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  • Subject Name : Nursing

Healthcare Plan for Type 1 Diabetes in Children 

Ans1: The pathophysiology of Type 1 Diabettes involves significant lymphocytic infiltration along with degradation or inability of beta cells of the (Biester et al., 2018)islets of Langerhans located in the pancreas to secrete enough amount of insulin. The insulin levels drop significantly and blood glucose levels escalate due to absence of regulatory mechanisms.

The significant decrease in cell mass of beta cells affects insulin production and this in turn affects the regulatory mechanisms for blood glucose.

 But detection of debates is possible only when there is destruction of 80-90% ((Streisand & Monaghan, 2014)) of the beta cells. After that there is development of a medical condition called hyperglycemia and type 1 diabetes can be detected and diagnosed.

Type 1 diabetes is more common in children and young individuals (Menon et al., 2016)as well as due to a genetic history of auto immune diseases it is significant that destruction of the pancreatic beta cells when body’s immune system destroys those cells. Also these diabetes 1 patients are more susceptible to ketoacidosis.

Mechanism of insulin action: Insulin wither injected externally or naturally present inside the human body enters the bloodstream and lowers the blood glucose levels which are provided by the simple sugars obtained from intake of food .Insulin g has a vital role that helps the blood glucose to enter the body cells involving the muscle cells and liver cells which have significantly higher energy needs. Also action of insulin is initiated by binding to a glycoprotein receptor on the cell surface.

The receptor to which insulin binds has a alpha subunit to which insulin binding is promoted hand also has a tyrosine-specific protein kinase. The activation of protein kinase generates a signal which stimulates the action of insulin on glucose.

Ans2: Zach Novorapid insulin administration in relation to food is a significant factor as blood glucose levels escalate and reach to their peak. After two to four hours (Menon et al., 2016) of intake of food there is a low level of both blood glucose and insulin as the pancreatic cells produce less insulin. But just after the meal is consumed, the blood glucose levels rise immediately and also glucose along with amino acids are absorbed directly into the bloodstream.

This rise in blood glucose levels stimulate the signaling of pancreatic cells called beta cells for secreting insulin, which is then mixed up in the bloodstream So it is concluded that insulin level has to increase within 20 minutes after the meal is consumed. In the present scenario also it is recommended to administer insulin into the patient body immediately after taking the meal so that glucose levels donot reach to uncontrollable levels.

Also there is a faster onset of action of NovoRapid and therefore it should be given close to a meal i.e. meal should be taken 5-10 minutes after the action onset injection but sometimes physiological body needs can differ so the injection can be given after the meal. In a meal-related treatment the drug Novorapid provides 50-70% of insulin required for the body. NovoRapid acts within 10-20 minutes after administration whereas too much dose of the medicine can lead to hypoglycemia i.e. significant reduction in blood glucose levels below the requirement. So the Novorapid rapidly transform the hyperglycemia condition into normal blood glucose levels and acts as an analogue to natural insulin.

Ans3: The rationale behind blood glucose level check before and after administration of novorapid injection is to measure the efficiency and impact of novorapid in response to blood glucose levels which can escalate after the meal (Streis, 2014). In addition to this it is important to check the time duration needed for novarapid to start its action and also by how much amount it decreases the blood glucose. This is an important check to analyze how much drug is required by the patient’s body to lower the blood glucose as it depends upon the actual blood glucose level before injecting, as to how much quantity of the medicine needs to be injected as per individual’s physiological body needs. In addition it is important to check the the blood glucose level has actually dropped after the injection and by how much amount, and it is important to analyze that the injection doesnot lead to hypoglycemia and impair important functions of the body.

Ans4: The emotional challenges for Zach need to be considered as he has a higher risk of developing, mental issues and more over risk assessment for diabetes 1 patients tells that Zach might develop depression, with elevated anxiety and stress as he might not be able to eat normally like his friends and being a child cannot play well due to fatigue and tiredness. Also Zach being a child, his mental well being will suffer due to reduced participation in daily physical activities which includes playing sports, inability to consume delicious sugary meals meals, and also sleep patterns will be disturbed. Also there will be reduced sibling interactions (Rao, 2015), due to missing of school during regular checkups.

  • In addition to this Zach might feel isolated from the his friends as sometimes he has to stay with a nurse due to medical intervention.
  • Also Zach might develop anger, frustration and resenet while taking the medicines and feel hopeless .
  • Also Zach might feel afraid because of needles and potential long-term health problems

Zach will develop a feeling of dependence towards their parents more than his peers and might hinder self-reliance in daily tasks.

As per the present scenario the physical challenges of living with diabettes 1 include reduced physical activity and also there is a need to balance energy with proper dietary nutrition and glucose level regulation as per insulin administration.

Also significant decline in physical activity leads to other health problems like obesity or retarded growth Alsom with this there is an increased risk of hypoglycemia due to extra energy expenditure.

References for Childhood Diabetes Mellitus

Biester, T., Kordonouri, O., & Danne, T. (2018). Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?. Therapeutic advances in endocrinology and metabolism, 9(5), 157–166. doi: 10.1177/2042018818763247

Menon, R. K., Thomas, I. H., & Sperling, M. A. (2016). Childhood diabetes mellitus: Advances & challenges. The Indian journal of medical research, 144(5), 641–644. http://www.ijmr.org.in/text.asp?2016/144/5/641/203455

Rao, P. (2015). Type 2 diabetes in children: Clinical aspects and risk factors. Indian Journal Of Endocrinology And Metabolism, 19(7), 47. DOI: 10.4103/2230-8210.155401

Streis and, R., & Monaghan, M. (2014). Young Children with Type 1 Diabetes: Challenges, Research, and Future Directions. Current Diabetes Reports, 14(9) doi: 10.1007/s11892-014-0520-2

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