Question

Discussion Topic

Maya Korrapati was diagnosed with T1DM when she was 7 years old, and her appetite suddenly soared.
“She was a skinny little thing,” her mother says, “even though she kept eating and eating and eating. She had six hot dogs one day at a neighbor’s backyard barbecue, and I was so embarrassed. I asked my neighbor, ‘Why didn’t you stop her?’ but they all thought it was cute. It was then that I noticed she was constantly running into the kitchen all day for a drink. I just thought at first it was because—hey, you know—it was summer, after all, and Maya was a very, very active little girl. It was my sister who finally said, ‘Maybe you should just get that checked out. You know why.’ I guess up until then, I was in a kind of denial. So I took her, and, of course, she was diagnosed with T1DM.”

When Maya was first diagnosed, her mother was given instructions on how to administer conventional insulin therapy. Now, however, Maya is starting her freshman year of high school, and she is requesting a switch to an intensive insulin therapy regimen.

“I’ll be in school all day and going to after-school activities. I’m on the girls’ soccer team and I am determined to make varsity by my sophomore year. So, my eating is going to be kind of weird.”

Her mother clicks her tongue in frustration at this, and the two exchange unhappy looks.

After a pause, her mother says, “I think Maya’s anorexic.”

“What? No! Stop it, Mom. You’re embarrassing me.”

“I’m concerned,” Mrs. Korrapati says.

1. Now that Maya is gaining a little more independence and is spending a little more time away from home, she wants to switch her insulin regimen. What might be her rationale for this? Do you think switching her regimen is a good idea?

2. Mrs. Korrapati suspects that Maya may have an eating disorder. What kinds of signs might the nurse look for to determine whether this is the case?

3. Mrs. Korrapati reports that she and Maya frequently argue about Maya’s involvement in team sports.
“I’d feel better if she’d switch to art or playing a musical instrument. Of all the extracurricular activities you could have chosen,” she says to Maya, “why go with sports when you know you have diabetes?”
Maya becomes resistant when her mother talks like this.

She responds now, “It’s not a death knell, Mom, and I’m good. I want to make varsity and then work for a scholarship. Don’t you always talk about wanting me to get a good scholarship?”

“Not if it makes you sick,” her mother says.

Her mother has to admit that Maya has always been pretty healthy, despite her T1DM; and as far as anyone can tell, she has been responsible about diet, maintaining good blood glucose levels, and managing self-administration. Based on these facts, how should the nurse advise Maya and her mother?

Answer 1

Type 1 Diabetes Mellitus :

Diabetes Mellitus is a medical disorder characterised by varying or persistent Hyperglycemia , especially after eating. Type 1 DM is also called as Juvenile diabetes and is a chronic disease characterised by Hyperglycemia due to an inability to produce sufficient quantities of the hormone insulin by Pancreas .

1. Rationale for switching insulin regimen:

Intensive insulin therapy is a type of Insulin therapy, in which the patient receives multiple shot of Insulin or make use of Insulin pumps and also frequent monitoring of blood glucose level.

Maya wants to switch to her insulin regimen from conventional to intensive insulin therapy as she thinks that , when she goes to high school, she may not be following the diet accordingly , that she is previously used to be for conventional therapy. Also she is in the soccer team, she has to engage in various activities and practices. Conventional regimen may be difficult for her as she is going to spend more time outside ( in school and play ground). if she is skipping a meal one time , then there is a chance of hypoglycemia, if she follow conventional regimen, as it is a fixed dose of insulin.

Maya, is a responsible adolescent, as her mother says. Switching to Intensive insulin therapy may increase the Autonomy of young people and it may be convenient for them. Many studies proven that, Intensive insulin therapy has a better outcome in controlling the blood sugar level of adolescents. But there should be regular monitoring of Blood - glucose level and constant communication with health team.

2. Eating disorders: Any psychological disorder characterised by abnormal eating habits .

Mrs. Korrapati thinks that Maya is Anorexic

Anorexia nervosa: An eating disorder characterised by self starvation due to an irrational fear of gaining weight.

Nursing Assessment: Nurse can look for signs , such as:

* Check body weight, if any underweight or loss of weight.

* Dehydration, dry skin, diziness , fainting

* low Blood pressure and low body temperature , slow heart rate

* Fluid- electrolyte imbalance

* osteoporosis

Nurse can also assess :

* Assess for any :self starvation, habits of induced vomiting , social isolation, compulsive behaviour or impulsivity

* Assess for any menstrual irregularities , depression, brittle hair and nail.

3. Advice to Maya and her mother:

To Maya: Instruct her regarding the Intensive Insulin therapy and importance of

* good understanding about Diabetes

* frequent monitoring of blood glucose in a day

* always communicate with the health team

* dose should be adjusted with the dietary intake .

* Calculation of calories of food that she consume.

* Avoiding artificial sweeteners and sugars

* Regular  follow up with the physician.

* Educate Maya regarding the use Insulin pump.

* warn her , there may be chances of low blood sugar, if she is not taking adequate food.

To Mrs. Korrapati:

* Assure her that Intensive insulin therapy can used if the patient is:

- not an older adult

- not having memory problems

- not suffering with frequent hypoglycemia incidence

- willing to monitor blood sugar or injecting insulin.

Maya is eligible to use Intensive insulin therapy, if the physician is agreeing for it.

* An adolescent with type 1 Diabetes can take part in sports and physical exercise, if that is her choice. Only concern that, they may be less efficient or competent , if their Blood glucose become high.

* Many adolescents, with well managed Type 1 diabetes , achieved prizes in University and national competitions.

* Provide Psychological support to Maya's mother. As Maya is a responsible girl , who manages her diet, blood sugar level, self administration of Insulin, she will be able to manage the Intensive Insulin therapy and her sports activity.