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Physical Challenges and Emotional Impacts of Living With Type 1 Diabetes Assessment 4 Answer

Medical history

Zach visited his local doctor after experiencing increased appetite and excessive thirst. He has been unusually tired when playing cricket and hasn't been able to perform at his best. He has lost 10 kilograms of weight over a two week period and has been frequently urinating at night. The doctor suspected type 1 diabetes and tested his urine, which was positive for glucose and ketones. A random capillary blood glucose level was 25.0mmol/L and blood ketone level was 1.5mmol/L. Zach was advised to attend the hospital emergency department immediately.

Social history

Zach lives with his mother (Susan), father (John) and 10 year old brother (Jacob). He is in year 10 at high school and works at McDonalds on a casual basis. Zach plays cricket on the weekends and trains two days during the week.

Emergency department review

Two hours after review by the local doctor, Zach's capillary blood glucose level (BGL) was 26.0mmol/L and blood ketone level was 1.6mmol/L. Other vital signs were within normal limits. After review by the endocrinologist, Zach was given a provisional diagnosis of type 1 diabetes based on his symptoms and family history of autoimmune disease (His mother has hyperthyroidism, Graves' disease). His blood test confirmed that he did not have ketoaddosis.

Treatment plan

Zach was prescribed subcutaneous insulin; Aspart (NovoRapid) Flexpen 8 units TDS and Glargine (Lantus) Solostar 24 units node. He was referred to the diabetes service for inpatient review and ongoing care.

Assessment instructions

Using the marking criteria and supporting academic references address the following questions.

Assessment Questions

Question 1. (10 marks) 

Explain why Zach has been prescribed insulin. Relate to the pathophysiology of type 1 diabetes and insulin mechanism of action. Support your answer with academic references.

Question 2. (5 marks)

Discuss the appropriate timing of Zach's NovoRapid insulin administration in relation to food. Relate to the insulin action profile of NovoRapid, hyperglycaemia and hypoglycaemia. Support your answer with academic references.

Question 3. (5 marks)

Discuss the rationale for testing Zach's blood glucose level (BGL) before and after his first NovoRapid insulin injection in the hospital setting. Support your answer with academic references.

Question 4. (10 marks)

Discuss the daily physical challenges and potential emotional impacts of living with type 1 diabetes that Zach may experience once he is discharged from hospital. Support your answer with academic references.

Language Use (5 marks) Sentences are well constructed, expression and meaning is clear, basic written language rules are followed. Referencing and in-text citations (5 marks) The APA (7th Edition) referencing style is used correctly for both in-text citations and reference list.

— Academic references include journal articles, textbooks and reports from professional nursing associations such as The Australian Diabetes Educators Association. — The Diabetes Australia website and patient information sheets are examples of consumer (general public) resources and are not considered academic references. Official reports published by Diabetes Australia for health professionals are considered academic references. — High quality academic references are current (within 5 years) and specifically relevant to type 1 diabetes or insulin administration.


1. Type 1 diabetes results from the destruction of beta cells of the pancreases combining genetical and environmental factors. Beta cells of the pancreas are responsible for the production of insulin (Fullerton et al., 2016). The autoimmune destruction is marked by the presence of insulin antibody, ICA512/ia-2 and glutamine acid. To manage the lowering level of insulin in the body Zach has been prescribed insulin’s therapeutic doses. With the progressive decline in the insulin production patient with type 1 diabetes requires replacement therapy dose calculated 0.5-1 units per kg of body weight per day of insulin (Donner & Sarkar, 2019). The blood glucose level of Zack is 24 mmol/L hence require subcutaneous insulin for controlling hyperglycemia. The starting treatment is the combination of intermittent acting insulin or basal insulin analogue and rapid-acting insulin analogues like insulin lispro. 

Zack is provided with combination of rapid acting and long acting insulin regime, NovoRapid flexopen 8 units and glargine Solostar 24 units respectively. The long-acting insulin analogues are basal insulin like detemir and glargine for regulating the glucose metabolism as liver releases glucose continually. The action peaks after 8-12 hours hence provided at bedtime, providing 24 hours support. The basal insulin is required for the suppression of the hepatic glucose production hence given overnight or between the meals Rapid/ short-acting or postprandial insulin regime like Novolin is given soon after the eating as glucose amount in body spikes soon after taking meals (Kildegaard et al., 2019). The regime is tailored as per the age, duration of diagnosis, daily intake of carbohydrates, the target of the metabolic control. The mealtime or prandial insulin replacement is provided for displacing the glucose after eating clearing glucose from blood. Intensive insulin therapy is provided for providing better glycemic control and less glucose variability (Fullerton et al., 2014). Insulin therapy is also provided to reduce the development and progression of macro and microvascular complication by facilitating glucose uptake by Musculo-skeletal system hence reducing glucose toxicity (DiMeglio et al., 2018)

2. NovoRapid is rapid-acting prandial insulin taken immediately before a meal to reduce the blood glucose levels. NovoRapid is a homologous to human insulin. It takes 20-30 minutes to start acting after the injection. The maximum effect is observed between 1 to 3 hours and decline after five hours (Hermansen et al., 2015).  When food is taken it may take an hour for glucose to reach the bloodstream. After taking meals the glucose level spikes, which is regulated with the help of short-acting insulin regime like NovoRapid. If meal is not taken after administration of NovoRapid it may cause an episode of hypoglycemia. While gauging the appropriate interval between the dose and eating, “lag time” calculation is necessary for avoiding hypoglycemia. If blood glucose levels are above a target range, lag time is increased allowing insulin to have a sooner effect. Being rapid-acting44 insulin NovoRapid can be given to Zack 20-30 minutes before meal for prevention of insulin induces hypoglycemia and depending upon the degree of hyperglycemia. If blood glucose levels taken premeal are below the target range NovoRapid must be postponed after carbohydrates intake to avoid hypoglycaemia (Subramanian et al., 2016).

3. Zack has been provided with Insulin therapy as management of type 1 diabetes based on physiological insulin replacement aiming to mimic normal pancreatic insulin secretion hence reducing glucose load and toxicity which could cause symptom and complications. Testing Zach’s blood glucose level while administering NovoRapid is recommended for achieving optimal glycemic control (Rubin et al., 2020).  Blood glucose level is measured after the dose of NovoRapid to assess hypoglycaemia if present, as NovoRapid produces more rapid and pronounced glucose-lowering effect than regular human insulin due to faster absorption.  Before meal blood, glucose monitoring is required to assess the extent of hyperglycaemia for calculating mealtime insulin dosage. The primary objective of treatment through NovoRapid is reducing the high blood glucose levels to ameliorate any symptoms of hyperglycemia and prevent diabetes complications onset (Silver et al., 2018). Testing of blood glucose level before and after insulin injection is required to access the target controlling or monitoring reduced blood glucose in response to elevated results (Rubin et al., 2020).

4. Diabetes is a chronic metabolic disorder which requires lifestyle adjustments impacting the physical, social and mental well-being of the individual. Addressing these cognitive, emotional, behavioural and social factors in treatment interventions help overcome multiple barriers which could affect the adherence and self-care in type 1 diabetes (Jena et al., 2018). Soon after the diagnosis Zack and his family may undergo varied emotions and stress. Diabetes distress Is a unique emotional burden and worries as experienced by the family and patient while managing a chronic disease like diabetes. Zack may face emotional burden, feeling of isolation, physical distress, regime related distress and interpersonal distress. The emotional turmoil associated with Zack diagnosis may include denial, anger, shock and anxiety. Emotional impact as an associated result of Diabetes can be reflected in the form of hostility, resentment, displeasure and frustrations. These responses can be perceived as the part of the coping mechanism Zack might exhibit after being diagnosed with Diabetes (Jena et al., 2018).  Emotional distress observed in the form of clinical depression is another marked implication of negative impacts on the patient with diabetes. As a result of discrimination, restriction, fear of complications and isolation. 

Being a lifestyle disease diabetes has different physical challenges than the communicable disease. Major physical challenges daily may include checking blood glucose, administering insulin and eating food different from their peers and maintaining physical activities. The restrictive nature of Diabetes regime may also interfere with the participation of Zack in social physical activities which may include certain sports driving and dining out with friends. The physical challenge for Zack would also include managing a lower glucose level in school due to lack of multiple meals and higher chances of skipping insulin dose. During physical activities in school, if Zack skips snaking, it may cause hypoglycaemia (Rankin et al., 2018).

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