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A Critical Analysis of the Adult Patient with type 1 Diabetes - Essay Example

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Management of Type-1 Diabetes in Adults Long term conditions are common in UK. In Britain alone, 6 out of 10 adults suffer from a long term condition that cannot be cured immediately and providing care for these patients is often complex (NHS, National Service Framework for Long term Conditions, 2006)…
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A Critical Analysis of the Adult Patient with type 1 Diabetes
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A Critical Analysis of the Adult Patient with type 1 Diabetes

Diabetes mellitus is a group of clinical syndromes which occurs due to insulin deficiency. The deficiency may be either absolute or secondary or relative (Khardori, 2011). Based on the pathophysiology of the disease, there are 2 types of diabetes and they are type-1 and type-2 diabetes. The former type, the type-1 diabetes mellitus occurs due to absolute insulin deficiency and is likely to occur in younger age groups like childhood, adolescence and early adulthood (Khardori, 2011). The condition occurs due to destruction of beta cells of Langerhans of pancreas, which are the principal insulin secreting cells. Destruction of these cells due to some mechanism or the other results in absolute insulin deficiency. This pathophysiology is different from that of type-2 diabetes mellitus in which the insulin secretion is present, but is either decreased or is resistant due to insensitive peripheral receptors. Diabetes type-2 mainly occurs in older patients and is predisposed by several hereditary and familial factors. The basic management is the same in both types of diabetes; more aggressive management is seen in type-1 diabetes because of early onset and hence increased risk of development of complications. In order to support individuals with long term conditions, the government elaborated plans in 2005, there by introducing social care models of care for these individuals. A part of such care is Expert Patients Programme which focuses on promoting self-management, provision of support by nurses in complex situations and functioning in a coordinated team (NHS, 2006). In this essay, management of type-1 diabetes in adult patients will be discussed through critical analysis and review of suitable literature. Pathophysiology and various aspects of long term care of diabetes type-1 with reference to National Service Framework, National Health Service Plan and Kaiser Health Model will all be reviewed. Insulin is a very important anabolic hormone that is mainly involved with glucose metabolism. It is secreted by beta cells of Langerhans which are scattered as islets in the pancreas. The hormone is also necessary for the metabolism of other types of carbohydrates and also fats and proteins (Lamb, 2009). Elevation of insulin levels causes glucose entry into the muscles where glucose is converted to glycogen and stored. It also prevents liver gluconeogenesis. The hormone also helps in slowing down the breakdown of proteins and fat. In type-1 diabetes, there is either complete loss or destruction of beta cells of Langerhans resulting in inadequate production of insulin. This leads to uninhibited gluconeogenesis in the liver. At the same time, glucose is not used up much, nor is it converted to the storage form this leads to hyperglycemia. Beyond a certain point, the kidneys fail to reabsorb the glucose in the urine and this eventually leads to glycosuria. Glycosuria causes osmotic diuresis that leads to dehydration. The patient feels very thirsty and this may be the first symptom of diabetes type-1. Uninhibited gluconeogenesis results in excessive breakdown of fat and protein causing increased production of ketones and also loss of weight. Patients who are not appropriately diagnosed and managed properly will succumb to diabetes ketoacidosis. Infact, in many patients, diabetic ketoacidosis may be the first presenting feature and it manifests as acidotic breathing, easy fatigability and dehydration (Lamb, 2009). The most important ... Read More
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