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 is insulin depenedent diabetes mellitus which  mainly affects children. it is caused by absence of insulin as a result of destruction of betacells of islets of langerhans. The main symptyoms of diabetes mellitus are polyphagia, polydipisia, polyuria apart from fatique and weakness. The main management of diabetes mellitus are insulin therapy, nutritional therapy, exercise and monitoring.

1.Maya has to continue insulin therapy as she has type 1 diabetes mellitus. she wanted intensive insulin therapy to  bring her blood glucose levels as non -diabetic. she needs multiple doses of insulin and monitoring  in intensive insulin therapy. obtaining physician help is important for switching regimen. she has to be educated about insulin therapy in supportive way.

2. Maya tend to eat more due to absene of glucose entering into cells. thereby, her mother can provide her smaller meals every 2 hours in order to control her hunger.

3. maya can continue her activities and her school education as she has good health and confident. more calories are needed for maya as sports are coming under vigrous activities. she can have snacks in hand while involving sports activities.she can be provided with ID Card which shows her as diabetic.

Nurse educate maya and her mother that maya has responsibility about her diet regulation and self -administration of insulin. she has to be instructed about monitoring her blood gucose. it is very important to provide emotional support for maya and her mother while giving advice as they are too embarressed

TYpe 1 diabetes mellitus children can continue education, exercise, insulin therapy life long and can have emergency snack in packet. regular testing is must to monitor their blood glucose.