Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical/structural consequences. (Wolfsdorf et al: 2009) It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin, which results from the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. Type 1 DM can occur at any age. It occurs most commonly in juveniles but can also occur in adults, especially in those in their late 30s and early 40s. Unlike people with Type 2 DM, those with Type 1 DM are generally not obese and may present initially with diabetic ketoacidosis (DKA). The distinguishing characteristic of a patient with Type 1 DM is that if his or her insulin is withdrawn, ketosis and eventually ketoacidosis develop. Therefore, patients are dependent on exogenous insulin. (Vanelli et al: 2007) Treatment of Type 1 DM in a young child requires a multidisciplinary approach inclusive of doctors, nurses, dieticians, parent/s and others who may have care for the child for periods longer than a few hours; so care and responsibility for Type 1 DM in a child, may also include teachers and extended family etc. (NICE 2004) In patients with new-onset Type 1 diabetes, lifelong insulin therapy must be started. As a chronic disease, Type 1 DM requires long-term medical attention, both to limit the development of its devastating complications and to manage them when they do occur, it is therefore essential that those caring for a child with Type 1 DM have a good working knowledge of the disease, and a practical understanding of how to manage and respond to this disease, if the child is too young to be able to manage this disease for themselves. (Craig et al: 2007) This case study examines the roles and responsibilities of those adults, who might have some element of accountability for managing and caring for a young child with Type 1 DM
Case Study of V
V, a 6 year old female, was taken to the doctor’s clinic with an approximate 10 lb. weight loss over the last few weeks; symptom’s included nausea, increased thirst and urination. When asked by the doctor, V denied having any abdominal pain. V’s father has had Type 1 DM for 14 years and one of V’s cousin’s was diagnosed with Type 1 DM at age 18 months. As a result of an existing family condition, the doctor tested V for Type 1 DM. Medical tests confirmed that V was suffering from Type 1 DM. Because Type 1 DM is a catabolic disorder in which circulating insulin is very low or absent, plasma glucagon is elevated, and the pancreatic beta cells fail to respond to all insulin-secretory stimuli. Tests also disclosed that V’s pancreas evidenced lymphocytic infiltration and destruction of insulin-secreting cells of the islets of Langerhans, causing insulin deficiency. As a result of the confirmation of Type 1 DM, the doctor administered exogenous insulin to reverse V’s catabolic condition, prevent ketosis, decrease hyperglucagonemia, and normalise V’s lipid and protein metabolism.
Prognosis for V.
Whilst the family have an above average comprehension of the difficulties that V will experience for the rest of her life, despite their own experiences and knowledge, the doctor still had a duty of care to outline to V’s parents how he intended to advise and support V. This is in keeping with best clinical practice, because every case of Type 1 DM has to be managed on an individual basis, according to the National Institute for Health and Clinical Excellence. (NICE 2004) NICE guidelines also recommend that children and young people with Type 1 DM should be offered an on-going integrated package of care, by a multidisciplinary paediatric diabetes care team. The reasons for this are to optimise the efficacy of care and to reduce the risk of difficulties or complications that a child might experience, as a result of this disease. NICE also recommend that the careteam should include members with...
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