Implications of Type 1 Diabetes-Long Term Condition on a Patients Life Journey and Wellbeing - Case Study Example

Student Name Tutor Title: Implications of a Type 1 diabetes-Long Term condition on a patient’s life journey and wellbeing Institution Date Implications of a Type 1 diabetes-Long Term condition on a patient’s life journey and wellbeing Introduction Type 1 diabetes constitute of 5-15% of 285 million adults with diabetes. The disease is increasing at 3% annually, particularly in white Europeans, including northern Europe (Hovorka et al 2011). It accounts for almost 57000 death every year among under 75years, the most intensive users of high cost services (DoH, 2008). As one of the diseases associated with long term conditions, type 1 diabetes is a global concern. Approximately 17.5 million people have a long term condition (Margereson and Trenoweth, 2010). In Britain, six out of ten adults have a long-term condition that can’t be cured thus making their care and management even more complex (Chronic disease management, 2004). This aim of this paper is to present a detailed discussion on the implications of a Type 1 diabetes long term condition on a patient’s life journey and wellbeing with a use of a case study of patient suffering from the disease. Background to LTC-Type 1 diabetes People with Type 1 diabetes are generally are not obese and may present initially with diabetic ketoacidosis (DKA). The distinguishing characteristic of a patient with type 1 diabetes is that if his or her insulin is withdrawn, ketosis and eventually ketoacidosis develop. Therefore, these patients are dependent on exogenous insulin which calls for a multidisciplinary approach by physician, nurse, and dietitian. At the new-onset of type 1 diabetes, permanent insulin therapy has to be started. There is also need for a long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. Type 1 diabetes is one of an autoimmune disease that results when the body’s system for fighting infection—the immune system—turns against a part of the body. In this case, immune system attacks and destroys the insulin-producing beta cells in the pancreas (Devendra, 2004). It is related to premature beta-cell failure or pancreatic beta-cell destruction where the patients completely lack insulin secretion leading to increased blood and urine glucose or severe metabolic lability and eventually ketoacidosis. According to McAnulty, Robertshaw and Hall, patients with type 1 diabetes are generally vulnerable or prone to lipolysis, proteolysis and ketogenesis. These processes are repressed by minimum levels of insulin secretion (McAnulty, Robertshaw and Hall, 2000). Associated symptoms include polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss. Several authors have also reported a close association between anxiety with Blood Glucose Monitoring and Glycemic Control (O’Kane, Bunting and Copeland, 2008; Herzer and Hood, 2009). Case Study: implications of a Type 1 diabetes-Long Term condition on a patient’s life journey and wellbeing The following case study describes the diagnostic dilemma presented by an aged man with type 1 diabetes and a history of severe hypoglycemia complicated by other medical, psychiatric, social, and functional problems but has also indicated a unique protection over some ailments. Diabetes, of course, may cause an increase in cognitive decline over the course of time because of vascular risk factors (Logroscino, Kang and Grodstein, 2004) in patients with type 1 diabetes; cognitive dysfunction is characterized by a slowing of mental speed and a diminished mental flexibility, whereas learning and memory are spared. The extent of the cognitive dysfunctions varies from mild to moderate, however even mild forms of cognitive dysfunction may hinder considerably daily activities because they can be likely to result to trouble in more challenging situations (Augustina et al 2005). Depression is also associated with patient suffering from diabetes particularly with old people. In part, this could be as a result of memory impairment, changes caused by the illness or treatment of diabetes, or due to the psychosocial demands related to diabetes and/or its treatment. In addition, it could also be linked to changes in physical activity and diet that may increase risk for diabetes, and depression may also produce physiological changes that increase risk for diabetes (Husain et al, 2004). One of the unique advantages of type 1 diabetes is its quality to protection against diseases. According Raha and his colleques, to some infections viruses may play a role in prevention rather than precipitation of disease. This emerges to be the molecular source of the diabetes protection credited to whole Freud’s adjuvant (CFA) and whole Mycobacterium Bovis in the model (Raha et al,2009) as a result of this, type 1 diabetes seems somewhat unique among autoimmune diseases in that in addition to forming susceptibility, certain MHC haplotypes provide significant protection, with protection dominant over susceptibility. Case Presentation Jack (not real name for confidentiality purposes’) is a 63-year-old retiree who was referred for psychosocial evaluation at the diabetes clinic after coming to an emergency room visit to a local hospital. He showed a rather confused state having also taken an overdose of insulin which he categorically denied but rather explained that it was a result of several types of insulin injections he has been using over the years. After a thorough psychiatric assessment he was not judged to be at great risk of suicidal incident. The patient was later discharged after his blood glucose levels became stable, and he assured to follow outpatient mental health treatment. His hemoglobin A1c (A1C) at the time was 7.9%—his lowest on record for several years. By and large, his blood glucose levels exhibited extensive swings. He described how high blood glucose levels made him experience lack of appetite regarding eating and depressed regarding his diabetes self-care. He reports that he has been adviced to Check blood sugar once a day at teatime making sure he reduce insulin if it is below If below 8 mmols/l or increase the insulin if it is above above 20 mmols/l. This corroborated to what is recommended as refelected in the Diabetes in Palliative Care Guidelines, 2010. Life history of jack has been that of has struggling with depression on and off for a span of almost twenty years. He felt more depressed after he retired form his job some three years ago. He revealed he has unsuccessfully contemplated suicide before He contemplated suicide for 3 months but never acted. All through this distressed moment, he slightly functioned had experienced memory lapses. His emotional struggles were made by diabetes, with blood glucose control varying uncontrollably and varying from periods of ketoacidosis that needed admission to harsh hypoglycemic episodes that lead to a more current incident of a vehicle accident. He has been approved for social security because of psychiatric disability. Although Jack usually arrives punctually and at the correct hour, he often goes on the wrong day in case of his medical appointments. He also has to grapples with random blood glucose levels. He monitors his blood glucose levels quite a number of times per day, 7-10 times and he is also conscious with what he eats. Jack also complains of sleep apnea, highly erratic sleep patterns. His sleep pattern has changed significantly. Whereas in the past he would wake up rested after eight hours of sleep, nowadays he frequently does not easily fall sleep until say 5.00am. If he has to sleep then can be for only three hours in spite of the apparent excess of sleep, his terminal fatigue has persistent to deteriorate. Another unique habit of Jack is that he often several hours in the afternoon. Jack has embarked on management options for his sleep problems as advised by his physician like continuous positive airway pressure. Generally the aim of this is relieve symptoms like snoring and extreme day sleepiness and to avoid other problems, such as high blood pressure. According to Margereson and Trenoweth worries about our self and the situations in which we find ourselves in has a significant impact on our health status (Margereson and Trenoweth, 2010). Jack seems to worry much about his prevailing conditions and the kind of coping mechanism he has to adopt with in order to control his long term condition. A thorough clinical evaluation found that indeed Jack had an insulin overdose which was majorly attributed to lack of attention from carers. He has been advised not to sleep during the day to help improve sleep. Enhanced sleeping patterns must develop his concentration span and largely cognitive functioning. Jack gladly accepted individual psychotherapy and psychiatric medications for depression and taking his therapy as recommended at the clinic easily enhanced assistance from other professionals to help regulate his erratic blood glucose levels. It is widely accepted that depression can create more difficulties in maintaining treatment adherence and that the hardships of managing diabetes can lead to depression (Margereson and Trenoweth). Jack has also witnessed loss of appetite though has maintained on fast-acting insulin to provide more flexibility with meals. He has also maintained one type of insulin to avoid mixing of insulin. Jack has also previously attended Blood Glucose Awareness Training sessions. This is a better recorded psycho educational program that presents a number of empirically authenticated benefits for people with type 1 diabetes. Benefits include among other things, improved accuracy of blood glucose estimations, improved detection of hypoglycemia and hyperglycemia, improved judgments related to decisions about treatment when blood glucose is low, and a reduction in episodes of severe hypoglycaemia. Jack revealed that he is quite lonely and isolated. He reported that he frequently experienced isolation from others, psychologically disconnected, and affectively crushed. He has been encouraged to join a hospital-based group for people who share long terms conditions. This could significantly help him learn how to cope with diabetes and depression. Although Jack has not been very comfortable with associated effects of his prevailing long terms condition, he is happy that he is resistant to some diseases. Apart from this, he has also been offered social security benefit because of his condition and also because he is not currently in a gainful employment. Jack seems to be resistant to some infections because of the diabetes. According to Raha and his colleques, Type 1 diabetes seems somewhat unique among autoimmune diseases in that in addition to forming susceptibility, certain MHC haplotypes provide significant protection, with protection dominant over susceptibility (Raha et al, 2009). Conclusion The aim of the paper was to discuss the some of the impacts of type 1 diabetes longer terms conditions on the patients’ journey and well being using a case study of one of the patient to give a holistic approach to some of these impacts. Type 1 diabetes one of autoimmune diseases the unlike diabetes type 2, patients suffering from it tend to show ketoclidosis. One of the problems associated with these conditions is cognitive decline evidenced by memory lapses and significant reduction of mental flexibility. Some of these cognitive problems may range from mild to moderate but all in all, they are all equally problematic this has caused a lot of challenges to the diabetics especially as they try to cope with their prevailing conditions and rather a new way of life. Apart from the cognitive dysfunction, it is clear that patient’s major problem revolves around their social and psychological environment. As such, patients show incidents of depression and some times isolation. Incidents of suicide are also common as their try to come to terms with their conditions. Depression and isolation are some of the manifestations of social and psychological impacts of type 1diabetes. Suicide attempts may also come in handy to illustrate these impacts attributed to stress and the hardship they have to deal with in their long terms conditions. Patients may also have changed sleep patterns. Type I diabetes can also bring with it some benefits. One of these may include social security benefits or considerations owing to their inabilities but more importantly is the capability of this disease to also fight other infections which is attributed to a genetic strain, MHC haplotype gene which can help the body to fight infections. It is not a surprise that type 1 diabetes patients may not suffer from other infections compared to the rest of the population. There is need to maintain appropriate management programs for instance the normal insulin injection and blood check. There is need to not only attend sensitization events but also associate or join groups with similar problems which will eventually help in adopting new skills of managing these long terms conditions. 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