Introduction
The patient is a 50-year-old woman who recently attended her yearly diabetes review appointment and is hospitalized due to complications linked with Type 1 diabetes mellitus. According to Perry (2022), Type 1 diabetes is a chronic disease where the body’s immune system devastates insulin-producing cells in the pancreas, resulting in an inability to produce insulin. Without insulin, the body is unable to regulate its blood sugar, which leads to elevated blood glucose levels (Kumar et al., 2020). Since the body cannot produce enough insulin to regulate their blood sugar levels, people with type 1 diabetes admittedly have a higher risk of developing type 2 diabetes (Leanza et al., 2019). Therefore, the case report will explore the patient’s clinical presentation, assessment, and management of Type 1 diabetes to ensure she does not develop Type 2 diabetes.
Patient Information
Demographic Information
- Age: 50 years old
- Gender: Female
- Ethnicity: Caucasian
Main Complaint
- The patient experiences hypoglycemia frequently, which is accompanied by symptoms such as confusion, perspiration, and shakiness.
Medical History
- Type 1 diabetes analysis: more than five years ago.
- A1C: 7.7
- Hemoglobin A1C: 6.9
- Medications: Insulin is taken twice daily through subcutaneous injection and a dose of 10 units each time before meals.
- Past Interventions: Previously, the patient was administered insulin analogs and metformin.
Family and Psychosocial History
- The patient works for a non-governmental organization.
- There is no history of diabetes in the patient’s family.
- She reports being able to control her diabetes with her current medication regimen and visits her endocrinologist regularly.
Relevant Comorbidities
- There are no significant predisposing factors in the patient.
Past Interventions and Outcomes
- The patient has been using metformin and insulin analogs for five years. While taking her current medication regimen, she has not had any severe hypoglycemic episodes in the past year.
Clinical Findings
Signs and Symptoms
The patient experiences frequent hypoglycemic episodes accompanied by confusion, perspiration, and trembling. Although it is commonly witnessed in people with diabetes, it can happen to anyone.
Physical Examination Findings
Vital signs: BP: 126/84 mmHg; Pulse: 68 bpm; Respirations: 18 bpm; Temperature: 97.6F.
Observations
The patient appears alert and oriented; skin is warm and dry; no evidence of edema or rashes; the patient can actively move all extremities.
Laboratory: A1C test result of 7.7 and Hemoglobin A1C test: 6.9
Diagnostic: The patient has been taking metformin along with insulin analogs for five years.
Timeline
- 2017: The patient was diagnosed with Type 1 diabetes.
- 2017: She started an insulin regimen.
- 2019: The patient has poor glycemic control.
- 2020: The patient started taking metformin along with insulin analogs.
- 2020-2022: She had good glycemic control.
- An episode of care is reported (2022): The patient reports frequent episodes of hypoglycemia.
Diagnostic Assessment
The patient underwent a thorough diagnostic evaluation to identify the health issue. According to Ackley et al. (2019), a diagnostic assessment includes several tests and procedures to determine a medical condition. Physical examinations, blood tests, imaging tests, and biopsies are a few examples of these tests. Additionally, the results are used to identify the disease’s type, severity, and ideal course of action (Redondo et al., 2019).
The patient’s main complaint was recurrent hypoglycemia, frequently accompanied by confusion, perspiration, and trembling. Based on this, the patient underwent several assessments, including a physical examination, surveys, and laboratory tests. However, no imaging was done as part of the assessment.
Despite being checked for any physical indications of the illness, the patient appeared to be in good health. With a blood pressure of 126/84 mmHg, a pulse of 68 bpm, respirations of 18 bpm, and a temperature of 98.6F, all vital signs were within the normal range. The patient had warm, dry skin without signs of edema or rashes.
The patient could actively move all her extremities and was conscious and oriented. These results indicate that the patient has no physical manifestations of type 1 diabetes. However, additional testing might be necessary if the patient displays non-obvious symptoms like fatigue or pain.
The patient underwent laboratory testing to determine her hemoglobin A1C and A1C levels. The A1C test determines an individual’s average blood sugar levels over the previous three months (Rajagopal, Ashwin, and Nanduri, 2019). Between 4 and 6 percent is considered normal for the A1C level, while 7% or higher denotes diabetes.
The patient has diabetes, as evidenced by the patient’s A1C level, which is 7.7, above the normal range. The amount of hemoglobin in the blood that is impacted by higher glucose levels is measured by the hemoglobin A1C test (Leong & Wheeler, 2018). The patient’s hemoglobin A1C level was 6.9, just below the A1C level, showing that their diabetes is generally under control, according to the test results.
The patient was identified as having Type I diabetes using data from the survey, her medical history, and the findings of the laboratory tests. The patient was questioned regarding their way of life, diet, level of exercise, and diabetes management. The number of times they test their blood sugar, their typical blood sugar levels, any changes in those levels, the medications they take, and how they handle missed doses were all questioned. For instance, she described having frequent hypoglycemic episodes with related symptoms of confusion, perspiration, and shakiness. Elevated glucose levels in the patient’s lab tests supported the diagnosis of Type 1 diabetes mellitus.
Type 2 diabetes mellitus and gestational diabetes are considered differential diagnoses. Because of the patient’s age and history of autoimmune disease, type 2 diabetes is frequently ruled out (Buzzetti et al., 2020; Nederstigt et al., 2019). Gestational diabetes was also disregarded because the patient had no recent pregnancies. With proper management and symptom monitoring, the patient has a good prognosis. The patient has maintained good glycemic control with her current insulin analogs and metformin regimen, and she has not had any severe hypoglycemic episodes in the previous 12 months. With continued self-management and monitoring, the patient is expected to be able to maintain good glycemic control and prevent any additional episodes of hypoglycemia.
Therapeutic Intervention
Pharmacologic and Preventive
Pharmacologic and preventive treatments are part of the patient’s therapeutic intervention. The primary treatment for type 1 diabetes, insulin therapy, is one of the pharmaceutical interventions that help to maintain normal blood glucose levels and prevent hyperglycemia and hypoglycemia (Perkins, Sherr, and Mathieu, 2021; Dong et al., 2019). The patient has also been given insulin, which helps lower blood glucose levels. Preventive actions like healthy eating, regular exercise, and routine visits to the endocrinologist should be a part of the treatment plan to avoid further complications (Mian, Hermayer, and Jenkins, 2019). As a result, the patient received advice on the significance of managing and administering insulin properly to maintain her blood sugar levels within the desired range.
The Administration of Therapeutic Intervention
As part of the therapeutic intervention, insulin doses were titrated according to the patient’s blood glucose levels. Metformin and insulin analogs were given twice daily to help keep blood sugar levels under control. Long-acting insulin analogs are a type of insulin that improves blood sugar management in people with type 1 diabetes (Sharma et al., 2019).
However, metformin enhances the body’s sensitivity to insulin and reduces liver glucose production (Beysel et al., 2018). To prevent further hypoglycemia episodes, the patient was counseled to maintain a balanced diet and increase physical activity. The patient was also kept under observation for symptoms of hypoglycemia and given glucose tablets to take in the event of an episode.
The Changes in Therapeutic Interventions
To prevent any further episodes of hypoglycemia, the patient was advised to continue to live a healthy lifestyle and eat a balanced diet. According to Zimmerman, Albanese-O’Neill, and Haller (2019) and Martyn-Nemeth et al. (2019), this involved reducing the amount of carbohydrates she eats and eating smaller, more frequent meals throughout the day. It was advised that she exercise regularly, as this would help maintain a healthy blood glucose level. It was also suggested that she regularly check the amount of glucose in her blood. Based on this, she will be able to recognize the symptoms of hypoglycemia and adjust how much insulin she takes.
Therapeutic Relationship
The patient’s improved glycemic control was evidence of the therapeutic alliance’s efficacy. The patient received the necessary tools and support, as well as clear instructions on how to manage her diabetes. The patient and the hospital agreed to allow her to visit for routine checkups and have her medications changed as necessary. The patient’s A1C levels fell from 7.7 to 6.9, within the desirable range for people with type 1 diabetes. Additionally, the patient reported no severe hypoglycemic episodes in the previous year and was able to manage her diabetes on her own with her current medication regimen.
Self-Care
To ensure the therapeutic intervention’s efficacy, the patient received education on diabetes self-care and self-management. This included guidelines for healthy eating and meal preparation, exercise, monitoring blood glucose, and identifying hypoglycemia warning signs and symptoms (Lee et al., 2019). The patient and her family received information on managing their diabetes at home and the value of routine follow-up appointments with their healthcare provider. The patient was inspired to engage in self-care practices and develop self-efficacy. She was urged to regularly check her blood sugar levels and adjust her insulin dosage as necessary.
Moreover, the patient was informed of dose adjustment for normal eating (DAFNE) to help with diabetes management. DAFNE has been effective in assisting patients in improving their glycemic control, lowering their risk of long-term complications, and increasing their quality of life (Neupane & Evans, 2019). She was told that the program teaches her how to adjust insulin doses, food intake, and other lifestyle factors such as physical activity and stress. Additionally, it is expected to provide patients with the skills they need to make informed decisions about their diabetes management. Through DAFNE, the patient will manage their diabetes, enhance their quality of life, and lower the risk of long-term complications.
Self-Efficacy
The patient expressed self-efficacy-based confidence in her ability to recover from her condition. She claims she knows her diabetes, medications, and treatment strategy. She was aware of the symptoms and signs of hypoglycemia and managed it appropriately.
In addition, she has stated that she feels in control of her diabetes and empowered, giving her a positive outlook on managing it. The patient received the tools and assistance, such as online diabetes support groups and diabetes self-management classes, that she needed to manage her diabetes actively. She was motivated to make necessary lifestyle adjustments and set reasonable blood sugar-related goals.
Follow-Up and Outcomes
Clinician- and Patient-Assessed Outcomes
The patient was closely watched during subsequent visits, and her treatment was modified as a result. During these visits, the providers checked her hemoglobin and A1C levels, as well as other vital signs, to determine how well her treatment was working. The patient has maintained good glycemic control with her current medication regimen, showing no signs of diabetic complications. Her hemoglobin A1C and A1C levels were within the desired range, demonstrating that her diabetes is effectively controlled. The patient reports that she is successfully managing her diabetes with her current medication regimen and no longer has episodes of hypoglycemia. As a result, the patient believes her diabetes is under good control and is happy with her current course of treatment.
Follow-Up Results
According to follow-up results, the patient’s glycemic control has improved since being given metformin and insulin analogs. She has not had any recent episodes of severe hypoglycemia, and her A1C and hemoglobin A1C are within the normal range. The patient continues to treat her diabetes with the same medication regimen and sees her endocrinologist on a regular basis. The patient continues to advocate for healthy lifestyle practices such as eating a balanced diet and exercising frequently. With continued diabetes management, the patient should maintain her current level of glycemic control.
Intervention Adherence and Tolerability
Key aspects of the patient’s diabetes management include medication tolerability and adherence to her insulin regimen. Poor medication adherence increases the risk of developing diabetes-related complications, which is strongly correlated with better glycemic control (Marchini et al., 2021; Kalra, Jena, and Yeravdekar, 2018). Additionally, a lack of adherence can increase the risk of hypoglycemia, which can be fatal. Unlike regular insulin, insulin analogs may be more effective at regulating blood sugar levels, and patients may tolerate them better due to fewer side effects (Nrgaard et al., 2018). Since the patient has maintained good glycemic control and has not had any life-threatening hypoglycemic episodes in the previous few months, her adherence and tolerability to her current insulin regimen are satisfactory.
Adverse and Unanticipated Events
Type 1 diabetes puts the patient at risk for unfavorable and unexpected events. Poor glycemic control can bring on long-term health problems such as cardiovascular disease, neuropathy, nephropathy, and retinopathy (Leanza et al., 2019; Khunti, Kosiborod, and Ray, 2018). Additionally, hypoglycemia can mimic the patient’s reported symptoms of shakiness and sweating (Heller & Novodvorsky, 2019). The patient has poor glycemic control, which raises the possibility of long-term complications, according to her hemoglobin and A1C readings. She may not be properly controlling her blood sugar levels with her current medication regimen, which increases the likelihood that she will experience more hypoglycemic episodes.
Biopsychosocial Impact
The patient’s biopsychosocial impact is significant since Type 1 diabetes can significantly negatively impact a person’s physical, psychological, and social well-being. Physical complications from Type 1 diabetes include blindness, heart disease, kidney failure, and nerve damage (Jiang et al., 2019; Balaji, Duraisamy, and Kumar, 2019). The stress and worry of managing the condition can psychologically lead to depression, anxiety, and other mental health problems (BR & Raman, 2019). Due to the need to monitor blood sugar levels, take medications, and the stigma associated with the condition, this type of diabetes can cause social isolation (Swanson & Maltinsky, 2019; Razaq, Mahdi, and Jawad, 2020). As a result, the patient might find it difficult to manage her diabetes while juggling her other responsibilities, like work.
Discussion
Type 1 diabetes mellitus is a chronic autoimmune disease attributed to destroying insulin-producing beta cells in the pancreas, resulting in insulin deficiency. Bullard et al. (2018) claim that the prevalence of type 1 diabetes varies between countries and regions, with an estimated global prevalence of 1.3 million individuals under 20 living with type 1 diabetes. Patients with Type 1 diabetes depend on exogenous insulin therapy to control their blood sugar levels. However, Haak et al. (2019) have stated that insulin therapy can lead to hypoglycemia if the dose or timing is inaccurate. Hypoglycemia is a common complication of insulin therapy and is characterized by low blood sugar levels and associated symptoms such as confusion, sweating, and shakiness.
An important aspect of managing type 1 diabetes is the attainment and maintenance of good glycemic control. According to Georga, Fotiadis, and Tigas (2018), the American Diabetes Association recommends a glycated hemoglobin (HbA1c) target of less than 7% for most individuals with diabetes to reduce the risk of microvascular and macrovascular complications. In this case, the patient’s HbA1c is 7.7, which suggests suboptimal glycemic control.
However, her most recent HbA1c is 6.9, which indicates an improvement in glycemic control. In support of this, Choudhary et al. (2019) believe that it is integral to constantly check glycemic control in individuals with type 1 diabetes to ensure that treatment regimens are efficient and appropriately adjusted. The management of hypoglycemia usually involves immediate administration to raise blood glucose levels.
The primary therapy for Type 1 diabetes is insulin replacement, delivered through injection or an insulin pump. Insulin analogs have replaced traditional human insulin in clinical practice due to their more predictable pharmacokinetic and pharmacodynamic profiles (Kramer, Retnakaran, and Zinman, 2021; Bolli, Cheng, and Owens, 2022). On the other hand, metformin, an oral medication for Type 2 diabetes, has been shown to lower insulin resistance in individuals with Type 1 diabetes when used together with insulin therapy (Prasad & Groop, 2019). The patient in this case study has been using a combination of insulin analogs and metformin for years, with good glycemic control and no severe hypoglycemic episodes in the past year. Therefore, Type 1 diabetes is a health problem that can be managed using appropriate medication and self-care.
This discussion teaches several valuable lessons on the importance of proper diabetes management to prevent complications. Firstly, timely diagnosis and prompt interventions are essential, as the lack of insulin in the body can result in dangerous glucose levels in the blood. Secondly, Type 1 diabetes patients are at greater risk of developing type 2 diabetes and may require a combination of insulin analogs and metformin to maintain good glycemic control. Thirdly, regular reviews and visits to an endocrinologist are key in managing this condition and preventing complications. Psychosocial support is important for individuals with diabetes since it ensures they properly manage their condition.
In the future, practice and research should focus on managing type 1 diabetes to lower the risk of complications, such as hypoglycemia, among patients. This should include adopting strategies to ensure appropriate medication adherence and glycemic control and creating effective patient education interventions to promote a healthy diet and lifestyle. Additionally, research should be done to enhance current treatments and determine new treatment alternatives for type 1 diabetes. Further research should be conducted to investigate the effects of psychological and social factors in managing type 1 diabetes to improve the quality of life for those living with the condition.
This case study report is a comprehensive summary of a patient with Type 1 diabetes. It offers pertinent demographic information, a thorough medical history, including data about past interventions and their outcomes, a psychosocial history, and relevant comorbidities. In addition, the report includes a detailed description of the patient’s presenting symptoms, physical examination findings, and laboratory test results. The information provides an overview of the patient’s condition and can offer guidance to help make other management decisions. Therefore, this case study report provides a comprehensive overview of the patient’s condition that can be used to inform future treatment decisions.
Despite the strengths mentioned above, the report has some limitations that should be considered. It has limited information about the patient’s medical and psychosocial history, family history, and comorbidities. The report does not offer information on the patient’s lifestyle, diet, or other risk factors contributing to their condition.
Additionally, there is a lack of information on the patient’s response to treatment and any potential side effects of the medications. Furthermore, the report does not provide any insight into the patient’s long-term prognosis or any potential complications of their condition. Thus, the report fails to provide suggestions for treatment or future monitoring.
Conclusion
The report has emphasized the significance of early diagnosis and management of Type 1 diabetes, as it can assist in preventing the development of Type 2 diabetes. The patient has been taught the importance of lifestyle modifications, such as a healthy diet, regular physical activity, and monitoring of her glucose levels. Therefore, she can continue to lead a healthy and active life through effective management of her condition.
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