F., Tirgari, B., &Cheraghi, M. A. (2018). Lived experiences of mothers with diabetic children from the transfer of caring role. International Journal of Community Based Nursing and Midwifery, 6(1), 76.
Leelarathna, L., Ashley, D., Fidler, C., & Parekh, W. (2018). The value of fast-acting insulin aspart compared with insulin aspart for patients with diabetes mellitus treated with bolus insulin from a UK health care system perspective. Therapeutic advances in endocrinology and metabolism, 9(7), 187-197.
Lašaitė, L., Dobrovolskienė, R., Danytė, E., Stankutė, I., Ražanskaitė-Virbickienė, D., Schwitzgebel, V., ... &Verkauskienė, R. (2016). Diabetes distress in males and females with type 1 diabetes in adolescence and emerging adulthood. Journal of Diabetes and its Complications, 30(8), 1500-1505.
Otto-Buczkowska, E., &Jainta, N. (2018). Pharmacological treatment in diabetes mellitus type 1–insulin and what else?. International journal of endocrinology and metabolism, 16(1).
Ouzouni, A., Galli-Tsinopoulou, A., Kyriakos Kazakos, M. D., & Maria Lavdaniti, R. N. (2019). Adolescents with Diabetes Type 1: Psychological and Behavioral Problems and Compliance with Treatment. International Journal of Caring Sciences, 12(2), 1-7.
Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine connections, 7(1), R38-R46.
Rubin, R., & McIver, L. A. (2019). Aspart Insulin. In StatPearls [Internet]. StatPearls Publishing.
Thompson, A. E. (2015). Hypoglycemia. Jama, 313(12), 1284-1284.
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