Causes, Pathophysiology, Mechanism of Development and Treatment of Diabetes Mellitus - Essay Example

Institution : xxxxxxxxxxx Title : Case Study: Diabetes Mellitus Tutor : xxxxxxxxxxx Course : xxxxxxxxxxx @2010 Introduction Type 1 Diabetes mellitus occurs due to destruction of the autoimmune of the beta cells of the pancreas that have the role of producing insulin in the body. This is explained by Jill, (2006 p.79) that failure of production of insulin results in high levels of glucose in the blood and in the urine. The symptoms that follow are frequent urination also known as polyuria, increased thirst also known as polydipsia and increased hunger also known as polyphagia. The person also loses weight as a result of this condition. This type of diabetes is fatal and must be treated with insulin. Diabetes is among the leading health threats among the Australians. It is a chronic illness that places those affected at risk of heart disease, kidney failure or even amputation. Documentations indicate that the condition is on increase in Australia and other parts of the world. The exact cause of type 1 diabetes is not yet known but it is likely that some people have genes that predispose them to type 1diabetes. This case study therefore looks at the health issues of diabetes and all that is related to it. Occurrence of Type 1 diabetes The type 1 diabetes is also called juvenile onset diabetes mellitus or insulin dependent diabetes mellitus. This condition can occur to individuals of all ages but it is most common among children and adolescents. In this condition, the beta cells may produce very little insulin or no insulin at all. The main role of insulin in the body is to move the blood sugar into inside the cells from where it can be stored to be used as a source of energy later. For diabetes patients to survive, they must inject themselves with insulin at least four injections per day. They must keep testing their blood sugar levels severally each day (Colman, Thomas, Zimmet, Welbon, Webb, Moore, 2005 p.32-5). Type 1 diabetes accounts for abut 10 to 15 percent of all cases of diabetes in Australia. From the data found in Australian National Diabetes Register, about 15,000 new cases of diabetes type 1 were reported in Australia. However, majority of these cases were among people aged above fifteen years. These cases were lower compared to those reported among children below the age of fourteen years. This was the trend between the year 2000 and 2006. The average number of cases per day was three or more cases per day. This rate however decreased with age indicating that the rate was high among those close to fifteen years. Among those living with diabetes type 1 in Australia, fifty percent of them developed the condition when they were above fifteen years and most of them do not have family history of disease (Hofmann & Greydanus, 2007 p.46). Management of Type I diabetes among adolescents Managing type 1 diabetes is a rather complex process that requires observing daily care activities, solving occurring problems and making personal decisions. This is very challenging especially among the adolescents who are experiencing several social, psychological and physiological changes at the time when they are faced with the responsibility of managing their diabetic condition. This becomes more challenging due to incorporation of the diabetes management tasks into their lifestyle which will then call for modification. Proper glucose control may reduce the risks of developing diabetes associated complications among the type 1 diabetes; adolescents usually have problems fitting in the difficult aspects of the diabetes treatment regime. According to investigation done by Anderson & Auslander (2003 p.102), the problem of adhering to diabetes treatment regime is more prevalent among the adolescents as compared to children. They view that the environment of an individual plays a great role on his or her ability to manage diabetes. The family of the affected individuals also should play a pivotal role in this. This is especially with the adolescents who are highly influenced by their peers. According to La Greca & Bearman (2001), it is important for the adolescents to develop behaviors that allow disease management so that this may go on even into their adulthood. Peers also play a big role in influencing the ability of their friends to succeed in managing their diabetes status. However their influence may be both positive and negative. According to research done by Lyons & Chamberlain, (2006 p.97), it was found out that when the adolescents are posed with a situation where they have to choose between adhering to their treatment regime and following the desires of their peers, most of them choose actions that are consistent with their peers and not adherence to diabetes treatment regime. It is therefore important to include lessons on how to manage peer influences while educating adolescents on diabetes management. The research however stated that it is important to include the peers as supportive friends during the observance of diet and exercise as this might have positive influence on diabetes management. In the case of Lauren, she is suffering from hypoglycemia due to intake of alcohol and fast food in parties. This may be due to peer influence where she feels that she must take alcohol together with her peers but at the same time she fears for her condition and that why she is playing with her doses of insulin. Hypoglycemia mostly happens in adolescents taking alcohol due to ethanol released from it. She therefore lands in hospital every time she attends a party. Her peers are therefore having a negative influence on her ability to manage the diabetes. Action of insulin in Diabetes type 1 According to Jill (2006) the pancreas of a person suffering from diabetes type 1 produces very little insulin or in some cases none at all. The patients must therefore survive on shots of insulin for dosage. Starting dosage of insulin may be challenging at times as it takes some tome for the patient to realize his or her right dose. The dosage of insulin depends on the lifestyle of the individual. This includes the level of activity, status of the body weight, diet and the health status. Most people keep changing their doses of insulin but it is important for them to contact their doctors before doing so. However this is not the case with Lauren who changes her dosage when she wants to attend a party without consulting her nurse. The basic role of insulin in a normal human body is to maintain the blood sugar at a normal level. When one is suffering from diabetes type 1, injection with insulin substitutes the role played by the insulin produced by the pancreas. Injections of insulin are therefore important in maintaining body homeostasis. It therefore plays the role of converting food into energy (Anderson & Auslander, 2002 p.211). It is very important to maintain the recommended levels of dosage of insulin since excess or too little can result into serious problems. Hypoglycemia is a condition of low glucose levels in the body that results due to excess insulin. This is the cause of hospitalization for Lauren who takes excess insulin while attending parties so that she can take alcohol and junk food. Eating out can be a challenging factor for someone trying to maintain her body glucose levels. This is due to difference in food ingredient used, portion sizes and energy content of the foods. Incidents of low or high blood sugars can therefore occur in individuals who take foods that are different from their usual home prepared. This is also happening with Lauren since the food prepared in the party is different from hey home prepared and mostly contains the junk food. Developmental issues involved in the case The condition of diabetes type 1 may subject Lauren to various cognitive, psychological, social, emotional and physical implications. One of the main hindrances to implementation of an effective diabetes treatment regime is the high risk of hypoglycemia. This poses the main problem in regulating the levels of glucose in the blood. Lauren is at risk of hypoglycemia due to the habit of playing with her insulin doses. Research done by Cryer, Davis, & Shamoon, (2003 p.56) frequent incidents of hypoglycemia may have cognitive consequences such as coma and seizure. Repeated incidents of hypoglycemia may result to problems in the ability of the infected person to perfume well in school or in future jobs. However, not much difference was observed between the performance of adolescents suffering from diabetes type 1 and their peers who did not suffer from it. Adolescents with type 1 diabetes may also suffer certain psychological problems. Most of them may have problems relating with their family members. This is because they often experience mood swings and they may become emotional. However, they may be not aware of the status of their moods or how they may impact others around them. Feelings of guilt, anxiety and anger highly affect them and they can become very emotional. This may affect their mental status and the levels of their hormones. Anxiety is high for diabetics because they are uncertain about their future and they may lack ability to control their disease (Brannon & Feist, 2004 p.141). Stress may also be present among adolescents with an ongoing disease. However, stress may have strong psychological reactions that may lead to production of certain hormones. These hormones may hinder proper faction of insulin and interfere with normal metabolic processes of insulin. Management of diabetes may also cause stress to patients. It may be out of this stress that most adolescents are unable to follow their treatment requirements. For example Lauren may be unable to contain the stress of watching her peers take alcohol and junk foods during the party. Baum, Reverson, & Singer, (2001 p.21) explains that the most common social problem experienced by adolescents with diabetes type 1 is the fear of being ridiculed by their peers. Where the peers and friends do not understand the condition, they really demoralize the adolescent and may prevent one from properly following the management regime. Adolescents suffering type 1 diabetes may be discriminated by their peers especially when those peers are not aware of the implications of the disease. The one suffering may lack social company, may feel depressed and socially isolated. This may in turn weaken her desires for proper management of her condition. Another social problem is making a decision between normalcy and their self care. This mostly happens among adolescents who drink alcohol since temptation to drink increases when they attend parties with their friends. Doing things that others are not doing in social gatherings may be difficult and makes most adolescents under look their self care. This is the case with Lauren who cannot resist to drink alcohol in a party where everyone else if drinking. Lack of emotional control is also associated with adolescents who suffer diabetes type 1. This is due to feelings of stigmatization that is caused by the long life illness. They become anxious and may experience mood swings. Sadness is also common where one has to lead a life that is not similar to other people. Insulin use among female adolescents with diabetes type 1 has been found to cause physical changes. Research done by Australian Institute of Health and Welfare, (2009 p.30) found out that the dosage of insulin used and the frequency of the insulin injection may hinder growth during adolescence and may result in accumulation of fat in girls which results in weight gain. This may be due to high levels of growth hormones and low levels of growth factors such as insulin, factors which are observed in diabetes type 1.Due to susceptibility of adolescents to the above cognitive, psychological, social, emotional and physical implications, this makes it hard for them to follow the required treatment measures. They are therefore often faced with complications associated with poor observance of treatment directions. Diabetes type 1 during adolescence in Australia The rising incidents of diabetes type 1 among adolescents have been a major concern in Australia. According to a research study published by Colman, Thomas, Zimmet, Welbon, Webb, Moore (2005) in the Medical Journal of Australia that was done in the New South Wales between the years 2000 to 2004. The study was done on both girls and boys with age groups of 0 to 4 years, 5 to 9 years, 10 to 14 years and 15 to 20 years. In all the age groups, the number of incidents was found to increase with most of them occurring in girls as compared to boys. Those aged between 15 to 20 years indicated the highest number of cases. Recent studies that have followed have however indicated a contrasting trend with incidents being higher in the lower age groups. This indicates that there are changes in time of onset of the disease. According to Lonnrot, Knip, & Roivainen (2008 p.7), the changing trend in incidents of diabetes type 1 may be associated more environmental factors as compared to genetic susceptibility. Another factor that may increase the incidents may be enteroviruses which may lead to early onset of diabetes. The incidents are on increase due to reduced maternal immunity to enteroviruses. Research has also indicated that the population with highest incidents of diabetes type 1 among those below 20 years is also characterized by overweight and obesity during childhood. This may be the cause of early onset of diabetes type 1. Obesity also increases the resistance of the cells to insulin which consequently results in destruction and fatigue of the beta cells. The end results are early onset of diabetes type 1 among children, a condition that goes on to adolescence. Trying to relate the rising incidents in New South Wales with the international data, there is a certain factor that is putting the population at risk. Some of the environmental factors identified during prospective studies in Australia include cow’s milk protein and virus which causes autoimmunity of the beta cells. Problems associated with management of diabetes among adolescents in Australia Literature related to the issues in the case study A study done by Bobrow, AvRuskin & Siller (2005 p.129) found out that parents, who are the key players in assisting their adolescent children to mange their diabetes status are faced with so many challenges. Most adolescents conflict with their parents as they try to push them for proper self management. Parents are therefore faced with a situation where they have to balance between the demands of the adolescents and the family resources. Some of the parents interviewed in the study stated that they are forced to adopt certain strategies to help them meet resources required for managing diabetes for their adolescent children. Some of the strategies include dietary and medical support, reorganizing the environment at home for one that will favour the diabetes management regime, and also changing routines at home so that the adolescents can get total support in their disease management. However, most of their efforts fail to succeed due to the adolescents’ busy schedules that make them to be away from home most of the times. This is because they desire to be with their peers more that with their family. They attend parties, classes and other sessions with their peers who lead normal lives. Therefore parents have difficulties in ensuring that their adolescents with type 1 diabetes are able to maintain their blood sugars. According to Hoffman (2002 p.27), there are other challenges that may be specific to the one managing the type 1 diabetes. These include the changes in needs of insulin that arise due to growth that is taking place during adolescence, inconsistency in activity level and meal patterns, and adherence to treatment which includes the injections. It is therefore important to have pooled support from the peers and friend, the family, teachers and dieticians. Their involvement may help in deciding insulin regimes that are flexible to fit in the varying schedules. From these studies, one can identify the problems faced by Lauren in management of her type 1 diabetes. One of the problems she is facing as explained in the literature is desire to be with her friends. This is reasons as to why she must attend parties and also must drink alcohol with her friends. However much her parents may be putting efforts in helping her manage the condition, she ends up in hospital with hypoglycemia. Adherence to treatment has been the main problem faced by adolescents. Lauren is also unable to adhere to her treatment and she manipulates her insulin doses to fir her desires of taking alcohol and junk foods. This leads he to the many complications associated with poor adherence to treatment. However, there are several limitations in the studies done regarding diabetes in adolescents. The results cannot be obviously generalized since the ability to manage diabetes type 1 treatment regime varies with the activity of the individuals. Some adolescents may not be able to follow the treatment regime due to the nature of work they do. Another limitation of the study is that it did not enquire about the level of parents’ involvement in helping their adolescent children to observe the management plan. These are the three most important factors in helping the adolescents cope with their condition. Complications of diabetes type 1 Some of the common complications of diabetes type 1 that are experienced by adolescents are hypoglycemia and weight gain. According to Cryer, Davis, & Shamoon, (2003 p.67) hypoglycemia comes with mild symptoms of hunger, sweating and irritability, to severe complications such as seizures and coma. Lauren experiences hypoglycemia due to improper use of insulin doses and intake of alcohol and junk foods. When she wants to attend a party, she plays with her doses of insulin and this often lands her in hospital due to hypoglycemia. To enable her overcome this complications, her friends and peers must be involved. This is because they will give her the support necessary in withstanding her desires for alcohol and junk foods. Efforts by her friends may include holding parties where there is no alcohol intake and also avoiding junk foods. It is due to this intake of junk foods that Lauren will develop complications of obesity and overweight. Overweight may result due to the habit of eating large amounts of food in efforts to compensate for excess insulin and avoiding hypoglycemia. Lauren takes high doses of insulin before going to a party so that she takes large amounts of junk foods and alcohol. If she continues with this trend, it is likely that she will develop overweight. The onset of these complications of diabetes may only be prevented by following the proper treatment and the recommended type of lifestyle. Responsible adolescent behaviour is the most important remedy for Lauren that includes ability to resist the desires of her friends and her own self which are against the recommendations of diabetes management regime. Conclusion Diabetes type 1 is a life time condition which may never be cured. This condition therefore relies on proper management which is characterized by proper dosage of insulin, proper diet and physical activity. However, these factors may be challenging to observe especially among the adolescents. This is difficult because adolescents suffer from cognitive, social, emotional and psychological implications that may hinder them from properly observing their treatment regimes. Dietary observations are the most challenging since adolescents mainly like eating away from home with their peers. They may also suffer emotionally due to the imagination of their life time condition that makes them lead a lifestyle that is different from their peers. They therefore suffer from peer influence that may affect their ability to follow the treatment regime. However, with support from their families, their peers and friends, they can be able to follow the management requirements and overcome the complications associated with the disease condition. Bibliography Cryer P, Davis, S., & Shamoon, H., 2003, Hypoglycemia in diabetes. Diabetes Care.26: 1902-1912. McAuley, V., Deary I., & Freier B., 2001, Symptoms of hypoglycemia in people with diabetes. Diabet Med 18:690 -705. Bobrow, E., AvRuskin, T., & Siller, J., 2005, Mother-daughter interaction and adherence to diabetes regimens. Diabetes Care. 8, 146-151 Jill, I., 2006, Diabetes type 1.The Australian Journal of Advanced Nursing, Vol. 25, No. 2. pp. 4-6. Colman, P., Thomas, D., Zimmet, P., Welbon, T., Webb, P., Moore, P., 2005, Diagnosis of type 1 Diabetes, Medical Journal of Australia, 170: 375-378. Australian Institute of Health and Welfare, 2009, Incidence of type 1 diabetes in Australian Children 2000-2008.Canberra: AIHW. Hoffman, R., 2002, Adolescent adherence in type 1 diabetes. Comprehensive therapy. Volume 28, Number 2, 128-133. La Greca, A., & Bearman, K., 2001, Commentary: If “an apple a day keeps the doctor away,” why is adherence so darn hard? Journal of Pediatric Psychology, 26(5), 279 -282. Anderson, B. J., & Auslander, W. F., 2002, Research on diabetes management and the family: A critique. Diabetes Care, 3(6), 696 -702. Lyons, A., & Chamberlain, K., 2006, Health psychology: a critical introduction, Cambridge, Melbourne. Hofmann, A., & Greydanus, D., 2007, Adolescent medicine, Appleton & Lange, Stamford, Conn. Baum, A., Reverson, T., & Singer, J., 2001, Handbook of health psychology, Lawrence Erlbaum, Mahwah, NJ. Brannon, L., & Feist, J., 2004, Health psychology: an introduction to behaviour and health, 5th ed, Wadsworth, Australia. Read More