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Hypoglycemia in Diabetic Patients Essay

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Introduction

In hypoglycemic conditions, the BG is less than 70mg/dl mostly caused by high insulin intake, less food, or prolonged activity. In the case study, Doughlas shows hypoglycemic symptoms: confusion, headaches, dizziness, shakiness, and sweatiness (British National Formulary). Hypoglycemia affects insulin-treated diabetic patients (Garg, & Hirsch, 2010, p. 10) or patients under insulin secretagogue therapy (Agabegi, & Agabegi, 2008, p.156). Doughlas is under insulin treatment; HumaloxMix and takes hypertensive drugs; nocte: perindophil. Usually, a timing mismatch in insulin and caloric intake causes hypoglycemia. In this regard, the essay covers the hypotheses, supporting rationales, questions, and assessments relative to the case study.

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Collecting Data

In the case study, the patient, Doughlas Adams, is 51years old, weighs 70 Kgs, and 196 cm tall. Doughlas has Diabetes type 1 and hypertension. He takes Humalox Mix 25:26 units and hypertension for which he takes nocte perindophil: 4mg tablets every morning. He also takes Aspirin: 100mg daily as a painkiller (Cooke, & Plotnick, 2008, p.134) and is allergic to penicillin. He does not take alcohol but smokes and lives all by himself.

Presently, he is admitted showing symptoms of confusion with Glasgow index of 14/15, which represents minor brain injury. On diagnosis, he was found to have an average HR of 82 bpm, a significantly high blood pressure of 110/87 mmHg, an RR of 18 and a body temperature of 36.8. He is due for an ACT test later to monitor his heparin anticoagulant therapy (Seligman et al., 2010, p. 1227) and currently he is under QID BSL with the first one, 5.2mmol/L, administered before breakfast. He is also under 4/24 neuro obs medication. Doughlas shows signs of poor health: paleness, confusion, and slurred speech. On diagnosis, his HR was found to have risen to 88 bpm, BP was 105/80mmHg, RR-18, and temperature dropped to 36.5 o C.

Hypotheses with Rationales

From the data collected, the following hypotheses can be identified with regard to the patient’s hypoglycemic episodes. First, altered nutrition during scheduled insulin therapy may cause hypoglycemia. Usually, out of concern of hypoglycemia, prandial insulin is administered only when the pre-meal glucose is high (Unger, 2011, p. 253). In the case study, the patient’s blood glucose must have been high before he received his main medications prior to breakfast. Consequently, he showed symptoms of hypoglycemia; increased HR of 88 bpm, reduced BP of 105/80mmHg, and a slight drop in temperature at 36.5. He also became sweaty and shaky, appeared confused, and had a slurred speech. Second, the paleness, anxiety, hand tremor and sweating could be the result of allergic reaction to the Humalogmix 25 medication. The patient exhibited adrenergic symptoms, which are indicative of a rapidly changing blood glucose levels or allergies (Koroscil, Kagzi, Zacharias, 2007, p. 228).

The third hypothesis that can be drawn from the patient data is that, the unawareness and confusion could be the result of low glucose levels in the blood. In the hypoglycemic episode, the patient appeared confused and unaware of his surroundings, which is a sign of low blood glucose level. Low blood glucose affects perceptions due to brain damage. Fourth, hypertensive medication reduces the feelings of hunger in hypoglycemic patients. When β- blocker medication is given to cardiac patients with diabetes, the symptoms of tremor and hunger are reduced (Arora, Marzec, Gates, Menchine, 2011, p. 6). Fifth, diabetic patient may suffer hypoglycemic complications due to lack of knowledge. Wexter found out that, outpatient patients have a high likelihood of making errors in insulin dosage administration and in timing of the medication (2008, p. 34). A timing mismatch in the administration of insulin mane and caloric intake contributed to the hypoglycemic episodes experienced.

Physical Assessment and questions
Endocrine Assessment

Under erratic caloric intake, close glucose monitoring before and after meals is essential (Kubiak et al., 2007, p.497). However, the use of Humalogmix 25 could affect the neurological system. A study by Aschner et al. established that, some diabetic patients have systemic allergy towards insulin regimens (2010, p. 305). To establish whether Doughlas has an endocrine malfunctioning, I would conduct an endocrine assessment. Effects to the pituitary gland could to memory impairment and loss of appetite. To establish this, assessment questions will be; has your appetite decreased or increased lately? Does anyone in your family suffer from diabetes or hypertension? Do you feel irritable or nervous most of the time?

Integumentary System Assessment

Self-management of diabetes by patients is often preferred to hospital care. According to Chen et al., patient self-care can be an appropriate means of reducing hypoglycemia in respect to timing of medication and caloric intake (2010, p.413). This can be achieved through effective education of patients (Arora, Marzec, Gates, & Menchine, 2011, p.5; Lim et al., 2011, p. 308). Since Doughlas lived alone, to obtain subjective information regarding skin disorders, I would ask the questions; do you often feel itching or pain on your skin? I would also inspect the skin to obtain objective information.

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Neurological System Assessment

Glucose imbalance primarily affects the neurological system. A study by Pickup, Freeman and Sutton established that, high blood glucose level in hypoglycemia patients affects their cognitive ability (2011, p. 343). To establish if there is alteration in memory, I would ask the patient the following questions; what is your name? Do you feel headaches, blurred vision, have a decreased hearing, taste, or feel dizzy? Does your family have a history of diabetes? (Ragia, Petridis, Tayridou, Christakidis, & Manolopoulos, 2009, p. 1787; Burke et al., 2007, p. 979). Additionally, Neurological inhibitors in diabetes drugs increase neurological disorders (Jong et al., 2009, p. 159; Liou et al., 2008, p. 207).

Conclusion

Hypoglycemic episodes are common in diabetic patients and are attributed to several risk factors. In Doughlas’ case, a combination of agents of the hypertensive drugs, lack of proper timing in meals and medication administration could be responsible for the hypoglycemic complications experienced by the patient. The drugs primarily affect the endocrine, integumentary, and the neurological system. For effective assessment of the patient, an overview of patient medical history and physical examination is important. These systems have far-reaching effects on the body functions. To evaluate the extent by which they are affected, nursing assessment includes the examination of symptoms associated with systems’ malfunctioning.

Reference List

Agabegi, E., & Agabegi, S. (2008). Step-Up to Medicine (Step-Up Series). Hagerstwon, MD: Lippincott Williams & Wilkins.

Arora, S., Marzec, K., Gates, C., & Menchine, M. (2011). Diabetes knowledge in Predominantly Latino patients and family caregivers in an urban emergency department. Ethn Dis., 21(1), 6-9.

Aschner, P., Horton, E., Leiter, L., Munro, N., & Skyler, S. (2010). The Practical steps to Improve the management of type 1 diabetes: recommendations from Global.

Partnership for Effective Diabetes Management. Int J Clin Pract, 64(3), 305-9. British National Formulary. (2007). Treatment of hypoglycaemia. Web.

Burke, T., Strkenboom, M., Ohman-Strickland, P., & Wentworth, E., Rhoads, G. (2007).

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The effect of antihypertensive drugs and drug combinations on the incidence of new-onset type-2 diabetes mellitus. Pharmacoepidemiol Drug, 16(9), 979-83.

Chen, H., Wu, T., Jap, T., Lin, H., Hsiao, L., & Lin, D. (2010). Improvement of glycaemiaControl in subjects with type 2 diabetes by self-monitoring of blood glucose: comparison of two management programs adjusting bedtime insulin dosage. Int J Clin Pract., 64(1), 413-22.

Cooke, D., & Plotnick, L. (2008). Type 1 diabetes mellitus in pediatrics. Pediatr Rev, 29 (11), 134-9.

Garg, S, & Hirsch, I. (2010). Self-monitoring of blood glucose. Int J Clin Pract Suppl., 66(4), 10-15.

Jong, G., Chang, H., Tien, L., Li, Y., Lung, H., & Ma, T. (2009). Antihypertensive drugs and new-onset diabetes: a retrospective longitudinal cohort study. Cardiovasc Ther, 27(2), 159-68.

Koroscil, T., Kagzi, Y., & Zacharias, D. (2007). Failure of Multiple therapies in the Treatment of a type 1 diabetic patient with insulin allergy: a case report. Patient Educ Couns., 60(2), 228-35.

Kubiak, T., Hermanns, N., Schreckling, J., Kulzer, B., & Haak, T. (2007). Evaluation of Self-management based patient education program for the treatment and prevention of hypoglycemia-related problems in type 1 diabetes. Expert Rev Pharmacoecon Outcomes Res, 7(5), 491-96.

Lim, S., Kang, M., Shin, H., Won, J., Yu, H., Kim, Y., Yoo, Y., Jung, S., Park, S., & Ryu, J., Jang. C. (2011). Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system. Diabetes Care, 34(2), 308-16.

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Liou, S., Ma, T., Tien, L., Chien, C., Chou, P., & Jong, G. (2008). Long-term effects of antihypertensive drugs on the risk of new-onset diabetes in elderly Taiwanese hypertensives. Int Heart J., 49(2), 205-9.

Pickup, J., Freeman, C., & Sutton, J. (2011). Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self-monitoring of blood glucose: meta-analysis of randomized controlled trials using individual patient data. BMJ, 7(2), 343-59.

Ragia, G., Petridis, I., Tayridou, A., Christkidis, D., & Manolopoulos, G. (2009). Presence of CYP2C9 allele increases risk for Hypoglycemia in Type 2 diabetic patients treated with sulfonylurea. Pharmacogenomics, 10 (11), 1781-96.

Seligman, H., Davis, T., Schillinger, D., & Wolf, S. (2010). Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes. J Health Care (21(4), 1227-40.

Unger, J. (2011). Insulin initiation and intensification in patients with T2DM for the Primary care physician. Diabetes Metab Syndr Obes, 4(2), 253-60.

Wexter, J. (2008). Inpatient diabetes management in general medical and surgical settings: evidence and update. Diabetes Obes Metab., 10(1), 34-44.

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