Question

A 23-year-old male with Type 1 diabetes presents to the ER complaining of fatigue and malaise. He tells you he has skipped his insulin injections the previous two days. His labs are:

PH	7.10	Na	140	BUN	35
PCO2	10	K	4.1	Crt	1.1
PO2	112	Cl	105	BS	845
HCO3	4	CO2	5	+ ketonemia

Answer 1

Type-1 Diabetes

It is also known as IDDM or Juvenile diabetes. Environmental factors such as virus are supposed to start autoimmune process that destroy the b-cells.

As per lab test Ketone is increases due to due to decrease in insulin in the body as patient has skipped his insulin injection

:-Here the pathophysiology with few symptoms when level of insulin decreases

Other symptoms includes:-

Fatigue,weakness,Recurrent and this type1 diabetes may also have nausea, vomiting or abdominal pain associated with it

Diagnostic evaluation will be:-

Fasting blood glucose- it is diagnosed by measuring blood glucose level it is normally less than 110 mg per DL

Random blood glucose- evaluate blood glucose level may occur after meals after stressful events ect random blood sugar 200 mg per DL

Oral glucose tolerance test

ketonuria- the presence of ketones in urine indicates that the body is using fat as a major source of energy

Proteinuria- presence of protein in urine indicates that protein is been used as a major source of energy

Management

It includes combination of medications ,dietary modification and physical exercises

Diet management:-

1. The main goal of dietary management is to help diabetic client to improve metabolic control by taking changes in nutrition habits it includes:

a. Improving blood glucose and lipid levels

b. Providing daily food intake plan

c. Help in weight management

d. Providing educate nutrition

Person's Lifestyle dietary habits are very important to control the state.

So, for Type 1 Diabetes, special diet management includes: mil should be adjusted to make insulin action. Breakfast should be taken within 1 hour after the morning insulin dose.A carbohydrate should be taken about three hours later. Lunch should be taken about 4-5hours the morning insulin dose

Exercise

Promote regular physical activity, walking is the best well-tolerated exercise. Also stationary bicycle or swimming good in useful and weight reduction, increase in insulin sensitivity, maintaining the insulin levels, lower BP, reduce stress and tension but hyperglycemia is a risk for those patients taking insulin or oral hypoglycemias, therefore, meal planning and exercises are collectively planned

Insulin therapy:

Insulin works to decrease blood glucose by promoting the transport of glucose into cells and inhibit the conservation of glycogen and amino acids to glucose. Insulin injected into the abdomen is absorbed fastest, where in ARM and leg available. It is various according to three main categories

1.Time,Course:

Rapid acting insulin, short acting insulin, immediate acting insulin, long-acting insulin

2. According to Specie-

All insolence are from beef and poke but human insulin is also available these days

3. Manufacturer

Insulin dose:

The starting dose of insulin is 0.5 unit/kg/day.2/3rd dose is commonly given in the morning and 1/3rd in the evening. The dose can be increase or decrease according to the food intake,exercise, stress or illness etc

Nursing management:

Nursing diagnosis

1. Impaired nutritional status more than the body requirement related to intake in excess of activity expenditure

2. Se related to insulin injection

.3. Activity intolerance related to weakness and as evidence bi Limited activities

4. Self care deficit related to disease condition