Standards of Medical Care in Diabetes - Research Paper Example

Teaching Plan For Type Diabetes 1. Patient goals/ outcomes Ellen B has just been diagnosed with diabetes mellitus type 1. Her symptoms just before admission into hospital are typical of this kind of diabetes. Ketoacidosis often occurs at the beginning of the condition. The patient should expect a symptom-free period in which most symptoms will remit even without the use of insulin. However recurrence of the disease may occur after an indefinite period; some patients can enjoy weeks, months or even a year of remission. Regardless, the disease will recur and necessitate insulin therapy. -At the end of the teaching plan the patient should be able to verbalize understanding. Of Diabetes Type 1: -The patient and her family will be able to perform blood sugars accurately. -The patient and her family will be able to identify normal glucose levels correctly. -The patient will verbalize understanding of Diabetes complications. -The patient and family will voice understanding of the need to do routine doctors exams. -The patient and family will learn how to perform foot exams. The goal of this treatment plan is to manage the disease. One long term goal of therapy is minimization of death or mortality. Death often occurs when a heart-related complication arises. Strokes and heart disease ought to be kept at bay. Another long-term goal of this treatment plan is to decrease complications at the macro and micro vascular levels. Peripheral vascular disease, stroke and heart disease are macro vascular while retinopathy, nephropathy and neuropathy are micro vascular complications. Short term goals for treatment include control and monitoring of blood glucose by the patient. Ellen should strive to have at least 50% of her glucose levels within the target range. Tight glycemic control is necessary in order to minimize the onset of micro vascular complications. Glycohemoglobin ought to be monitored within the patient. Sometimes, the oxygen transporter in the blood may combine with glucose inside the blood to lead to the latter condition. This reaction is relatively common in all humans; however, extreme cases may be detrimental to a diabetic patient’s well-being. The aim of therapy is to keep these quantities below 7%. If the patient consumes food with high carbohydrates, then it is likely that her glycohemoglobin will be high. The component of blood that carries oxygen will continue to combine with glucose if blood sugar levels are persistently elevated. A test designed to measure this element can assist Ellen in determining how well she is controlling her diabetes. Therefore, the patient ought to carry out this test after three months. Frequency of testing can be reduced once the patient has mastered glucose levels for over a year (Melmed et. al., 2011). Another short term goal of therapy is to minimize incidences of hypoglycemia. Usually, hypoglycemia results when blood glucose levels are less than 60mg/dl for those without symptoms and less than 70mg/dl for those with symptoms of hypoglycemia (American Diabetes Association, 2013). Hypoglycemia arises when the patient records abnormally low instances of blood glucose. It may occur in diabetes when excess insulin is in the body thus stimulating the liver and cells to take too much glucose from the body. Ellen has been admitted with ketoacidosis, which is a condition in which the body’s inability to stimulate intake of glucose from the blood causes it to rely on fat as a source. This often arises from the lack of insulin or minimal production of the hormone by the pancreas. The process of breaking down fat leads to availability of ketones as waste products. Excessive levels of those ketones are poisonous to the body. In order to minimize this situation, Ellen’s urine should be monitored closely for ketones. The test should be negative for ketones. Finally, another short term goal of therapy is to ensure that the patient stays within the normal range for blood constituents. This should minimize the onset of comorbidities like dyslipidemia and hypertension. The following goals should be maintained for blood pressure, lipids, cholesterol, triglycerides HDL (High density lipoprotein) and LDL (low density lipoprotein). Unit Limit HDL Greater than 40mg/dL LDL Less than 100mg/L Blood pressure Less than 130/80mmHG Total cholesterol Less than 200mg/dL (American Diabetes Association, 2013) 2. Nutritional needs Consistent meal plans will be prepared for the patient. Ellen must follow them consistently and aggressively. All meals ought to be balanced by containing enough fruit, grain, vegetables, lean meats, and low fat dairies. The dietician will calculate the quantity of carbohydrates needed for the patient at each meal and this should be used to control blood sugar level. Low fat foods are quite helpful and so is the need to minimize saturated fat. Drinking plenty of water and eating foods that are high in fiber is critical. Salt should be taken in moderation. Alongside nutritional requirements is the need to take care of one’s feet. As soon as the patient looses feeling in the legs, they should wear clean socks, examine her feet for injuries, wash them regularly and properly, and protect her feet from the general environment. These steps are necessary because the patient lacks regular physiological methods to protect the feet. Exercise is also helpful in control blood glucose level so it needs to be done after consultation with the healthcare provider. 3. Medication needs The patient is currently taking three forms of medication: Lantus, Lisinopril and Humalog. Humalog is a form of rapid-acting insulin that affects the body almost immediately. It should therefore be consumed ten minutes before or after each meal. Lantus, on the other hand is a type of long-acting insulin that ought to be taken on a daily basis (Cipolle, 2004). However, because Lantus may sometimes have adverse reactions with other insulins, the patient should ensure that only one form of insulin is injected into the body at a time (American Diabetes Association, 2013). When taking Humalog, the patient should be careful not to use more than has been prescribed. This drug should be clear when placed into the injecting device. Different part of the skin area should be selected every time the patient administers the drug. Injecting into the same location two times in a row can cause complications. In the event that a patient misses a dose, no extra Humalog ought to be taken as this upsets glucose balance in the blood. Once the patient injects Lantus into the body, it may take approximately one and a half hours to work. Its effect in the body lasts for approxiamtely one day, so this explains why it needs to be replaced when the time period expires. The patient’s consumption quantities depend on a number of factors that have all been taken into consideration when establishing the dose (12 units). Only under-the-skin injections should be used; Lantus should not to be introduced into the veins directly. Since food intake may alter glucose levels, it is essential to use another type of insulin other than Lantus to control those quantities. For that reason, Humalog will supplement Lantus’ action (Cipolle, 2004). Diabetes makes individuals predisposed to a number of illnesses such as renal failure. Other complications like high blood pressure may also manifest. Usually, a patient whose diabetes has just begun may not experience any problems with the renal function. However, after a relatively long period of time, protein will seep into urine. With time, this compromises the kidney’s ability to carry out its normal function. After 15-20 years, the kidney may no longer be able to eliminate waste from the body (Melmed et. al., 2011). This leads to increases in blood pressure, as well. Therefore a drug that prevents these conditions should be consumed. Lisonopril prevents occurrence of the same and ought not to exceed 5 mg. A number of safety measures need to be adhered to when injecting insulin. First, family members or the patient ought to check on the vial to ensure that it is the right one. An analysis of the color and expiration date needs to occur at this point. Once clarification has been done, the patient should choose an injection site. Preferred areas include the lateral thigh, buttocks, abdomen and upper arm (American Diabetes Association, 2013). For abdomen injections, the patient should not get 2 inches close to the navel. Ellen should ensure she has clean hands when administering all the drugs. Lightly flicking the insulin syringe is necessary to remove air bubbles. The injection should then enter the body at a 90-degree angle after lightly pinching the skin. All devices should be disposed off carefully. Self monitoring of blood glucose is critical to the proper functioning of these two types of insulin. This should be done by family members of the patient or by the patient herself. The test is done at home and consists of a glucose monitor. The test works by assessing only a small drop of blood from the body. Normally, this may come from the finger. Once the test is completed, information should be recorded for clinical use (Cipolle, 2004. Self monitoring for the drug should occur at least four times a day. Critical times include before meals, bedtime, after meals and when not eating. Since demand for glucose can alter after heightened metabolic activity, such as exercise, the patient should test after working out. When implementing changes to Ellen’s dose, all alterations ought to be done by the doctor. 4. Short-term complications Hyperglycemia is a perpetual problem that must be curtailed by the patient. It occurs when too much glucose is prevalent in the body (approximately 180mg per dl or more) (American Diabetes Association, 2013). The hormone insulin assists in alteration of blood sugar to energy. Absence or shortage of the substance means that too many simple sugars will be available in the blood but the body will not be able to use them. Human beings require energy to perform daily tasks like body movement or internal organ actions like transmission of brain messages. If a malfunction exists in production of energy, then a patient will keep consuming food but will not be able to tap into its usefulness. For the above reason, a person with hyperglycemia exhibits symptoms that indicate a lack of energy in the body. The patient may feel fatigued easily and may have difficulties in concentration because the brain function may be temporarily harmed. Furthermore, because too many glucose molecules are available in the blood, then the fluid’s viscosity is likely to increase. This may manifest as headaches and increased urges to consume water. Since several body functions occur when little energy is available, then organ problems may manifests. The skin, blood vessels, kidneys, stomach and reproductive organs may develop infections or complications. Patients may spark off hyperglycemia trough various pathways. If Ellen does not follow her diet plan and consumes too many carbohydrates, then the insulin in her body will not be sufficient to convert all the sugars to energy. Furthermore, if a miscalculation of Humalog takes place, then chances are that the external insulin introduced into the body will not be enough to work on the foods in the system. Usually, taking an amount that is less than the prescribed dose will lead to this problem (Cipolle, 2004). The patient ought to be careful about the intensity of exercise that she engages in. If it is excessive, then more energy will be needed, yet conversion levels are limited by the quantity of insulin injected. Certain illnesses in the body may change metabolic levels and thus demand for glucose. Even too much stress can precipitate hyperglycemia by changing hormone levels in the body. This may interfere with insulin’s role in the system. Perpetual hyperglycemia needs to be avoided because this leads to ketoacidosis. When the body lacks fuel from it primary source; glucose, it then uses an alternative substance for the same. Fats are alternative sources of energy but their breakdown often occurs at the body’s peril. They chemical process leads to a release of toxic acids, which may poison the system. The condition can be detected by visual impairment. Since unwanted substances are in the body, then a patient will react to it by vomiting. Some qualities that mirror hyperglycemia may also manifest like general body weakness. Ellen may also experience appetite loss at this point (Melmed et. al., 2011). Hypoglycemia is another condition that the patient should be familiar with. It occurs when low blood sugar is prevalent in the body. Insulin overdose may lead to the problem as well as consumption of fewer calories than had been prescribed. The condition also comes from too much body activity. The patient ought to measure her glucose level in order to ascertain that it is not below the norm. Symptoms of the condition mimic those of a person who has eaten. In other words, they will feel hungry and sweat uncontrollably. The patient may also report an increase in heart rate. 5. Long-term complications Stroke and heart disease are critical complications that may arise from diabetes. Hypertension can occur a far as 7 years after diagnosis of diabetes. Medical and nutritional therapy may be used to keep the disease under control but blood pressure readings indicate if there is cause for alarm. “Retinopathy, nephropathy and neuropathy are other complications that may manifest in the future. Retinopathy is a retinal inflammatory condition that may sometimes cause blindness. “The symptoms include blurry vision and pain in the eyes” (Cipolle, 2004, p. 14). Further examination can confirm its existence. Neuropathy refers to a condition in which nerve-function in the body’s extremities is affected. It causes pricking and tingling sensations in the feet. Finally, Nephropathy can arise when kidneys are affected by diabetes. Blood pressure issues may cause the problem so annual kidney tests should occur. 6. Routine following and monitoring Blood sugar testing is the most vital routine activity that needs to be done by a diabetes patient. Ellen ought to do this at home and have records of the time, date, medication use, exercise and possibly food consumed at the time of the measurement. The healthcare provider should review this information with the patient in order to ascertain that it is accurate. 240 milligrams per deciliter is the quantity of blood glucose that should warrant a urine test. These need to be done when the preconditions for hyperglycemia have prevailed, as well (American Diabetes Association, 2013). The patient should carry a glucose meter to their health professional in order to check its accuracy. All the short-term complications of diabetes should be understood and responded to. Glucagon injections help in hypoglycemic emergencies. High-calorie foods can rectify the problem in the short term. Blood pressure control is also imperative. Evaluations of this level need to occur after two to three weeks. If high blood pressure manifests, then certain medication will be given. Cholesterol monitoring may sometimes be necessary. Medications could be given if cholesterol levels are too high and indicated through frequent laboratory tests. At the end of the teaching plan the patient should be able to identify blood sugar levels and know to call 911 if hypoglycemia occurs. Take Glucagon or another form of glucose to increase low blood sugars, if sugar levels are low. Patient should also know which symptoms she need to notify her health care provider, like numbness in peripheries, cuts, loss of vision, increased blood sugars, and any urinary concerns. References American Diabetes Association (2013). Standards of medical care in diabetes. Diabetes Care, 36(1), S11-S66. Cipolle, C. (2004). Type 1 Diabetes Mellitus. CA: Peters Institute of Pharmaceutical Care. Melmed, S., Larsen, P., Kronenberg, H. and Polonsky, K. (2011). Type 1 diabetes mellitus. Philadelphia, Pa: Elsevier Saunders. Read More