Question

Jerry Thomas is a 26-year-old type 1 diabetic. He was originally diagnosed at the age of 14 and currently manages his disease with an intensive regimen of insulin injections. Jerry is employed as a school teacher and soccer coach. He presents today with a 2-day history of vomiting and diarrhea. He has been closely monitoring his blood glucose and is using regular insulin for high blood glucose levels. He has only been able to tolerate fluids such as Gatorade, but today he is unable to even tolerate that and comes to the clinic for evaluation of possible diabetic ketoacidosis (DKA). (Learning Objective 9)

a. describe the pathophysiology of DKA and why it occurs in patients with type 1 diabetes.

b. Based on the diagnosis of DKA, what assessment findings does the nurse correlate to this disorder?

c. The physician orders a complete metabolic panel and Jerry’s blood glucose is 425. Otherlab values include serum sodium of 152, serum potassium of 3.0, and BUN of 64. Whatis your assessment of these results?

d. Explain why it is important for Jerry to continue to take his insulin even though his oral intake is decreased.

Answer 1

a.DKA is common in type 1 diabetes because lack or inadequate insulin will lead to this condition. Usually when the food is consumed it is converted to glucose and it reaches the blood vessels when the body is in need of energy ,the insulin comes and pushes the glucose from blood to the cells and provide energy.Similarly the excess glicose stored in the liver in form of glycogen are also released and balanced by insulin . This is a normal process but in type 1 diabetes thus lack of insulin stimulates the triglycerides and aminoacids to give energy instead of stimulating the glucose.This is called lipolysis which leads to release of glycerol and alanine.Glucogon converts free fatty acids to ketones (ketogenesis) this is blocked only in presence of insulin, so when there is no insulin the ketones are continuously releases ketoacids causing diabetic ketoacidosis

b.The assessment findings which can be correlated are

• Vomiting and diarrhoea is a sign of DKA
• high blood sugar level

c.The laboratory reports suggests hyperglycemia,Hypernatremia, Hypokalemia This is suggestive of hyperosmolarity in the patient and increased BUN is a hallmark for metabolic acidosis which leads to DKA

d.It is a must to take to take insulin because body has no reserve of it ,so during illness the hormones come in action and increasing the blood sugar level to a very abnormal high ranges and leading to DKA.If insulin is administered this can be prevented and patient be saved from complications.