In: Nursing
Diabetes
R.M. is a 17-year-old African-American girl with new-onset
diabetes, presumed to be type 2 diabetes. She presented to her
pediatrician during the winter months with the classic symptoms of
polyuria and polydipsia. She reported weight loss over the
preceding weeks, but was otherwise well. Her family history was
positive for type 2 diabetes in grandparents and some distant
relatives and negative for autoimmune diseases.
Physical examination revealed a blood pressure of 103/53 mmHg,
pulse of 79, and temperature of 38°C. Her weight was 60 kg (132 lb,
50–75th percentile), height was 155 cm (61 inches, 10th
percentile), and body mass index (BMI) was 25 kg/m2 (85th
percentile). She had acanthosis nigricans and was at Tanner V stage
of sexual development.
Urinalysis revealed a glucose level of >1,000 mg/dl and ketones
of 40 mg/dl. Her initial laboratory studies included a blood
glucose measurement of 726 mg/dl, bicarbonate of 21 mmol/l (normal
range 23–32 mmol/l), venous pH of 7.37, hemoglobin A1c (A1C) of
8.6%, and C-peptide of 1.0 ng/ml (normal range 0.6–3.2
ng/ml).
Discussion Questions: Review the case above and answer these
questions.
1.What is the significant differences between type 1 and 2
diabetes.
2. Discuss 4 priority nursing diagnoses?
1. There are two main types of diabetes: type 1 and type 2. Both types of diabetes are chronic diseases that affect the way your body regulates blood sugar, or glucose. Glucose is the fuel that feeds your body’s cells, but to enter your cells it needs a key. Insulin is that key.People with type 1 diabetes don’t produce insulin. You can think of it as not having a key.People with type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin. You can think of this as having a broken key.
Both types of diabetes can lead to chronically high blood sugar levels. That increases the risk of diabetes complications.
symptoms of diabetes:-
Both types of diabetes, if not controlled, share many similar symptoms, including:
frequent urination
feeling very thirsty and drinking a lot
feeling very hungry
feeling very fatigued
blurry vision
cuts or sores that don’t heal properly
People with type 1 diabetes may also experience irritability and mood changes, and unintentionally lose weight. People with type 2 diabetes may also have numbness and tingling in their hands or feet.
Although many of the symptoms of type 1 and type 2 diabetes are similar, they present in very different ways. Many people with type 2 diabetes won’t have symptoms for many years. Then often the symptoms of type 2 diabetes develop slowly over the course of time. Some people with type 2 diabetes have no symptoms at all and don’t discover their condition until complications develop.
The symptoms of type 1 diabetes develop fast, typically over the course of several weeks. Type 1 diabetes, which was once known as juvenile diabetes, usually develops in childhood or adolescence. But it’s possible to get type 1 diabetes later in life.
Causes of type 1 diabetes
The body’s immune system is responsible for fighting off foreign invaders, like harmful viruses and bacteria. In people with type 1 diabetes, the immune system mistakes the body’s own healthy cells for foreign invaders. The immune system attacks and destroys the insulin-producing beta cells in the pancreas. After these beta cells are destroyed, the body is unable to produce insulin.
Researchers don’t know why the immune system attacks the body’s own cells. It may have something to do with genetic and environmental factors, like exposure to viruses. Research is ongoing.
Causes of type 2 diabetes
People with type 2 diabetes have insulin resistance. The body still produces insulin, but it’s unable to use it effectively. Researchers aren’t sure why some people become insulin resistant and others don’t, but several lifestyle factors may contribute, including excess weight and inactivity.
Other genetic and environmental factors may also contribute. When you develop type 2 diabetes, your pancreas will try to compensate by producing more insulin. Because your body is unable to effectively use insulin, glucose will accumulate in your bloodstream.
Risk factors for type 1 diabetes include:
Family history: People with a parent or sibling with type 1 diabetes have a higher risk of developing it themselves.
Age: Type 1 diabetes can appear at any age, but it’s most common among children and adolescents.
Geography: The prevalence of type 1 diabetes increases the farther away you are from the equator.
Genetics: The presence of some genes point to an increased risk of developing type 1 diabetes.
Type 1 diabetes can’t be prevented.
You are at risk of developing type 2 diabetes if you:
have prediabetes (slightly elevated blood sugar levels)
are overweight or obese
have an immediate family member with type 2 diabetes
are over age 45
are physically inactive
have ever had gestational diabetes, which is diabetes during pregnancy
have given birth to a baby weighing more than 9 pounds
are African-American, Hispanic or Latino American, American Indian, or Alaska Native
have polycystic ovarian syndrome
have a lot of belly fat
2.(a) Assess for signs of hyperglycemia.
(b)Assess blood glucose levels before meals and at bedtime.
(c)Monitor the patient’s HbA1c-glycosylated hemoglobin.
(d)Assess for anxiety, tremors, and slurring of speech. Treat hypoglycemia with 50% dextrose.
(e)Assess feet for temperature, pulses, color, and sensation.
(f)Assess the patient’s current knowledge and understanding about the prescribed diet.
(g)Assess the pattern of physical activity.
(f)Teach patient how to perform home glucose monitoring.
(g)Report BP of more than 160 mm Hg (systolic). Administer hypertensive as prescribed.