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Question1. Pathophysiology of clinical manifestations of Type 1 diabetes

  1. High blood glucose level

The primary cause of diabetes type I is lack of insulin production to counter elevation of glucose levels (Craft et al., 2015). It is majorly caused by autoimmune autoantibodies against beta cells of the islets of Langerhans including insulin and against beta cell enzyme glutamic acid decarboxylase leads to lack of insulin secretion. Insulin normally converts excess glucose into glycogen for storage in muscles, adipose and hepatocytes. In insulin deficiency, dietary glucose would not be converted into storage form (glycogen) and would therefore circulate in blood resulting into hyperglycaemia.

  1. Glucose in the urine

Decreased glucose absorption and storage in form of glycogen by insulin leads to elevated blood glucose levels (Craft et al, 2015. The systemic blood flow is therefore hyperglycaemic. The renal arteries that serve the kidneys therefore supply blood with increased glucose concentration. The resultant impacts overwhelm the functional threshold for renal reabsorption by the counter current system between the blood and the proximal convoluted tubules (Craig et al, 2014). This would therefore lead to diminished glucose reabsorption leading to loss of glucose through urine, glycosuria.

  1. Increased urination

Elevated blood glucose leads to supply of kidneys with hyperglycaemic blood. This exceeds the kidneys’ reabsorption of glucose through selective reabsorption. This would then lead to glycosuria as explained above (Craft, et. al, 2015. The presence of glucose in urine, glycosuria, exerts an osmotic pressure, osmotic diuresis which then leads to increased withdrawal of water from the blood into the renal tubules which then results into increased urgency to urinate. This leads to polyuria (Craig et al., 2014). This causes immense loos of water and electrolytes.

  1. Increased thirst

The hyperglycaemic blood supply to the kidneys leads to elevated kidney tubules glucose content. Water would then be drawn into the kidney tubules through osmotic diuresis. The continued loss of water due to the osmotic diuresis exerted by increased urine glucose levels results into hyperosmolarity (Craft et. Al., 2015. The elevated osmolality is also due to elevated blood glucose levels as a result of poor glucose absorption and lack of storage of the absorbed glucose. The elevated osmolality leads to diminished intracellular water levels as intracellular water is utilized as a response to reduce the hyperosmolarity (Craig et al., 2014). This then triggers the osmoreceptors the thirst centres of the brain. This then leads to intense thirst that would be resolved by increased water intake, polydipsia.

  1. Increased appetite

With lack of insulin, the parameters shift from the insulin-induced anabolism to catabolism of both fats and protein (Craig et al., 2014). What then follows is enzymatic breakdown of proteins, proteolysis and subsequently lead to removal of gluconeogenic amino acids by the liver and used up as glucose building blocks (University of Western Sydney, 2016).

As breakdown of proteins and fats continues, a negative energy balance ensues. The negative energy balance in turn stimulate increased appetite, polyphagia. This completes the pathological triad of the triad of diabetes, polyuria, polydipsia, and polyphagia.

  1. Ketones in the urine and blood

The alterations from the normal dietary intake, physical activities, infections as well as stress predisposes a type I diabetic patient to diabetic ketoacidosis.

Insulin deficiency results into stimulation of lipoprotein lipase. Lipoprotein lipase would then lead to increased and excessive breakdown of adipose stores (University of Western Sydney, 2016). This is so to serve as an alternative source of energy production with the diminished carbohydrate breakdown to serve as the major source of ATP (University of Western Sydney, 2016). Breakdown of adipose tissues leads to production of free fatty acids, the simplest forms of fats. When oxidised by the liver, the free fatty acids produce ketones. Ketogenesis is strategy that serves to alleviate starvation to meet the energy demands of essential organs such as brain and blood.

  1. Weight loss

Lack of insulin shifts the normal process from insulin-induced anabolism to catabolism of proteins and fats as a counter regulatory process to restore the lack of energy. The adaptive mechanism to restore the glucose levels in form of increased food intake, polyphagia, cannot meet the excessive catabolism of proteins and fats (University of Western Sydney, 2016). This would then leads to an energy depleted state in which catabolism supersedes polyphagia. The resultant effect is muscle weakness, energy loss and weight loss (Marieb & Hoehn, 2016). This is therefore the principal diagnostic criteria for diabetes.

Question 2: Nursingconsiderations relatedto the administrationof NovoRapid

Prior to administration

Prior to administration, the nurse should be cautious about any malabsorption syndromes Bianca might be having, in this case, celiac disease. This would necessitate decreased insulin therapy.

Before administration, the nurse should determine whether the patient has symptoms such as diarrhoea, nausea, vomiting, (LeMone et al, 2013). Others that the nurse should consider are hepatic impairment. These symptoms necessitate decreased insulin requirement. The nurse should therefore have a plan to mange the symptoms such diarrhoea with antidiarrheal drugs such as loperamide (Bullock & Manias, 2014).

If Bianca has conditions such as fever, graves disease, traumatic conditions, infectious manifestations, surgery among others, the nurse would consider increased insulin therapy. In Bianca, there is a higher possibility of hyperthyroidism such as Graves’ diseases as autoimmune conditions usually occur together.

During administration

The FlexPen must never be shared between Bianca and other patients. This is to prevent cross contamination through blood borne diseases. The dosage should be 1mm units/Ml for injectable. Prefilled syringe is 100 units/ Ml (3mL NovoLog FlexPen or Flex Touch). This would prevent overload and under dosage to Bianca. The nurse would administer 200units/mg/day and avail a maintenance dose of 500units/mg/day to ensure that Bianca is constantly on an appropriate dosage.

The nurse, while considering that aspart is a rapidly acting pro-insulin drug that would rapidly deplete the elevated glucose levels, would have a plan of basal insulin and more total insulin to counter the possibility or pre-prandial hyperglycaemia that might occur in Bianca (LeMone et al, 2013).

After administration

Watch out for adverse effects such as allergic reactions throughout Bianca’s body to prevent late stage diagnosis of these conditions. The nurse should also watch for hypoglycaemia, hypokalaemia. Hypokalaemia would be controlled by periodic controlled potassium (Bullock & Manias, 2014). Weight gain is an effect that has occurred due to anabolic effects and reduced glycosuria with other patients and should therefore be monitored in Bianca.

At injection sites, they would be a possibility of lipodystrophy, irritation and allergic reaction on Bianca. Skin diseases might also occur. The nurse should therefore adopt a strategy that would minimize the impacts of these side effects most probably be appropriate measures that would limit the impacts (Burke, 2013).

The level of glucose in Bianca’s blood and urine are determined periodically to prevent excessive loss and elevated levels. In so doing, the nurse should be cautious of any major illness, patterns postprandial and co-administered drugs.

Hypoglycaemia that would occur in Bianca would require the nurse to closely monitor its effects. This is so to avoid lack of glucose for the normal functioning of the brain. Hypoglycaemia would lead to hypotensive effects including headache, drowsiness, blurred vision, tachycardia, profuse sweating (Bullock & Manias, 2014). Other effects of hypoglycaemia are convulsions and tremors.

Additionally, diabetes requires a particular type of selective dietary intake for Bianca, regular blood testing as well as strict adherence to self care medication (Burke, 2013). This should be adhered to for regulated impacts that would occur on Bianca.

Question 3: The potential impact of type 1 diabetes on Briana and her family


Emotionally, diabetes may leads to depression of the family as stress sets in. Hypoglycemia, a feature of diabetes, is more commonly associated with convulsions (Burke, 2013). This may lead to irritating behaviors thus depressing the people around the patients, in this case, Bianca’s family. With seizures, the family is at a risk of compromised performance due to impaired concentration that may set in during situations such as driving (University of Western Sydney, 2016).


Occurrence of accidents due to prolonged reaction times as convulsions may occur when Bianca is holding something. Physically, Bianca may suffer from a long term complication of diabetic foot due to damaged blood vessels by accumulation of AGES forming sticky surface for lipids (National Diabetes Services Scheme, 2016). This leads to atherosclerosis and infarction at the end arterials. Nephrons may be damaged; retina may also be damages (retinopathy) (National Diabetes Services Scheme, 2016).

Question 4: Adaptation of nursing care to accommodate Tom’s intellectual disability

Accordingto a study, person with intellectual disability, Tom, do not have an understanding for diabetes and as such have difficulty to function in an effective satisfying way (University of Western Sydney, 2016). Tom would therefore be opposed to Bianca’s medication and adaptation to life. People with Intellectual disability tend to demand for things most so foodstuffs that they do not have. At times demand for chocolate, beer and lollies (Flixercise, 2017). From the study, the conclusion was that patients with patients with intelligent disability have negative perception in all aspects towards patients living with diabetes.

The nurse should therefore manage Tom’s conditions through language therapists, special educators, and occupational therapists Mr. Tom’s lifestyle should be regulated to icorporate exercise, and management of individual effects such as pains with NSAIDs, Acetaminiophen for neuropathic effects, sedatives (Bullock & Manias, 2014).


Bullock, S., & Manias, E. (2014). Fundamentals of pharmacology (7th ed.). Frenchs Forest, NSW: Pearson Australia.

Created from wsudt on 2017-01-31 21:06:21.
Burke, K. M. L. P. L. (2013). Medical-Surgical Nursing VS. : Pearson Education Australia. Retrieved from

Craft,J., Gordon, C., Tiziani, A., Heuther, S., McCance, K., Brashers, V., & Rote, N. (2015). Understanding pathophysiology (2nd ed.). Chatswood, NSW: Elsevier Australia.

Craig, M. E., Jefferies, C., Dabelea, D., Balde, N., Seth, A., & Donaghue, K. C. (2014). Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatric Diabetes,

For personal use only. No other uses without permission. Copyright ©2016. Elsevier Inc. All rights reserved.
Downloaded from at University of Western Sydney December 07, 2016.

Flixercise Adapted Physical Education 2017-01-31 21:06:21.

LeMone, P., Burke, K., Levett-Jones, T., Dwyer, T., Moxham, L., Reid-Searl, K. Raymond,D. (2013). Medical-surgical nursing: Critical thinking for person-centred care (2nd Australian ed.). Frenchs Forest, NSW: Pearson Australia.

Marieb, E. N., & Hoehn, K. (2016). Human anatomy and physiology (10th ed.). Essex, UK: Pearson.

The National Diabetes Services Scheme is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Published June 2016