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Study about a patient with type 1 diabetes

Info: 2862 words (11 pages) Essay
Published: 1st Jan 2015 in Nursing

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Health behaviour describes those actions or lifestyles that people would conform to when they are enjoying good health so as to keep healthy and also to prevent diseases from attacking them. On the other hand what is known of illness behaviour is what people try to do when they start noticing the symptoms of a certain disease in them or in other people. The sick role behaviour will occur later when a person has consulted a doctor, and has been diagnosed and had started on a course of treatment. When the disease does not go away but instead turns to follow a chronic course, the person will have to adjust to a more permanent condition thus, impairing the then developed role behaviour.

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Another important area in health behaviour involves the interpersonal, social and cultural surroundings. Not only is the behaviour of the individual/patient of importance but also those of other people in their life e.g., family members, workmates, bosses, friends will affect whatever the individual does to maintain their healthy status or treat disease. The behaviour of the doctor or physician who is providing health care is also important in the way they interact with the patient. This will on a broader scale involve the institutions in which the health care services take place. This is because these institutions are the ones that decide what kind of health care services are to be provided, and the duration of the treatment and how it will be evaluated.

The states of health or illness are not to be looked at only as events that are related to the biological function of people’s bodies. In essence they are linked to whatever people do. For example, a lot of research has been done lately concerning the link between stress and illness. This has revealed that indeed the state of stress in a person’s life could cause some diseases either directly or indirectly by predisposing them to those diseases. This usually happens because the person’s bodily functions e.g. the endocrine functions, the immune system, or the nervous functions are normally altered or weakened making the likelihood of diseases to attack.

This is what has given rise to the field of behavioural medicine. This field has discovered that we can use techniques that are related to behaviour of the patient in place of the conventional medications and surgery so as to change the course of disease or prevent the occurrence of certain disease. Therefore so as to keep in good health and effectively prevent diseases, people need to engage in behaviours that are considered healthy. They should also be regular for medical checkups and be on time to consult concerned physicians when they are experiencing symptoms of a particular disease. After a diagnosis by a physician a patient should actively participate in the treatment of the conditions that are acute or when the condition is chronic then, they should participate in the proper management. They should strictly adhere to whatever medications or modification of behaviour that has been prescribed.

Case study: type I diabetes

My patient is a fiffty year old woman who is a retail owner and is suffering from type I diabetes. She had been diagnosed with this disease ever since she was a child. In this case her case of the diabetes Type I is chronic and needs serious management because it will never go away. If the management of the disease is not put in place it can cost the patient her life. This disease has often been referred to as the silent killer. My patient is a married woman with family support. Since her work at the retail outlet involves a lot of energy draining tasks she finds that most of the time she did not adhere to the prescribed diet. Instead of eating more she just omitted her insulin when her blood sugar dropped. She was also consuming greasy foods without paying attention to her carbohydrates.

Diabetes type I

Diabetes type I is what was previously called the insulin dependent type diabetes mellitus (IDDM). It is mostly common in very young people thus the name juvenile onset diabetes. This happens when the body does not produce the hormone insulin or only produces it in very small quantities. The symptoms will always appear unexpectedly especially in persons under the age of twenty years. In the United States alone this type of diabetes accounts for about 10% of the cases of diabetes, the same as in Canada. In most cases this is as a result of an auto immune defect where the cells that produce insulin in the pancreas, the beta cells are attacked. The causes of this type of diabetes are wide and varied.

The experts believe that the combination of several factors, i.e., genetic and those of the environment could be the leading cause that triggers the onset of this diseases by making the immune system to riot against self. As many as twenty genes have since been identified which are said to play a role in the occurrence of this disease; however, not all is clear as they are still investigating the functions of these particular genes. Factors of the environment that may play a role include various viruses, which are said to contribute to the development of the disease. This is especially true in people who already have the genetic susceptibility for the disease. Apart from the genetic and the environmental factors, this type of diabetes can result after the removal of the pancreas surgically.

Apart from leading to a buildup of blood glucose levels it also affects the metabolism of fat when left untreated. The body is unable to convert the available glucose to energy, thus it begins to break down fat that had been stored to give fuel. This will lead to increased amounts of the acidic compounds known as ketones. These compounds usually impede the cellular respiration process, which produces energy in cells. This type of diabetes may also cause other major and life threatening conditions. It can cause a person to slip into a coma because of the extremely elevated levels of the blood glucose. In extreme cases this situation can also lead to death.

Other complications may include loss of vision, kidney failure or even diseases of the heart. It can also cause the small blood vessels to have some blockages. When the blockages occur in the small vessels of the eye it causes what is called retinopathy. The lining at the back of the eye degenerates and results in blindness. When it affects the kidney, it leads to what is known as nephropathy. The kidneys become unable to efficiently filter the toxins in the blood. This leads to renal disease or kidney disease. Sometimes the blockages can occur in the large blood vessels. This will lead to problems of the cardiovascular system, e.g., hypertension, heart attack and even stroke. People with this type of diabetes are about three times likely to develop the cardiovascular diseases than people who are free from diabetes.

People who are suffering from this type of diabetes may lose sensory feelings in their lower limbs. Therefore when something sharp causes a cut or an irritation, these people might not feel anything. Thus they might not notice an infection until when dire complications have arisen which might lead to amputation of an appendage. They can also experience periodic burning sensations, sensitivity to the feeling of touch and freezing in the lower limbs. These conditions are what are jointly known as neuropathy. Women in the child bearing with diabetes age may put themselves in grave danger when they get pregnant. Also common is the greater occurrences of dental infections.

Diagnosis and treatment

By measuring the amount of blood glucose in an individual after staying for a period of about eight hours without food, suggest whether the person is suffering from diabetes. Other physicians might use what is called an oral glucose tolerance test. This will be conclusive after the glucose levels before and after the given amount of sugar has been eaten by the patient. In diagnosis, an individual’s blood or urine can be used. Blood glucose levels need to be monitored regularly and kept as close to normal as possible.

After a person has been known to have diabetes, the methods of treatment will include the control of the blood glucose levels and making sure that the complications that may arise are prevented. Regular physical exercise, a carefully controlled diet and adherence to the proper medication and access to a self monitoring blood glucose meter such as the accu-check performa are recommended. Those who are suffering from the type I diabetes have to be given their insulin injections about 2-4 times in one day. The form that is used as an injection is compulsory because when taken orally the hormone will become destroyed in the digestive system. The hypodermic needle has ever since been used though now many have started disliking it because it gives them calluses all over their skin. As technology advanced, a beeper sized pump was made that connects to a needle inserted under the skin, yet again another form of taking in insulin was discovered where the patient would just inhale it then it becomes absorbed by the blood in the lungs.

Many factors may affect the amount of insulin that an individual might need. Examples of such factors are the level of physical activity, the diet, and the existence of other health disorders. By constantly monitoring the level of the blood sugar, type I diabetes patients can then accordingly adjust the dosage of the insulin, the physical exercise or even the food intake to meet the requirements. Such patients should be careful to carefully control their diets and make sure that they distribute all their meals and snacks equally through the day. This will make sure that the ability of the insulin available to help the body cells to absorb the glucose is not overpowered. It is very important that the patients eat foods that are rich in complex sugars. This is because these sugars breakdown much slowly thus the rise in the blood sugar levels will be slow.

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The main aim of medication in patients with diabetes Type I is to lower the amount of glucose in the blood. However levels that go down too far can also cause health problems. This can result in a hypoglycemic condition where the patient may start shaking, being confused, and anxious. To reverse the effects of hypoglycemia, one has to quickly ingest some form of glucose or the foods that have high sugar content such as candies or fruit juices. Others have sought alternative treatments in natural medicine, e.g., by hypnosis.

Physical reaction of the patient

This patient is a very busy woman, and the retail shop that she does manage needs a great deal of her physical effort. This is exactly what made establishing her therapy to be difficult as she never stuck to her diet while doing her physical hard work. Sometimes she would even forget to monitor her blood sugar level and when it dropped, instead of eating more she just omitted her insulin. She says that it was very rare for her to find a little time when she could sit down and eat. This problem would continue even when on her days off and she continued not to pay attention to her eating habits. She became constantly fatigued and extremely hungry and that is when she would consume greasy foods without paying attention to her carbohydrate levels. She would frequently become thirsty and frequently pass urine. She also would frequently experience muscle cramps, nausea and irritability.

Emotional reaction

She still goes through emotional turmoil as if she has just learnt that she has this disease. She is sometimes overwhelmed with feelings of anger and depression. She knows that she has a responsibility to her health just as the doctor had told her. She admits that she needs to cultivate a positive outlook on life and self control. She says that she loves her family and she does not want to do things that would hurt them. It is just that sometimes at work she is tempted to eat food that is unwholesome especially when she sees her customers or passersby enjoying such junk. She also has intentions of exercising regularly but at the end of the day she is so tired that she just wants to go retire to her bed. It was very clear that the patient was withholding her emotions about her health.

Cognitive behavioural reaction

She has not been strictly adhering to the prescriptions of her medication for example at times she would not take her insulin, eat well or even exercise well. She does blame all of these on her work commitments. Though she did not spell it out loud she might be thinking that her family has not done enough to support her. She perceives that things will change but only if the situation around her does change first.

Health behaviour to be adopted/strategies to cope with her illness

Proper diet is one very important way to help manage diabetes. My patient even suggested that her diet needs to be managed. To do this she has to have the full support of her family in that they should not be eating junk food in front of her. The best thing is for her family to completely change their diet to match hers. This way, they will be showing togetherness and unity that will help the patient be strong. Exercise is also very important and the same way I advise the family to support her in her diet is the same way I will ask them to do the same in exercising. Help to make the exercises fun for the patient. It can even be just a thirty minute brisk walk together with her and indeed a repeat of this every day will go a long way. The family could even decide to have a pet that will help her in training. The patient should realise that it is important for her to submit herself to the treatment of the insulin therapy. This should be explained to her in a gentle way by the health professionals and also her family. If it is about the discomfort of the needles they could arrange to get the easier to use and less traumatic insulin pens with the micro fine needles.

Factors that affect her family in decision making

The family and also her friends are very concerned about the health of my patient. They feel extremely bad when they realise that the patient has not been strictly adhering to the regimen that was prescribed for her. They want to see her eat healthy, exercise right and stick to her medications. They do not want anything bad happening to her. That is why they wanted to evoke the patient’s responsibility to start caring about her health and that is when they brought the patients grand children and told her that those children needed her very much and if she continued in such a way as to risk complications from her disease, then she would not be able to perform her work, or carry out her responsibilities and thus not being able to support her family.

The family now needs to make all their decisions by taking into account the patient’s welfare. This way they will be able to help her get on track and control her health. This patient and the family can definitely afford to buy health food. It is only that she does not seem to have that kind of motivation as everyone around her is digging into unhealthy food and thus her desire to eat the same. She has the sense of responsibility and totally knows what she is supposed to do but needs that slight push from her family. This is the same thing with exercises; at least one person in the family should offer to go with her every day when exercising. This will even make her keep looking forwards for the time so that she can exercise and at the same time spend quality time with her family member. Actually a day should not go by without the patient taking a walk. The family members should not allow that.

Conclusion

For now there is no cureĀ for diabetes and still experts cannot exactly put a finger on the exact cause. Most of the scientists are working towards identifying the environmental factors that trigger Type I diabetes in patients who initially had a predisposition for the disease. They are hoping to determine the cause that leads the immune system to attack those cells that manufacture insulin. This might make it able to prevent the condition from developing. Studies have suggested that some viruses may trigger a reaction of that kind however those studies are not complete.

Research has also shown that transplanting a healthy pancreas or injecting the insulin producing beta cells into a patient may work substantially. Those who receive a transplant of the pancreas have seen considerable improvement while with those who received the beta cells may not enjoy some long term benefits. Scientists are also considering the possibility of the development of an artificial pancreas and are also looking for ways to manipulate those cells that do not produce insulin to start producing insulin. New drugs have also been identified that help in controlling the blood sugar, e.g., glargine and lantus.

 

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