Type 1 Diabetes: Pathophysiology and Care

Introduction

According to WHO, long term condition is referred as the illness that can nit be cured permanently but the effect of this disease can be controlled and reduces through the medication, innovative clinical settings and appropriate diet. Example of long terms condition is diabetes, arthritis, asthma, high blood pressure and heart failure. This essay is going to highlight the pathophysiology and diagnosis of patient who suffers from the Type 1 Diabetes. This essay will also identify the physical as well as the petrophysical challenges faced by the patient in the selected case study. It will also highlight the UK based policies and healthcare guidelines for preventing and managing the long terms condition in the patient. Moreover, the essay will discuss the integrated care process and proactive management of diabetes for the patient in the case study in order to promote patient’s health and wellbeing. This essay will also identify the role of nurses and health care professionals in order yo follow the NHS and NMC constitution to promote the health and wellbeing of the patient in the different healthcare setting.

Case study:

A 50-year-old patient, John, has been admitted into the emergency department with abdominal pain and vomiting. He has his own business and stays with his wife and two daughters. He is fun-loving persons and spend his quality tile, with neighbours, family and friends. He is highly dedicated to his family and friends, he dies not have any history of smoking and drinking. He had 2 weeks experience of polydipsia and polyuria. He also experiences 20-pound weight loss and the blurred vision. From the hospital laboratory studies and the clinical intervention, it is clear that the patient suffers from Type 1 Diabetes with Glucose level 1192mg/dL. From the laboratory findings and the health assessment process it can be found out the patient suffers from Diabetes Ketoacidosis (DKA). The patient is treated properly for DKA with applying the innovating as well as appropriate clinical process. After the treatment the patient is discharged from the hospital, 3 days after the insulin regimen containing 30 units of NHP/regular human insulin70/30mixture before breakfast. The patient is also provided with the 15 units of the regular human insulin before diner and 20 units of NPH insulin during the bed time. On discharge, the patient is instructed to carry out the blood glucose test for 4 times a day. The laboratory study report of the glucose measurements during the intervals are as follows:

Pathophysiology:

Pathophysiology of this patient presents his physical condition with the acute onset of diabetes with sever insulin deficiency. When he was admitted into the emergency ward, his blood glucose level was 1192 mg/dL (in case of normal male adult the blood Glucose level is 70-125mg/dL). This patient has been discharging form the hospital on insulin regimen that is designed for the ease of administration, containing premixed 70/30 mixture before the breakfast. The recent studies state that the Type 1 diabetes is associated with the culminative lymphotropic filtration and severe destruction of the insulin secreting Beta cells. Due to the destruction of beta calls, there is huge reduction in the insulin level which makes ot unable to maintain the proper balance of the blood glucose level.

As stated by Ashelford et al. (2016), nearly 80-90% of the beta cells destruction is associated with the hyperglycaemic condition and development of Type 1 diabetes. in this aspect the patient in the case needs the exogenous insulin which will transform the blood glues into the glycogen and stored it into the body cells fir the future use. In case of the patient in the case study, 70/30 mixture of insulin before breakfast, assist the body reverse the catabolic condition, decreasing the hyperglucagonemia and preventing the ketosis. Moreover, through delivering the 30 units of NHP/regular human insulin to the patient, it can be; possible to normalize the protein and lipid metabolism.

Recent studies consider the autoimmunity as one of eth important fact in pathophysiology of Type 1 diabetes (Carrier, 2015). If the patient is genetically susceptible then the viral infection can stimulate the production of different antibodies against the viral protein that triggers the proper autoimmune response against the antigenically similar beta cells.

Nearly 90% of the Type 1 diabetes patients have reduced number of detectable anti-insulin antibodies and circulating islet cell antibodies before taking the insulin therapy (Carrier, 2015). Moreover, in case of the Type 1 diabetic patient the most common types of the islet cell antibodies are found that are directed against the glutamic acid decarboxylase (GAD), the enzyme that is located into the beta cells of the pancreas. The computed tomography (CT) scan and the glucagon simulated test focuses on the measurement of fecal elastase-1 (Evans et al. 2017). Through this measurement it is possible to determine the actual measurement of the pancreas in the diabetic patient. In case of the patient with diabetes Type 1, the size of pancreas is smaller than that of the normal people. in case of the patient with Type 1diebetis, there is risk of associated endocrine dysfunction that reduce the ability of body in order to maintain the proper balance of insulin and glucagon in the blood. As stated by Ashelford et al. (2016), recent clinical intervention on the diabetes suggest that Type 1 diabetes is associated with the polymorphism of the Class 2 human leukocyte antigen (HLA), the gene that is responsible for encoding the DR and DQ protein. In 95% of the patient with Type 1 diabetes, there are either HLA-DR4 or HLA-DR3. on the other hand, the recent clinical studies also suggest that the presence of HLA-DQ also acts as one of the important markers of the Type 1 diabetes.

Physical and psycho social challenges faced by the patient in the case study:

As stated by Stanhope and Lancaster (2015), Type 1 diabetes is associated with the changes on the physical, emotional and physical aspects of the patient. In the case study the patient John also can face the following challenges during his illness. According to Carrier (2015), recent studies have shown that, majority if the patient with Type 1 diabetes is prevalent to the reduces psychological and physical well-being. This is due to changes in different aspects of their life such as changes I relationship, daily routine, financial issues and work-related issues.

Physical changes:

Hormonal imbalance:

Type 1 diabetes has negative impact on the physical health wellbeing. Form the NHS reports it is seen that the 40% of the Type 1 diabetes patient has inability to perform their normal life. Due to Type 1 diabetes, the endocrine functions function sf the body destroyed.

Endocrine functions are important for maintaining the hormonal balance into our blood. Due to the reduction of insulin level, the blood glucose level increases at higher amount. In case of the patient in eth case study the blood glucose level in 1192mg/dL, whereas the normal blood glucose level in adult male is only 70-125mg/dL. Due to this higher rate of blood glucose, the patient in the case study suffers from the polyuria and polydipsia (Hosseini et al. 2015). Therefore, it is important for the people with the Type 1 diabetes, to take the exogenous insulin in order to maintain the normal sugar balance in the body.

Damage of blood vessel:

According to Smith et al. (2015), recent medical studies has shown that, the high glucose level at blood lead to severe damages of the blood vessel in the retina and the vision perceiving tissue at the back of the eye, which leads to the permanent loss of visions. This the reason behind the blurred vision of the patient John in the case study. Moreover, the NHS reports suggest that Type 1 diabetes is also associated with the chronic kidney disease. In this aspect the patient in the case study has high risk of damaging or arteries and vessels in the kidney which leads to reductions of filtration capacity of the kidney (Ashelford et al. 2016). Long term diabetic condition can lead to massive heart attack and stroke due to the obstruction blood flow to the brain and heart. High glucose causes severe damages of the blood vessel, which makes the arteries harder thereby making the arteries unable to flow the blood to the brain cells and heart.

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Nerve damage:

Nerve is associated with controlling the function of different body organs. Type 1 diabetes I associated with damaging the nerve cells due to elevated blood glucose level (Smith et al. 2015). Increasing blood glucose level also causes the disturbance into the nerve controlling bladder which is associated with the control of the urinary bladder. Therefore, the patient in case study is highly prevent to the nerve damages which can leads to negative effects on the brain and heart. Due to damage of the nerves, the heartrate increases, which causes the dizziness on standing.

Psychosocial effects:

The diabetes also affects the psychosocial aspect of the patient by affecting his or her social and emotional wellbeing.

As stated by Matthew-Maich et al. (2016), diabetes increases the risk of anxiety, depressional and mental illness. Human bodies deal with the negatives and positive emotion pathway. Patient suffering from Type 1 diabetes, have to deal with the negatives emotional and negative behavioural changes. Negative emotional and negatives behaviour intensify the different mental instability such as anxiety, stress, poor decision-making ability and reduce self-confidence.

Self-regulation is also reducing due to development of diabetes. The patient in the case study may develop poor self-regulation process, in which he is unable to form his own decisions. As stated by Smith et al. (2015), Social cognitional Theory highlights the importance of self-regulation in term of controlling own emotions, behaviour and thoughts. Based on the perspectives the self-regulation is important psychosocial aspect that maintain the positive behavioural changes into human being which assist them to form the strong relation with society people, Type 1Diebetes is the long terms condition that is associate with nerve damage and tissues damage which leads to reductional of self-regulation.

Social connections

Patient suffering from Type 1 diabetes experiences severe behavioural changes such as depression, loneliness, stress and anxiety (Matthew-Maich et al. 2016). Due to their poor mental stability and physical health, family members avoid them taking into the social activities. Moreover, poor decision-making ability and problem-solving skill of diabetic patient makes them away from the society, they chose to stay alone rather than sharing their thought within their neighbour, however, in the case study, John has strong social connection which can be positive sign for his recovery. As he has god relationship with his neighbours and friends, he can overcome the risk if stress, loneliness and anxiety.

Financial challenges:

One of the important challenges that a diabetic patient face is the financial challenge. As the patient suffering from Type 1 diabetes, have very exocrine secretion of insulin, he or she needs heavy dose of exogenous insulin therapy which is costly (Carroll et al. 2016). Moreover, the mental health is also affected due to the hormonal imbalance into blood, patient with Type 1 diabetes needs to take proper psycho therapies which is also costly. Therefore, for affording the appropriate treatment process, financial stability of eth patient is highly important, in case of the patient in the case study, he has his own business, which can assist him to maintain his financial stability during his treatment process. However, in case of any kind of financial difficulties John needs to take financial assistance from his family member and neighbours.

Consider various policies these are related to effectiveness of care and public health and long term/life shortening conditions:

National Policies include National Service Frameworks:

People suffering from diabetes is projected to increase in number from 3.1 million to 3.9 million in 2020 in UK (Knowles et al. 2015). For managing and controlling the situation, it will cost to NHS nearly £3.9 billion a year, which can pose high financial burden on UK government. For controlling and prevent the occurrence of diabetes, National Institute for Health and Care Excellence (NICE) has taken the National Strategy and Policy to prevent the Type 1 and Type 2 diabetes (Edwards et al. 2015). Four important national strategies have been taken by NICE, in order to prevent as well as control the effect of the diabetes:

Strategy to offer the adequate and appropriate food in order to maintain the healthy diet for the people with diabetes. Moreover, the strategy highlights the importance of physical exercise, regular activities and mental activities for developing the physical and mental strength in diabetic patient (Carrier, 2015).

Strategy to convey the heathier message lifestyle for the entire population

Strategy to work with the food manufacturers as well as with the retailers to encourage heathy eating for the entire community

Strategy to offer health education to the community in order to improve their knowledge about diabetes and other chronic diseases. If the community people get the proper knowledge about different disease, they can take the proper precautions to prevent the risk of these diseases.

Guidelines set by NICE to prevent diabetes at local level:

NICE has set guidelines for the local healthcare authorities in UK, in order t prevent and control the occurrence of diabetes (NICE, 2015). The strategies that are set by NICE to prevent the diabetes at local level are as follows:

Proper health assessment of the diabetic people in the local community by the local health care committee, needs to be done for understand the actual health needs of these people. in the case study, the patient, John, is entitled to get the healthcare support from the local health care committee in terms of improving his health (NMC, 2015).

Proper clinical intervention of the entire community, in order to check whether the population is prevalent to diabetes and other chronic diseases.

Proper risk identification, assessment of the risk and conducting the intensive lifestyle change programme

Encourage people to involve into the risk assessment process for detecting the diabetes and conducting proper clinical setting for encountering the risk.

Conduct the group as well as individual level clinical intervention for preventing and control the effect od diabetes in the community.

Care pathways and strategies set by NHS and NICE:

NHS health check program:

The National Institute for Health and Clinical Excellence (NICE) and Department of Health (DOH) have conducted the NHS health check programme that aims to detect the risk od long term or chronic disease in the community such as diabetes, heart stroke, kidney disease and arterial disease (NHS, 2016). NHS Health Check program is systematic programme that aims to assess the health of 15millions eligible people within the age group 40-74 in UK. This programme has been conducted to detect the risk od vascular diseases such as diabetes, heart disease and kidney disorder. NHS nurse, health professionals and midwives are obliged to meet the guidelines of NHS Health check programme in order to make the complete health assessment of eligible patient. In the case study, John, is entitled to get the health assessment benefited of NHS Health check programme. In this programmed health professional would make proper health check-up of John such as regular BP measure, regular detection of the blood glucose (Knowles et al. 2015). Moreover, NHS Health check programme would make self-assessment questioners that will be asked to John inn terms of understating his physical and mental strength. This questioner would be followed up with simple blood test in order to asses the long terms measure of the average blood sugar level (HbA1c).

Risk assessment and the lifestyle intervention program:

NICE and NHS has conducted the risk assessment program that is designed to ofre the variety of settings such as

GP surgeries

Pharmacy

Community health care facilities

Free blood tests n the local healthcare council

This risk assessment and lifestyle intervention program offers proper screening process to reduce the health inequality in the community (Matthew-Maich et al. 2016). In the case study the patient John can consult with the local NHS centre in terms of receiving the risk assessment and lifestyle interventional program. This program focuses on the special needs of the vulnerable and minority group who suffer from diabetes and other long terms diseases.

National strategies by UK government:’

In 2011, Department of Health (DOH), UK has taken the health initiative “Heathy lives, Heathy People,” that aims to controls and the occurrence long term diseases such as heart strike, kidney dysfunction and diabetes. this initiative also aims to make the UK community free from obesity, over weight and chronic disease by 2022. The Department of health (DOH) has two major programmes in order to control and reduce the development of different diseases:

Change4Life:

This program is conducted to promote the heathy eating as well as regular physical activities. The patient John in the case study can improve his diet chart and eating process through following the guidelines of this programmes. Moreover, Health Service Executives (HSE) in the local NHS centre can provide the proper assistance to John in terms of choosing eth heathy diet and appropriate physical exercise (Ashelford et al. 2016).

Public Health Responsibility Deal:

This program had been introduced during 2011. It has set out the voluntary pledges among the government, charities and some industries. Based on the guidelines of this program the food manufacturers in UK would use the food labelling in which there would be clear description of calorie and fats in each food items (Stanhope and Lancaster, 2015). Through this process, UK government wants to limits the calorie intake by community people. the patient in the case study, John, can maintain his daily calorie intake through understand the limit of calorie intake per day. Limited intake of carbohydrate in each day can reduce the blood glucose level of John, thereby reduce the effect of diabetes.

Personalised care framework:

Target approaches for the local community:

NICE and NMC has set codes of practice for the local health care committees in order to asses the different needs and changing behaviour of eth community people who suffers from diabetes and other long-term disease. The approaches taken by NICE and NMC involve using the community resources and local media in order to publicise the health massages about their personalised care process (NMC, 2017). Through conveying this health-related massages NICE and NMC can develop the knowledge and understating of community people regarding setting their regular lifestyle, diet and physical exercise to reduce the risk of eth chroming diseases. In the case study the patient John can be assist through the health massages which wiil asssit him to improv his overall lifestyles and diet. Through these health massages the NICE and NHS professionals are able to offer appropriate advice regarding the reduction of eth diabetic risk in the UK community (NHS, 2018).

Guidelines for Nurse Midwives and health visitors:

Nurses, Midwives and Health visitors are obliged to follows the guidelines set by NICE, NMC and NHS, in order to deals with the following aspects:

Conducting proper health assessment process Promoting the health and wellbeing of the patient Improving the lifestyles, diet and eating habits of the patient

Based on the NMC Code of Practice, the health professional Health Service Executives, Nurses and Midwifes needs to be follow the following guidelines in terms of reducing eth risk of debates.

Nurses, Midwives and Health professional would be highly skilled and well-trained in order to assess the health needs of the patient suffering from diabetes and other long-term disease (Carrier, 2015). They need to conduct the effective communication with service users in terms of understand their health needs. Nurses and midwives need to focus on maintaining proper discussion with family and neighbours of patient in terms of understand their behaviour and health needs. Under the guldens of Equality Act (2010), NHS staffs, NMC nurses and midwives would ensure that all the service users with diabetes and other chronic diseases, are provide with the equal care and support (Smith et al. 2015).

In the case study the, the patient John needs proper assistance of nurses and midwives in term of involving him into his own risk assessment process. The nurses, HSE and midwives need to assist John to know about his regular diet, proper food chart, regular exercise which are important for maintaining the blood sugar level.

Discussion on Integrated care and how the integrated care hinder or benefit the patients in case of older people and the people in the bong terms condition:

What is integrated care

Integrated care is referred as the coordinated, compassionate and comprehensive care process that focuses on the healthcare reforms as well as organisational arrangements that focuses more on the integrated and coordinated care provision (Smith et al. 2015). According to World Health Organisation integrated care is considers as cumulative care process that bring together the delivery, inputs, organisational and management of health café service related to innovative treatment, care, diagnosis, rehabilitation, health promotion and promoting the mental and physical wellbeing (WHS, 2018). In the given case study, as John is suffering from the Type 1 Diabetes, he needs integrated care process. Through offering integrated care, health professional, nurses and midwives can conduct proper person-centred care for John. Through proper diagnosis, improved health assessment process, management of diseases, timely delivery of treatment and rehabilitation after the hospital discharge, it is possible to control and cure the diabetes in case of John.

Benefits and barriers associated with the integrated care:

Different benefits and care are associated with the integrated care process. In case of older patient and the patient with long term condition integrated care is highly effective in the following ways:

Increased communication:

Based on the NMC codes of practice and NICE guidelines for integrated care, the nurses, health service providers and health professional can organise different types of communication which are as follows:

Face to face communication

Real time communication

One to one discussion

Meeting with patient and their families

Online conference and video calling

Through integrated cate process, health professionals, nurse and NHS staffs are able to conduct the person-centred communication process which is highly helpful to detect as well as evaluate the needs of the patient. In the given case study, the patient john suffers from the long terms condition (Type 1Diebetes). Therefore, integrated care is paramount in his case to organisation direct communication with John and his family (Evans et al. 2017). Through the apocopate communicational process, health professional can understand the actual health needs and current health status of John, which will assist them to offer the best care for his recovery.

Coordinated care:

During the integrated care process, nurses and health professional offers the compassionate and coordinated care based on the actual need and preference of the patient. As stated by Ashelford et al. (2016) , in case of older patient, the coordinated care is important to provide information about lab results, allergies health precaution, wellbeing needs, mental health and long terms disease. Moreover, integrated care process offers the coordinated care to the older adults which is offers based on their body needs and health condition. In the case study, coordinated care will improve the health condition of John by offering him the person-centred care.

Evidence based practice:

The delivery of integrated care is based on through research, review, planning and revision, that improves the knowledge and perception of the health professional regarding the particular health condition (Ashelford et al. 2016). In the case study, health professional needs to make proper health assessment of John in order to understand his current blood sugar level. Through integrated care process, health professional can make proper research on the health of older people.

Screening:

Integrated care offers different screening facilities such as:

Cancer screening Depression screening Substance abuse screening Chronic disease screening

Through these screening process, the health professional is to find out the disease and risk factors associated with the disease. Through detecting the risk factor through organising screening process, the health professional are able to determine the current health condition if the patient. In the case study, the Blood sugar screening process has been done which can assist eth doctors and nurse to determine the blood sugar level of this patient. Therefore, integrated care would assist John to get proper care and clinical screening process that assist the doctors to find out the risk factors associated with the disease.

Different barriers are associated with integrated care process such as:

Communicational barriers are important barriers, in which most of the older patient do not show interest to reveal the health condition in front of the nurses and doctors. This could be occurring due to the communicational gap between the patient and health staffs. On the other hand, most of the patient are not interest in online communicational or video calling process (Hosseini et al. 2015). Therefore, in absence of doctors in the hospitals, it is difficult for the patient and their families to communicate with doctors. Mis-understanding, mis-conception among the health staffs, health professional and nurse can create huge conflict regarding the treatment of the patient. Difficulties in coordinating among the different healthcare stakeholders due to their different roles and responsibilities. In the case study, John can face conflict and controversies regarding his care process among the health professionals, which can affect the implementation of integrated care process into the practice.

Identify and discuss the role of the nurse in preventing ill health and promotion of health and wellbeing within different health care settings:

According to the Nursing and Midwifery Council (NMC), the nurses, midwives and other healthcare staffs would offer the compassionate care to the service users (Smith et al. 2015). The Codes for Nurses and Midwives, would focus on the person-centred care that assist them to treat people with respect and dignity. NMC sets the Standard for the Nursing associates, which make legal obligation for the nurses and midwives in terms of providing the proper care and support in case of patient with ill health and long terms condition. In case of the John, in the case study, the Standard for the Nursing associates would deal with the following aspects: The standard assists the nursing ascites to maintain clarity in their role. nurses and midwives would maintain the synergies and integrity inn theory work, in terms of offering the cumulative care process to the patient wit ill health and long terms condition. In case of john, he needs integrated care process, in which all the nurses, midwives and health professional would maintain proper coordination in their work. Based on the standard set by NHS and NICE for the healthcare stakeholders, it is duty of nurses and midwives to show proper respect, politeness and friendly approach to the patient (Ashelford et al. 2016). John needs friendly support from the nurses, in order to improve his self-confidence and the problem-solving skill. Based on the NMC standard, nurses and midwives would focus on improving the behaviour and attitude of the service users in terms of reinforcing positive behaviour into them. Nurses and health staffs are responsible to offer the health information of the patient in terms of improving their knowledge and perception regarding maintaining their own health condition.

Conclusion:

This essay concludes that, long terms condition and chronic disease such as diabetes, heart disease and kidney disorders need high quality integrated care process. In the case study, the patient neds proper social, physical and emotional support from the health professional and nurses in order to improve his mental and physical; health. Moreover, this assay also concludes that, effective care process is important for the patient with Type 1 diabetes in terms of improving their behaviour attitude and physical health. There are several benefits ands barriers are associated with eth integrated healthcare. However, nurses and midwives need to meet their professional standard set by NMC in order to offer the compassionate care t the service users.

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