ASSIGNMENT 1

Assignment 1: Case Analysis 3

Assignment 1: Case Analysis 3

Case Selected

B. L., age 65 years, has come to the emergency department with complaints of increasing chest discomfort over the last few weeks, the worst episode happening this morning. History includes type I diabetes mellitus since age 7 years.

Review of Systems

Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin (figure 1). Insulin is a hormone that helps the body to absorb and use glucose and other nutrients from food, store fat, and build up protein. Without insulin, blood glucose (sugar) levels become higher than normal. Type 1 diabetes requires regular blood sugar monitoring and treatment with insulin. Treatment, lifestyle adjustments, and self-care can control blood sugar levels and minimize the risk of disease-related complications (Wulsin & Hillard, et al, 1988: 315). Type 1 diabetes usually begins in childhood or young adulthood, but can develop at any age. In the United States, Canada, and Europe, type 1 diabetes accounts for 5 to 10 percent of all cases of diabetes.

Assessment Techniques

Being diagnosed with type 1 diabetes can be a frightening and overwhelming experience, and it is common to have questions about why it developed, what it means for long-term health, and how it will affect everyday life. For most patients, the first few months after being diagnosed are filled with emotional highs and lows. You and your family can use this time to learn as much as possible so that diabetes-related care (e.g., self-blood sugar testing, medical appointments, daily insulin) becomes a "normal" part of your routine.

In addition, you should talk with your doctor or nurse about resources that are available for medical as well as psychological support. This might include group classes, meetings with a nutritionist, social worker, or nurse educator, and other educational resources such as books, web sites, or magazines (Yingling & Wulsin et al, 1993: 231). Despite the risks associated with type 1 diabetes, most people can lead active lives and continue to enjoy the foods and activities they enjoyed before being diagnosed with diabetes. Diabetes does not mean an end to special occasion foods like birthday cake. With a little advanced planning, most people with diabetes can enjoy exercise in almost any form.

Type 1 Diabetes Causes

Type 1 diabetes usually develops when the immune system destroys the insulin-producing cells (called the beta cells) in the pancreas. This is called an autoimmune response. The cause of this abnormal immune response is being studied. This process occurs over many months or years, and there may be no symptoms of diabetes. High blood sugar and its associated symptoms (frequent urination, thirst) do not usually occur until more than 90 percent of the cells that make insulin have been destroyed.

Type 1 diabetes can develop in people with a family history of type 1 diabetes, but it also develops in people with no family history of diabetes. In either case, people who develop diabetes have one or more genes ...