Down Syndrome and a Moderate Intellectual Disability - Essay Example

Introduction Down syndrome is a disability caused by having an additional copy of chromosome 21 in majority of body cells or all the cell lines, which causes intellectual disability (ID) (McCabe & McCabe, 2011). People with Down syndrome have developmental challenges that relate to behaviour and social life which vary from a person to another (Morris& Alberman, 2009). Following these challenges, people with Down syndrome are also prone to medical conditions such as diabetes that brings in more challenges. American Diabetes Association (ADA) (2011) says diabetes occurs when blood glucose levels raises above 7mmol/l of blood. This is because either the insulin produced by the pancreas not enough or no insulin at all to convert blood sugar for energy use. There is type 1(T1D) and type 2 diabetes (T2D). According to Schnell, Alawi, Battelino, Ceriello, Diem, Felton, Grzeszczak, Harno, Kempler, Satman & Vergès (2011),. proper management of diabetes is required to avoid the challenges in either case. This essay discusses the challenges and management of people with type 2 diabetes and the implications if the person suffers intellectual disability such as Down syndrome with reference to a case of 45year old man. Health challenges T2D is a condition that keeps on progressing to more complications if proper management is not followed. T2D is caused by inability of the pancreas to produce sufficient insulin required to aid the glucose to enter the cells for energy (ADA, 2011). People with diabetes are faced with the challenges that relate to increased risk of stroke heart attack and kidney damage (>). Therefore, continuous management is required to avoid hypoglycaemia and hyperglycaemia which pose great danger to the clients. According to ADA (2011) people with ID tend to have behavioural challenges and may find it difficult to monitor the blood sugar, lead a healthy lifestyle and adhere to medical requirements on their own. This predisposes them to more challenges mainly due to poor management of diabetes. ADA (2011) stated that, there is no unique symptom of diabetes in people with ID, the challenges mainly relate to its management. The treatment of diabetes is aimed at keeping the blood glucose at the recommended levels Schnell et al., (2011) explains. If the blood glucose is high, the risk of developing the long term complications such as heart and kidney failures increases. The treatment of diabetes requires regular monitoring and adjustments in order to take corrective measures in case of rise or fall outside the blood sugar targets. The people with diabetes need empowerment in order to manage. In many cases these people are in-groups where they are educated on healthy lifestyles and are normally under diet and exercise regimes. Down syndrome is a disability caused by having an additional copy of chromosome 21 in majority of body cells or all the cell lines, which causes intellectual disability (McCabe & McCabe, 2011). Bearing in mind the healthy lifestyle that is required for the people with diabetes; it becomes worrying if the person has an intellectual disorder. For instance, the people with the Down syndrome may find it difficult to comply with the diet and exercise regimes. There is also the risk of the clinician to misdiagnose some risky symptoms due to the underlying cognitive deficiency. This becomes another challenge as the patent will not get the right treatment and sometimes pertinent needs may be assumed due to confusion of the challenges of intellectual disability. Therefore, health officials dealing with patients with intellectual disabilities should not assume any symptom. Activity and Participation (ICF Model) Activity and participation are crucial in the management of T2D and they become more paramount when the person with diabetes has also an intellectual disability. The ICF Model is designed to ensure holistic considerations of life when taking care of people with ID (Stucki, Ewert, & Cieza, 2002). Activity and participation is one of the components of the ICF Model. Morris and Alberman (2009) found that people with ID have challenges of learning and applying the acquired knowledge, social interaction, self care and general tasks and demands are limited. This is due to the mental developmental limitations unlike in the people without the intellectual disabilities. The man with ID has an increased probably of being socially withdrawn since he has lived in a community group home. This means that the man is heavily assisted in a number of physical works, social or domestic activities. This highlights the extent in which the man is disabled by his chronic illness and impairment. Hence, he may live a sedentary life at home which can increase the chance of obese which future increases the risk of other chronic illnesses (McCabe & McCabe, 2011). The man with ID may have limitations in language, cognition and communication skills. He thus, has increased vulnerability of deficits in social relatedness, fatigue and mood related problems (Friedlander & Kingston, 2009). Coupled with diabetic problems, he may tend to shun away from people (back up). This self isolative behaviour makes it difficult to participate in social activities in the general public. Generalised anxiety and obsessive compulsive behaviour are common in people with intellectual disorders. These make the persons’ to have diminished interest in most of activities and participation (Friedlander & Kingston, 2009). Their coping skills are also reduced thus reduced their ability to freely interact with the community members and tendency to avoid the community groups such as the organised diabetes community meetings. This man with ID may depend on the caregivers for everything due to the social, mental and behavioural limitations (Morris & Alberman, 2009). For instance, in learning the health requirements, the man may not easily understand the knowledge and practical skills being taught and as a result he may not adapt the healthy lifestyle. The overdependence on other people means that he requires more level of assistance to achieve full participations in daily activity. Friedlander and Kingston (2009) noted that the people with intellectual disabilities have low self esteem and regression, they are likely to suffer from anxiety disorders and other mental problems which limits their self care and compliance to diabetes management skills. Diet and physical exercise intervention Physical exercise and diet are important in managing type 2 diabetes. T2D is prevalent in people aged forty years and above. Gerstein, Miller and Byington (2011) noted that the T2D could be managed through behavioural change and is greatly influenced by the diet and lack of physical activity, which may result to increase in body weight and subsequently obesity. The community nurse should initiate an intervention strategy of diet and increased physical exercise for the client. Among people that are overweight and diabetic, weight loss through healthy diet and increased physical exercise has been shown to improve insulin resistance (Gerstein, Miller &Byington, 2008). The intervention will thus include programs aimed at lifestyle change from a more sedentary lifestyle to active participation. The health education on diet will include proper nutrition based on the man’s physical needs and restricting excessive consumption of fats and carbohydrate diets. However, the diet should provide daily nutrition recommendation to sustain daily metabolic and physical activities to avoid the energy imbalance that may result due to excessive energy and fat restriction (Schnell et al, 2011). The intervention will also educate the man on importance of daily physical exercise. According to (Schnell et al, 2011) intensive lifestyle programs that are based on participant education, counselling reduction in dietary energy and fat combined with regular physical exercise can result to 5-7% reduction in starting weight. Schnell et al (2011) noted that healthy diet and regular exercise should be encouraged because they improve the body’s insulin sensitivity and are important in long term management of weight. For the client to actively engage and adhere to the program, nurses should educate him on the importance of healthy diet and exercise and group him with members who can reach and encourage him daily (Medical Advisory Secretariat (MAS), 2009). The community nurse should also be visiting him daily for follow up to find out the progress and compliance to health education, Embse, Brown and Fortain (2011) found that follow ups regularises activities in people and makes it habitual for the person with intellectual disorder, i.e. he adopts the lifestyle. Conclusion There are many health challenges brought about by diabetes type 2, which mainly affects people aged 40 years and above. The diabetes type 2 is one of the chronic diseases that need good management in order to avoid the healthy challenges posed by them. The management of the type 2 diabetes requires identification of the right intervention which suites individuals needs. One of the interventions that have been proved to be effective in the management of diabetes is the diet and increased physical exercise. The exercise and diet are normally influenced by an individual’s attitude, and sometimes the decision of the families. People with disabilities may not be in a position to follow the diet and physical exercises due to the extra challenges that are brought up by the disability. For the people with Down syndrome, they have behavioural, social, learning and interaction challenges. This makes it difficult for them to mange the diabetes, the reason being that the disabilities limit their ability to fully engage in the intervention. Therefore, in planning the intervention for the man, the special needs need to be taken into consideration and used in the implementation of the intervention in order to reduce the challenges of diabetes. References American Diabetes Association. (2011). Standards of medical care in diabetes. Diabetes Care, 34(1), pp.11–61. Embse, N. Brown, A., and Fortain, J. (2011). Reducing problem behaviors for students with intellectual disorders. Intervention in School and Clinic, 47(1), pp. 22-30. Friedlander, R and Kingston, J. (2009). Down syndrome: when to worry about mental health and what to do about it- a guide to parents and care givers. International Journal of Down Syndrome, 4 (2), pp.461-479. Gerstein, H. C, Miller, M. E and Byington, R.P. (2008). Effects of diet and exercise in glucose lowering in type 2 diabetes. International Journal of Diabetes Management 358(24), pp.2545-59. McCabe, L. L, and McCabe, E. B. (2011). 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