Diabetic Scenario: Dealing With High Blood Pressure Essay

Case Summary

Douglas Adams is a 51 male patient with type 1 diabetes and hypertension. In order to manage his problem, he was taking medication, insulin. He was found unconscious by a friend who called the ambulance to bring him in. This report is a brief assessment of his health including physical assessment and other relevant tests.

Data Information

Subjective Data

Apparently, the patient lives alone in a single unit house and this could cause loneliness to him. Besides he is a heavy smoker even though he does not drink, Dunning, (2010, p. 45). The complications that come as a result of the pathophysiological development of diabetes are numerous and they are all detrimental sometimes leading to death American Diabetes Association, 2006, p. 5). DA was admitted after diagnosis of disorientation and confusion after he was found by a friend.

DA was taking insulin in the form of Humalog Mix 25: 26 units Mane Nocte, Perindopril: 4 mg mane and Aspirin 100 mg per day. He does not drink but he is a heavy smoker (one packet per day) and lives alone.

Objective Data

Douglas’s Glasgow coma score was 14/15 in the Emergency Room. He had vital signs as follows; HR-82 bpm, BP-110/87 mmHg, RR-18 and T-36.8. The doctor planned a CT scan on him later in the day. He was also having QID and 4/24 neurological observations as recorded in the morning. In the morning, his blood sugar level was 5.2 mmol/L and the nurses administered his medication. Before seeing the doctor, he was sweaty and a little shaky. He ate part of his breakfast and claimed he wasn’t hungry. He was found to be pale and spoke with a slightly slurred speech. The vital signs are HR – 88 bpm, BP – 105/80 mmHg, RR-18, T – 36.5.

When there is no enough insulin, the body is unable to utilise the blood sugar hence causing hyperglycaemia. It therefore requires daily injections of insulin (Rossetti, 2008, p. 118). However, sometimes the insulin treatment often reduces glucose much lower than the normal range hence hypoglycaemia (Zarowitz et al., 2006, p. 236).

Hypothesis

Douglas Adams suffered hypoglycaemic reaction caused as a result of very low blood glucose. When diabetes patients are on insulin medication and also taking drugs to manage hypertension they can suffer hypoglycaemia because the drugs could cause too much utilization of glucose (Zarowitz et al., 2006, p. 236). However, the insulin shock could still have been caused by causes like CAD or accelerated hypertension.

Discussion of the Hypothesis

The causes of hypoglycaemia are forgetting to eat, eat very little food, the patient drunk alcohol, exercised too much or did not adhered to insulin regime (Ali, 2007, p. 49). The hypoglycaemic effects come as a result of side effects especially the oral or some specific types of insulin drugs (Zrebiec, 2006, p. 213: ADA, 2006, p. 5). This causes hypoglycaemia when the blood glucose falls below 70mg/dL. The symptoms of hypoglycaemia ensue;

1. Hypoglycaemia reduces the level of consciousness of the patient. Essentially, glucose is needed for energy, maintenance of body cells and for growth (ADA, 2007, p. 15) especially the brain Brands, 2005, p. 728). When blood glucose gets low, the brain cannot function well. Cognitive function is affected and the patient suffered confusion and disorientation (ADA, 2007, p. 15). The patient also becomes very weak and aggressive. In such a state, the patient does not have energy even to move and even if he is able to move, he may not know direction (Zrebiec, 2006, p. 213). To determine this I would ask his name and if he knows where he was at the moment.
2. The patient could suffer coma. Insufficient glucose to the brain could be severe that the loss of consciousness exacerbate to seizures and then to total unconsciousness (Briscoe, & Davis, 2006, p. 115). This is diabetic coma. Hypoglycaemia is commonly experienced at night when the patient is asleep (ADA, 2008, p. 51). This could be probably the reason why Douglas was found disoriented in the morning. The patient can be seen to be sweating, hungry, trembling and with a very fast heart rate (Johnson, 2008, p. 154). When the patient regains consciousness, I would ask whether he took normal doses as prescribed by the physician or was it excess.
3. Hypoglycaemia may cause anxiety for the patient. Many patient of type 1 diabetes suffer hypoglycaemia episodically (Johnson, 2008, p. 154: Patton et al., 2008, p. 252). This can happen anytime and it is often very dangerous during the night. The risk of experiencing seizures, coma and possible death causes anxiety (Johnson, 2008, p. 155). Many patients panic when they experience such attacks since they need to frequently check their blood glucose levels (Briscoe, & Davis, 2006, p. 115: Brands, 2005, p. 728). At this point I would ask the patient whether he understood what could happen and if he was scared.
4. The mood of the patient may be aggressive. in a hypoglycaemic state the feeling is nasty and as a result, the patient tends to be moody (Daneman, 2006, p. 847). This is because, when cognitive function of brain is affected and the patient is undergoing confusion, nausea, light headedness, fatigue, restlessness and possible dizziness they will tend to get have sudden moodiness and clumsy behavior (Wang, et al., 2008, p. 169). When I see such behavior and ask the patient whether he was angry.

Discussion Of The Patient Interview

There are some vital physical assessments that I would conduct to help in making proper diagnosis.

1. General Appearance: Tired-looking adult male
2. Vital signs: HR-82 bpm, BP-110/87 mmHg, RR-18 and T-36.8.
3. Pulse: Regular heart rate and rhythm, the heart sounds normal
4. Head, Eyes, Ears, Nose, Throat – HEENT: Non-contributory
5. Skin: smooth, warm, and sweaty; better turgidity; non edematous
6. Chest/lungs: should be clear
7. Neurologic: confused and disoriented
8. Peripheral vascular: arterial Pulse 4+ bilaterally (bounding pulse), warm, no edema

Essentially, diabetes mellitus is the problem that faces a person when he or she is unable to manage blood glucose properly. When the problem is left unmanaged, it can exacerbate and cause complications (Winkler 2007, p. 1543). Patients suffering from diabetes are called diabetics and in order for them to maintain their blood sugar at a normal level, they have to watch their diet, do regular exercises, take oral medications and/or insulin to attain normal sugar level (Rossetti, 2008, p. 117). When blood sugar levels are very low, the patient can suffer what is called ‘Hypoglycaemic reaction’ and this is also called insulin reaction, low blood sugar reaction or insulin shock (Briscoe & Davis, 2006, p. 117). This happens when blood sugar get too low that the patient suffers confusion and disorientation (Johnson, 2008, p. 152: Ali, 2007, 39). The symptoms of this are confusion, disorientation, vomiting and slurred speech (Donnelly et al., (2005, p. 752). The general appearance test helps to ascertain this.

Vital signs like heart rate blood pressure and respiratory rate on the other hand play a crucial role in determining the contribution of hypertension to the problem the patient was suffering. Fortunately all this fell in the normal range when the patient had been assessed and have to be ruled out. The skin assessment is important because hypoglycaemia is accompanied by pale and sweaty skin because of the osmotic pressure characteristics of glucose. Neurologic tests confirm the impact of low glucose on the CNS leading to confusion (Donnelly et al., (2005, p. 752).

Reference List

Ali, R., (2007), Management of Diabetes in Older Adults, American Journal of the Medical Sciences, Vol. 333, Issue 1, pp. 35-47.

American Diabetes Association, (2007), Clinical Practice Recommendations, Diabetes Care; 30 (Suppl 1): S1- S103. Web.

American Diabetes Association, (2008), Standards of Medical Care in Diabetes [Position Statement], Diabetes Care 31 (Suppl. 1): S12 -S54.

American Diabetes Association, ADA (2006), ‘Standards of Medical Care In Diabetes,’ Diabetes Care, 29, S4 – S42.

Brands, A.M.A. (2005), ‘The Effects of Type 1 Diabetes on Cognitive Performance, A Meta-Analysis,’ Diabetes Care, Vol. 28 No. 3, p. 726-735.

Briscoe, V. J., & Davis, S. N. (2006), ‘Hypoglycaemia in Type 1 and Type 2 Diabetes: Physiology, Pathophysiology, and Management,’ Clin. Diabet., 24 , 115–121.

Daneman, D., (2006), Type 1 Diabetes, The Lancet, Vol. 367, Issue 9513, Pp. 847-858.

Donnelly, L.A., et al., (2005), ‘Frequency and Predictors of Hypoglycaemia in Type 1 and Insulin-Treated Type 2 Diabetes: A Population-Based Study,’ Diabet Med, 22, pp. 749-755.

Dunning, T., (2010), Nursing Care Of Older People With Diabetes, Dunning, Oxford, Wiley Blackwell.

Johnson, E., (2008), ‘Treatment of Diabetes in Long-Term Care Facilities: A Primary Care Approach,’ Clinical Diabetes, Vol. 26, No. 4 pp. 152-156.

Patton, S.R., et al., (2008) ‘Fear Of Hypoglycemia In Parents Of Young Children With Type 1 Diabetes,’ Journal Of Clinical Psychology In Medical Setting, Vol. 15, No. 5, Pp. 252-259.

Rossetti, P., (2008), ‘Prevention Of Hypoglycaemia While Achieving Good Glycemic Control In Type 1 Diabetes: The Role Of Insulin Analogs,’ Diabetes Care, Vol. 31 No. Supplement 2, S113 – S120.

Wang, Z.H., Kihl-Selstam, E., & Eriksson, J.W., (2008), Ketoacidosis Occurs In Both Type 1and Type 2 Diabetes – A Population-Based Study From Northern Sweden, Diabetic medicine; 25: 867–70.

Winkler G. (2007), Complications of Diabetes Mellitus, In the Basics Of Internal Medicine, Budapest. , Pp. 1541–1569.

Zarowitz, B.J., et al., (2006), ‘Application of Evidence-Based Principles of Care in Older Persons: Issue 3: Management of Diabetes Mellitus,’ J Am Med Direct Assoc 7: pp. 234-240.

Zrebiec, J., (2006), ‘Case Study: Cognitive Impairment, Depression, and Severe Hypoglycemia,’ Diabetes Spectrum, 19, pp. 212-215.