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Case
Summary
1.
Insulin-Dependent Diabetes Mellitus (IDDM), also categorized as
Type I diabetes, is an autoimmune disease of children in which
the body's immune system attacks the insulin producing beta cells
on the pancreas. It is theorized that this immune response
may be triggered during a viral infection in those with a genetic
predisposition to the disease.
2. The symptoms of
undiagnosed diabetes include excessive hunger and thirst, weight
loss, frequent urination, and fatigue.
3.
The diagnoses of diabetes in this case was made by the
endocrinologist based upon elevated levels of glucose in the
blood and urine. Ali was not seen until her disease had
progressed to diabetic ketoacidosis. DKA was diagnosed based on
the arterial blood gas results showing a pH of less than 7.3,
large amounts of ketones in the urine, elevated potassium, and
physical symptoms such as rapid heart rate and rapid breathing.
4.
The goal of treatment of Type I diabetes is to regulate the
patient's blood glucose so that it does not rise too high
(hyperglycemia) or drop too low (hypoglycemia). This is
done by insulin injections, a controlled diet, and exercise.
Insulin
pumps
function much more like a normal pancreas and are being used
increasingly more. Because of the complexity of operating
insulin pumps, they are generally not recommended until the
teenage years.
5.
There is no cure for Type I Diabetes Mellitus, except for a
pancreas transplant. Because of the highly volatile nature
of the pancreas, a transplant is generally done as a last
resort. Studies have now proven that diabetics who
remain in tight control may prevent or slow the start of diabetic
complications.
6.
There is no known prevention of Type I diabetes. Animal
research and small studies in people have indicated that type 1
diabetes can be delayed in those at high risk for the disease by
regular, small doses of insulin.
This is currently
under study.
7.
Healthcare workers depend on each other in treating a diabetic
patient. Laboratory personnel report critical laboratory values
including blood chemistry, CBC, and urinalysis results. The
respiratory therapist monitors arterial blood gasses in the
diabetic patient in DKA. Diabetic educator nurses have a
responsibility to not only show the patient how to give
injections, but to educate the diabetic about all aspects of
their disease. It should be noted that in many cases staff
nurses may work to educate patients about diabetes. The diabetics
overall control relies heavily on their diet. The dietician
plays a key role in developing a meal plan and educating the
patient about the importance of diet. Social changes and
adjustments by the patient and family are facilitated by the
medical social worker. The endocrinologist has the ultimate
responsibility for the diabetics health. He prescribes
insulin based on the patient's diet and lifestyle. He must
be ready to make key decisions for the day to day health of the
diabetic as well as for life threatening complications.
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