Question

Melissa is a 6-year-old girl who has been newly diagnosed with type 1 diabetes. Her physician has ordered a treatment regimen that includes blood glucose monitoring and regular insulin injections four times a day. Melissa and her parents have presented to the medical clinic for follow-up and teaching regarding Melissa’s condition and care needs.

1. Discuss the impact of Melissa’s diet on her diabetes management. What additional areas should be included in teaching Melissa’s parents about managing her diabetes?

2.Melissa’s father makes the following statement: “I guess it would be better to err on the side of giving her too much insulin rather than not enough.” How should the nurse respond to this statement? Also, describe the signs and symptoms of hypoglycemia that the nurse should teach Melissa’s parents, including the potential effects of hypoglycemia on Melissa’s health.

3.Melissa’s mother expresses her concern about the frequent blood glucose checks and insulin injections. She asks if an insulin pump would be a better, less traumatic alternative for Melissa. What factors impact the selection of an insulin pump for diabetic treatment?

4. The nurse completes the teaching session, and Melissa and her parents return home. The following afternoon, the nurse receives a frantic phone call from Melissa’s mother. She states that she has found Melissa unresponsive in her room. Upon further questioning, the nurse learns that Melissa is breathing and has a pulse but is very lethargic. It is unclear what her blood glucose level is. Melissa’s mother states that she cannot check her blood sugar, that she is having problems with the machine. How should the nurse advise Melissa’s mother

Answer 1

Ans)1) Impact of diet:

- Diabetics are a persistent disease where food is not completely absorbed in the body and thus cannot be used as a source of energy.

- Insulin is not produced in the body of the patients who are suffering from diabetics.

- In type 1 diabetics, the pancreatic beta cells are destroyed in the body, and they are not able to produce insulin.
- A proper and planned diet can help in the control of blood sugar level of the body.

- The daily meal for the child should be planned according to the decision of the child and the insulin should be given strictly on time.
- Diabetics can produce effects on different parts of the body, therefore, extreme care should be taken of eyes, foot, kidneys, heart and other body organs.

Importance of Insulin:

- Insulin helps in maintaining the blood sugar level of the body. In healthy individuals, insulin is produced by pancreas, and it is a hormone which facilitates the sugar to enter into the blood stream by which the level of blood glucose in maintained. Therefore, in diabetic condition, due to the unavailability of insulin production, insulin dosage is necessary.

2) The nurse would reply to this statement by telling them that

LOW BLOOD SUGAR (HYPOGLYCEMIA):

The most common side effect experienced with insulin therapy is hypoglycemia. Hypoglycemia can be caused by:

• Giving too much insulin.
• Missing or delaying food.
• Change in food, diet, or amount fed.
• Infection or illness.
• Change in the body's need for insulin.
• Diseases of the adrenal, pituitary, or thyroid glands, or progression of liver or kidney disease.
• Interaction with other drugs (such as steroids).
• Change (increase) in exercise

SIGNS OF HYPOGLYCEMIA MAY OCCUR SUDDENLY AND CAN INCLUDE:

• Weakness
• Depression
• Behavioral changes
• Muscle twitching
• Anxiety
• Seizures
• Coma
• Death

3) Teaching the patient/ family about insulin pump therapy can allow the patient to:
- Understand the importance of site rotation, how site rotation is achieved, and how frequently site changes should be made
- Record data using a log or diary and/or upload data stored in the pump and be able to use the data to make reasonable adjustments in insulin administration.

Factors for Insulin pump for managing diabetic treatment:

- Intermittent insulin injection

- Frequently blood sugar levels

- Hypglycemic event interfere work, family obligations.

4) The nurse would advise Melissa's mother that-

- It is mainly due to low blood sugar which can happen in people with diabetes who take medicines that increase insulin levels in the body. Taking too much medication, skipping meals, eating less than normal, or exercising more than usual can lead to low blood sugar for these individuals.

To help prevent diabetic hypoglycemia:

* Don't skip or delay meals or snacks.

* If you take insulin or oral diabetes medication, be consistent about the amount you eat and the timing of your meals and snacks.

* You may:

• Call 911 or have someone else do it for you.
• In the meantime, anyone trained to give an emergency injection of glucagon* should do so even before the emergency personnel arrive.
• Take 30 grams or more of glucose or sugar such as a glucose gel, if you are able
• Check your blood sugar with your meter, if you are able, after you have obtained emergency medical help, glucagon and/or have eaten.