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Pathophysiology of Type 1 Diabetes - Question 1

Zach has been prescribed insulin because he had high blood sugar levels and is diagnosed with diabetes. The symptoms in his medical history like increased appetite, frequent urination, increased thirst, tiredness, fatigue, weight loss, and a positive urine test for ketones and glucose showed that he had diabetes for which he had been prescribed insulin. His capillary blood glucose levels are higher with a value of 26.0nmol/L than the normal values of 3.9 to 7.1 nmol/L. According to Gómez-Díaz (2019), the pathophysiology of type 1 diabetes is – it is the culmination of the destruction of beta cells of islets of Langerhans in the pancreas that secretes insulin. As the number of beta cells decreases resulting in decreased insulin-secreting and the blood glucose is no longer up-taken by the insulin so blood glucose levels get elevated resulting in type 1 DM (Trefz et al., 2019). However, intake of insulin in the form of injections or tablets the levels can be kept under control. According to Petersen & Shulman (2018), the mechanism of insulin action involves – it is responsible for regulating the movement of glucose in the blood of the organism. It stimulates skeletal muscle cells and fat cells to perform peripheral glucose uptake, resulting in the lowering of blood glucose levels to normal range. It inhibits the insulin released by the liver and also inhibits excessive glucose production in the body. Insulin is prescribed for diabetic patients to prevent blood glucose levels from getting too low (hypoglycemia) or too high (hyperglycemia).

Pathophysiology of Type 1 Diabetes - Question 2

The NovoRapid is an insulin injection medication used to treat type 1 DM. As it has a very fast onset action, it is given close to the meal intake and the food should be taken within 5 to 10 minutes of injection administration without any delay. However, if necessary, it can also be taken soon after the meal as well. This medication is absorbed in a faster rate by the body as it is similar to insulin and this feature enables it to act at a faster rate than insulin. It enables the blog glucose to enter inside the cells of the body ensuring that the body gets energy and lower the hyperglycemic conditions. According to Svendsen et al. (2018), if levels of insulin are excessively secreted in the body then the body’s normal blood glucose level will decrease as glucose enters the cells and is utilized, resulting in hypoglycemia. Whereas, if the less insulin is released by the pancreas then cells are unable to take up glucose from the blood results in high blood glucose levels - a condition leading to hyperglycemia.

Pathophysiology of Type 1 Diabetes - Question 3

According to Kwok et al. (2017), the NovoRapid is taken close to the meal as it has a fast action inside the body. Therefore, a patient with diabetes should be checked with his/her blood glucose levels before the administration to get information about his glucose levels so that the concentration of the medication can be set accordingly to meet the required results of normal glucose levels in a type 1 DM patient. After administrations also it is necessary to check the blood glucose levels to get ensured that the levels are under control or not and no condition of either hypoglycemia or hyperglycemia has taken place. This before and after testing ensures patient's safety in hospital and quality care as well. According to Rothberg et al (2016), the testing of blood glucose levels (BGL) provides useful insights about the patient like to understand how factors like stress or others can affect the BGL, to detect how the patient’s diet and medications affect his/her BGL and keep a track record to monitor the BGL regularly to provide continued and effective care to the patient. This information can also help in managing and improving the medication and treatment plans of the diabetic patient concerning diet, medicines, or lifestyle.

Pathophysiology of Type 1 Diabetes - Question 4

The daily physical challenges that are faced by Zach include – he might lose more weight and this will restrict his cricket practices. Being in a highly active stage of growth, he might not be able to take part in the sports day of his school as the family might have a fear of health risks due to the diabetic condition of Zach. According to Streisand & Monaghan (2015), if a patient with type 1 diabetes performs excessive physical activities then he might end up with the condition of hypoglycemia. A student with type 1 diabetes who is prescribed with NovoRapid has to take the medication soon before the meal, due to this he might disturb his study periods as he had to take medications within time. The emotional impacts are also faced by the child and his/her family members as well. In this case, Zach being in his growing age and as he had lost weight due to his condition, he might not be able to take part in some social functions due to his diabetic condition. According to Nieuwesteeg et al. (2017), the emotional stress as they cannot do parties with friends, camping, or friends’ sleepovers, due to the fear of health-harming consequences of their diabetic condition. Moreover, whenever the patient will administer the insulin injection in schools or other public places he/she might feel embarrassed about the people’s perceptions near him/her at the time of medication administration. Living with such a health condition in case of a growing stage the child might get exposed to anxiety, depression, and stress due to his daily medication pattern and physician visits. All these factors can restrict Zach from taking part in various activities and this will end up in reduced confidence and feeling a dependency on medication in Zach.

References for Pathophysiology of Type 1 Diabetes

Gómez-Díaz, R. A. (2019). Pathophysiology of Type 1 Diabetes. The Diabetes Textbook (pp. 89-99). Springer, Cham.

Kwok, R., Sztal‐Mazer, S., Hopkins, R. E., Poole, S. G., Grannell, L., Coutsouvelis, J., & Topliss, D. J. (2017). Evaluation of NovoRapid infusion as a treatment option in the management of diabetic ketoacidosis. Internal Medicine Journal47(11), 1317-1320.

Nieuwesteeg, A., Hartman, E., Emons, W., van Bakel, H., Aanstoot, H. J., van Mil, E. G. A. H., & Pouwer, F. (2017). Paediatric parenting stress in fathers and mothers of young children with Type 1 diabetes: a longitudinal study. Diabetic Medicine34(6), 821-827. https://doi.org/10.1111/dme.13300

Petersen, M. C., & Shulman, G. I. (2018). Mechanisms of insulin action and insulin resistance. Physiological Reviews98(4), 2133-2223. https://doi.org/10.1152/physrev.00063.2017

Rothberg, L. J., Lees, T., Clifton-Bligh, R., & Lal, S. (2016). Association between heart rate variability measures and blood glucose levels: Implications for noninvasive glucose monitoring for diabetes. Diabetes Technology & Therapeutics18(6), 366-376.

Streisand, R., & Monaghan, M. (2015). Young children with type 1 diabetes: Challenges, research, and future directions. Current Diabetes Reports14(9), 520. https://doi.org/10.1007/s11892-014-0520-2

Svendsen, B., Larsen, O., Gabe, M. B. N., Christiansen, C. B., Rosenkilde, M. M., Drucker, D. J., & Holst, J. J. (2018). Insulin secretion depends on intra-islet glucagon signaling. Cell Reports25(5), 1127-1134. https://doi.org/10.1016/j.celrep.2018.10.018

Trefz, P., Obermeier, J., Lehbrink, R., Schubert, J. K., Miekisch, W., & Fischer, D. C. (2019). Exhaled volatile substances in children suffering from type 1 diabetes mellitus: Results from a cross-sectional study. Scientific Reports9(1), 1-9. https://doi.org/10.1038/s41598-019-52165-x

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