Sample Case Study
Diabetes – Hypoglycemia
John Smith, an elementary school teacher with type I diabetes is taken to the hospital after not feeling well. He states that after his busy day organizing a field trip, he had felt very faint. It started with a headache but throughout the day, he noticed that his hands started shaking, his vision was going in and out, and the room started spinning. John reports he had missed lunch because of his busy day. Findings show that his pulse is 115 beats/min with a blood glucose level of 55mg/dl. John was diagnosed as having a hypoglycemic episode.
Type I diabetes affects both children and adults but is mainly seen before the age of 30 (American Diabetes Association, 2018). This disease has a rapid onset, so it is important to act promptly. In 2018, 34.2 million Americans were diagnosed with diabetes. African Americans, Hispanics, and American Indians are the highest groups at risk for diabetes mellitus (DM). Chronic complications for untreated DM include retinopathic, neuropathic, and nephropathic problems.
Hypoglycemia is a condition when the blood glucose drops below 70mg/dl (McCloud, 2013). Hypoglycemia “can result from increased insulin sensitivity, decreased glycogen reserves, and decreased gluconeogenesis associated with hypercorticolism” (McCloud, 2013, p. 1420). With type I diabetes, you will find impaired insulin secretion in the pancreas. Injection of insulin is required in order for the uptake of glucose. If glucose levels drop, with the example of skipping meals or an overload of insulin, the body will feel less energized with signs and symptoms of shaking, sweating, anxiety, dizziness, hunger, increased heartbeat, vision changed, fatigue, headache, and irritability (McCloud, 2013).
Insulin is a glucose regulator. It is secreted by the beta cells of the pancreas which promotes the entry of glucose to become “energy” cells (Brashers & Huether, 2020). When there is no insulin, the tissue becomes starved and energy levels decrease. With type I Diabetes, the patient will have a complete absence of beta cell functioning resulting in a dependency of an outer source for insulin.
Treatment for a hypoglycemic episode will depend on the patient’s level of consciousness and whether or not the patient can swallow. If conscious and able to swallow, the patient needs to ingest simple sugars such as 4 ounces of orange juice or regular (not diet) soda, or 5-6 pieces of hard candy, or 1 tablespoon (15 mL) of sugar, jelly, or honey, or 3 glucose tablets, or a serving of glucose gel (American Diabetes Association, 2018). If the patient is unable to swallow or is unconscious/ stuperous then glucagon will need to be administered IM or IV. With either oral or IM/ IV treatment, the blood glucose will need to be checked again 15 minutes later. If the blood sugar is still low, continue to treat. If the blood sugar is normal, and the patient is asymptomatic, the regular scheduling of food/ insulin/ accuchecks should be resumed.
John should be educated on the s/s of a hypoglycemic episode and what treatments he can do at home & when to come to the ED. He also needs to be educated on the importance of not skipping a meal. It is also important for him to know that when increasing physical activity (as with his upcoming field trip) additional snacks and adjustments to medication may be necessary. In John’s case, he should be encouraged to go to the doctor to review if his insulin dose is appropriate. As with many chronic diseases, the prevalence of depression and anxiety is higher in people with diabetes, and even higher in those patients whose diabetes is not well controlled. John should be educated about support groups in the area. He should also be encouraged to discuss any feelings of anxiety or depression, and if severe, consider anti-depressants or anti-anxiety medications.
Question:
What are some examples of retinopathic, neuropathic, and nephropathic complications of DM?
References:
American Diabetes Association. (2018, March 22). Statistics about diabetes. http://www.diabetes.org/diabetes-basics/statistics/
Brashers, V.L., & Huether S.E. (2020). Alterations of hormonal regulation. In S.E. Huether, K.L.
McCance, & V.L. Brashers (Eds.) Understanding pathophysiology (7th ed., pp. 447-473). Elsevier.
McCloud, M.E. (2013). Care of patients with diabetes mellitus. In D. Ignatavicius & M. Workman (Eds.) Medical-surgical nursing: Patient-centered collaborative care (7th ed., pp. 1410 – 1464). Elsevier.
