Diabetes Mellitus Type One - Report Example

Institution : xxxxxxxxxxx Title : Case Study: Diabetes Mellitus Tutor : xxxxxxxxxxx Course : xxxxxxxxxxx @2010 Introduction The diabetes mellitus type 1 is a form of diabetes disease that is caused by the destruction of the autoimmunity of the beta cells found in the pancreas. The function of these beta cells is mainly to produce insulin. When they are destroyed, there is failure in production of insulin in the body resulting in high glucose levels in the blood and in the urine. Insulin is the hormone that is required for conversion of energy foods into sugar in the body. When insulin production fails, symptoms such as frequent urination and increased hunger results. Prevalence of this condition has been reported to be high in Australia and other areas in the world. However, its exact cause is not yet known but it is likely that some people have genes that predispose them to type 1diabetes. Its management therefore entirely depends on monitoring and controlling blood sugar levels (The Australian Psychological Society, 2007, p112). This case study therefore looks at the health issues of diabetes and all that is related to it. This disease mostly affects children below the age of fourteen years but it also occurs in some adults. Occurrence of Type 1 diabetes in Australia Previously, the type 1 diabetes was referred to as juvenile onset diabetes mellitus. This is because its occurrence was very common in children and young adults (Australian Institute of Health and Welfare, 2006, p 3). Type 1 diabetes accounts for abut 10 to 15 percent of all cases of diabetes in Australia. From the data found in Australian National Diabetes Register, about 15,000 new cases of diabetes type 1 were reported in Australia. However, majority of these cases were among people aged above fifteen years. These cases were lower compared to those reported among children below the age of fourteen years. This was the trend between the year 2000 and 2006. The average number of cases per day was three or more cases per day. This rate however decreased with age indicating that the rate was high among those close to fifteen years. Among those living with diabetes type 1 in Australia, fifty percent of them developed the condition when they were above fifteen years and most of them do not have family history of disease (Hofmann & Greydanus, 2007 p.46). Action of insulin in Diabetes type 1 According to Burns (2009, p 273)Once the destruction of beta cells has started, this goes on insidiously until the number of beta cells that are left cannot sufficiently regulate the level of glucose in the blood. This then results to excess blood glucose levels or hyperglycemia. This therefore prompts an individual to use alternative sources of insulin. The alternative insulin therefore takes the role of the insulin that would have been produced by the beta cells. Proper use of insulin has proved to be effective in preventing the long term complications of diabetes in children and adolescents. However, the dosage of insulin depends on the lifestyle of the individual. This includes the level of activity, status of the body weight, diet and the health status. Most people keep changing their doses of insulin but it is important for them to contact their doctors before doing so. However this is not the case with Lauren who changes her dosage when she wants to attend a party without consulting her nurse. It is very important to maintain the recommended levels of dosage of insulin since excess or too little can result into serious problems. Hypoglycemia is a condition of low glucose levels in the body that results due to excess insulin (McAuley, Deary, & Freier 2001). This is the cause of hospitalization for Lauren who takes excess insulin while attending parties so that she can take alcohol and junk food. Eating out can be a challenging factor for someone trying to maintain her body glucose levels. This is due to difference in food ingredient used, portion sizes and energy content of the foods. Incidents of low or high blood sugars can therefore occur in individuals who take foods that are different from their usual home prepared. This is also happening with Lauren since the food prepared in the party is different from hey home prepared and mostly contains the junk food. Developmental issues involved in the case Diabetes type 1 among adolescents subjects them to various life problems some of which may hinder them from attaining proper management of the condition. Research done by Cryer, Davis, & Shamoon, (2003 p.56) frequent incidents of hypoglycemia may have cognitive consequences such as coma and seizure. Repeated incidents of hypoglycemia may result to problems in the ability of the infected person to perform well in school or in future jobs. However, not much difference was observed between the performance of adolescents suffering from diabetes type 1 and their peers who did not suffer from it. Adolescents with type 1 diabetes may also suffer certain psychological problems. Most of them may have problems relating with their family members. This is because they often experience mood swings and they may become emotional. However, they may be not aware of the status of their moods or how they may impact others around them. Feelings of guilt, anxiety and anger highly affect them and they can become very emotional. This may affect their mental status and the levels of their hormones. Anxiety is high for diabetics because they are uncertain about their future and they may lack ability to control their disease (Brannon & Feist, 2004 p.141). They may also feel stressed by their condition since it is an ongoing disease. Stress may have strong psychological reactions that may lead to production of certain hormones. These hormones may hinder proper faction of insulin and interfere with normal metabolic processes of insulin. For example Lauren may be unable to contain the stress of watching her peers take alcohol and junk foods during the party. Baum, Reverson, & Singer, (2001 p.21) explains that the most common social problem experienced by adolescents with diabetes type 1 is the fear of being ridiculed by their peers. Some adolescents may be unable to explain to their peers what they are going through and to avoid being ridiculed; they just follow what their peers want. Where peers are not be willing to understand, the affected adolescents may suffer from lack social company, they may feel depressed and socially isolated. This may in turn weaken her desires for proper management of her condition (Peterson 2004, p 35). Another social problem is making a decision between normalcy and their self care. This mostly happens among adolescents who drink alcohol since temptation to drink increases when they attend parties with their friends. Doing things that others are not doing in social gatherings may be difficult and makes most adolescents under look their self care. This is the case with Lauren who cannot resist to drink alcohol in a party where everyone else if drinking. Lack of emotional control is also associated with adolescents who suffer diabetes type 1. This is due to feelings of stigmatization that is caused by the long life illness. They become anxious and may experience mood swings. Sadness is also common where one has to lead a life that is not similar to other people. Insulin use among female adolescents with diabetes type 1 has been found to cause physical changes. Research done by Australian Institute of Health and Welfare, (2009 p.30) found out that the dosage of insulin used and the frequency of the insulin injection may hinder growth during adolescence and may result in accumulation of fat in girls which results in weight gain. This may be due to high levels of growth hormones and low levels of growth factors such as insulin, factors which are observed in diabetes type 1.Due to susceptibility of adolescents to the above cognitive, psychological, social, emotional and physical implications, this makes it hard for them to follow the required treatment measures. They are therefore often faced with complications associated with poor observance of treatment directions. Diabetes type 1 during adolescence in Australia Diabetes in Australian adolescents has been noted to change its onset trend. Initially, onset was identified to be common between 12 and fourteen years. However, recent research has found out that the trend has changed with many of them being attacked at between 15 and 20 years. This rate of incidents has also been found to be higher for girls as compared to boys. Incidents of diabetes type 1 among adolescents in Australia have also been found to increase by 2.7 percent per year (Institute of Endocrinology and Diabetes, 2008, pp 2). None of the researches done on Australia has identified the real cause and cure of diabetes type 1. However, a recent research done in the Royal Melbourne Hospital has identified a vaccine that can be given to help delay the onset of the disease. The vaccine is still under since it has been discovered that giving insulin solution through the intra nasal delivery can alter the immune system and such that it cannot be attacked. Before the vaccine is given, blood test is done to check whether one is at risk of diabetes attack. Those found at risk are given the vaccine continuously for a consecutive period of seven days and than once per week for a whole year (Diabetes Australia 2009, pp3). Another factor that may increase the incidents may be enteroviruses which may lead to early onset of diabetes. The incidents are on increase due to reduced maternal immunity to enteroviruses. Research has also indicated that the population with highest incidents of diabetes type 1 among those below 20 years is also characterized by overweight and obesity during childhood. This may be the cause of early onset of diabetes type 1. Obesity also increases the resistance of the cells to insulin which consequently results in destruction and fatigue of the beta cells. The end results are early onset of diabetes type 1 among children, a condition that goes on to adolescence. Trying to relate the rising incidents in New South Wales with the international data, there is a certain factor that is putting the population at risk. Some of the environmental factors identified during prospective studies in Australia include cow’s milk protein and virus which causes autoimmunity of the beta cells. Problems associated with management of diabetes among adolescents in Australia Literature related to the issues in the case study Once an adolescent has been diagnosed with diabetes type 1, the life changes and issues such as daily injection with insulin sets on. The blood levels of glucose must be monitored continuously, and several times a day. The adolescent is required to change his or her meals and also the type of activities she engages in. this affects the life of the adolescent as well as her parents and peers. High quality care is very essential in the management of diabetes type 1. Glycemic control is the measure of how well the blood sugar is regulated (Rewers 2009, p 71). Better glycemic control is essential for prevention of chronic complications of the disease. The quality of care that is given to diabetic adolescents is assessed by the extent to which it prevents occurrence of any complication whether acute or chronic, and also on how it reduces incidences of hypoglycemia and hyperglycemia. However, obtaining quality care among the adolescents is a difficult task. Most adolescents do not achieve quality care and therefore needs to be supported by their family and peers. Diabetic adolescents may not be able to control their blood sugars since they often suffer from depression as compared to their non diabetic peers. Research has reported that depression contributes to poor glycemic control. Adolescents also fail to control their blood sugar due to per influence. This is seen in Laura who takes excess levels of insulin before going to parties so that she can enjoy junk foods and alcohol. Management of Type I diabetes among adolescents According to La Greca & Bearman (2001), it is important for the adolescents to develop behaviors that allow disease management so that this may go on even into their adulthood. Peers also play a big role in influencing the ability of their friends to succeed in managing their diabetes status. However their influence may be both positive and negative. Research done by Lyons & Chamberlain, (2006 p.97), found out that when the adolescents are posed with a situation where they have to choose between adhering to their treatment regime and following the desires of their peers, most of them choose actions that are consistent with their peers and not adherence to diabetes treatment regime. Support from the teachers and the parents may therefore be very necessary and adequate guidance. The research also found out that it is important for the diabetic adolescents to identify among her peers those who are ready to offer during the observance of diet and exercise as this might have positive influence on diabetes management. In the case of Lauren, she is suffering from hypoglycemia due to intake of alcohol and fast food in parties. This may be due to peer influence where she feels that she must take alcohol together with her peers but at the same time she fears for her condition and that why she is playing with her doses of insulin. She should find friends who may not encourage her to take alcohol and give her company in the same. Hypoglycemia mostly happens in adolescents taking alcohol due to ethanol released from it. She therefore lands in hospital every time she attends a party. Her peers are therefore having a negative influence on her ability to manage the diabetes. Research findings of challenges faced by diabetic adolescents A research done by Halvorson, Yasuda, Carpenter, & Kaiserman, (2005, pp 5-7) identified several factors poses challenge to the adolescents in their efforts to manage their diabetic condition. The association did several researches where one of them was done on a 16 year boy who was not able to control his blood sugar. Some of the factors that they identified as challenges include their stage of growth. There are many changes in the body that takes place during puberty and they may affect action of insulin in the body. Some of them increase insulin resistance in the body. This therefore challenges the assessment of insulin function in the body. Insulin response was found to be lower by 30 percent in adolescents than in non adolescents. Another factor was the psychological characteristics such as eating disorders, depression and anxiety. The research found out that such psychological factors affect glycemic control in adolescents. Adolescents suffer more often from depression especially when things are not working as they wish. Anxiety also frequently affects them and this hinders their efforts in controlling their sugar levels. When in depression, most of them fail to observe proper eating. Another factor that was identified is their care when outside home. When away from home, adolescents attend parties, and involve in eating habits similar to those of their non diabetic peers. They therefore manipulate their insulin doses to allow them to enjoy together with their peers. They therefore don’t take responsibility over their own condition. From these studies, one can identify the problems faced by Lauren in management of her type 1 diabetes. One of the problems she is facing as explained in the literature is desire to be with her friends. This is reasons as to why she must attend parties and also must drink alcohol with her friends. However much her parents may be putting efforts in helping her manage the condition, she ends up in hospital with hypoglycemia. Adherence to treatment has been the main problem faced by adolescents. Lauren is also unable to adhere to her treatment and she manipulates her insulin doses to fir her desires of taking alcohol and junk foods. This leads he to the many complications associated with poor adherence to treatment. However, there are several limitations in the studies done regarding diabetes in adolescents. The results cannot be obviously generalized since the ability to manage diabetes type 1 treatment regime varies with the activity of the individuals and the support given by the parents. Some adolescents may not be able to follow the treatment regime due to the nature of work they do. Another limitation of the study is that it did not enquire about the level of parents’ involvement in helping their adolescent children to observe the management plan. These are the three most important factors in helping the adolescents cope with their condition. Possible Complications of diabetes type 1 identified in the case study Some of the common complications of diabetes type 1 that are experienced by adolescents are hypoglycemia and weight gain. According to Cryer, Davis, & Shamoon, (2003 p.67) hypoglycemia comes with mild symptoms of hunger, sweating and irritability, to severe complications such as seizures and coma. Lauren experiences hypoglycemia due to improper use of insulin doses and intake of alcohol and junk foods. When she wants to attend a party, she plays with her doses of insulin and this often lands her in hospital due to hypoglycemia. To enable her overcome this complications, her friends and peers must be involved. This is because they will give her the support necessary in withstanding her desires for alcohol and junk foods. Efforts by her friends may include holding parties where there is no alcohol intake and also avoiding junk foods. It is due to this intake of junk foods that Lauren will develop complications of obesity and overweight. Overweight may result due to the habit of eating large amounts of food in efforts to compensate for excess insulin and avoiding hypoglycemia. Lauren takes high doses of insulin before going to a party so that she takes large amounts of junk foods and alcohol. If she continues with this trend, it is likely that she will develop overweight. The onset of these complications of diabetes may only be prevented by following the proper treatment and the recommended type of lifestyle. Responsible adolescent behaviour is the most important remedy for Lauren that includes ability to resist the desires of her friends and her own self which are against the recommendations of diabetes management regime. Helping adolescents to deal with diabetes type 1 The two most important aspects that can assist adolescents to deal with challenges of managing diabetes type 1 include empowerment and education. Empowerment helps one to discover and develop his or her capacity in taking up responsibility over one’s own health. Empowerment works on individuals who have knowledge and self awareness that is required in managing their conditions. In the case of Laura, she has the knowledge, skills and is aware of her ability regarding her condition. This is why she knows how she can play with her doses of insulin before going to parties. Empowerment therefore can help her to reason critically and act responsibly using the knowledge and skills available. Education involves teaching the patient things that may help her prevent complications. This may also be done to the family members since they may also get involved in the management. The patient is provided with information that can help her to understand her condition well including possible complications of malpractices in the management. The parents are also educated on what they can do to assist the adolescents in managing their conditions. Conclusion Diabetes type 1 is a life time condition which may never be cured. This condition therefore relies on proper management which is characterized by proper dosage of insulin, proper diet and physical activity. However, these factors may be challenging to observe especially among the adolescents. This is difficult because adolescents suffer from cognitive, social, emotional and psychological implications that may hinder them from properly observing their treatment regimes. Dietary observations are the most challenging since adolescents mainly like eating away from home with their peers. They may also suffer emotionally due to the imagination of their life time condition that makes them lead a lifestyle that is different from their peers. They therefore suffer from peer influence that may affect their ability to follow the treatment regime. However, with support from their families, their peers and friends, they can be able to follow the management requirements and overcome the complications associated with the disease condition. Bibliography Halvorson, M., Yasuda, P., Carpenter, S., & Kaiserman, K., 2005, Unique challenges for Pediatric Patients with Diabetes , retrieved on 7th October, 2010, from . Cryer P, Davis, S., & Shamoon, H., 2003, Hypoglycemia in diabetes. Diabetes Care.26: 1902-1912. Peterson, C 2004, Looking forward through the lifespan: development psychology, 4th edn, Prentice Hall, Frenchs Forest, NSW. 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