401209 Health Variations For the Chronic Illness and Disability

When given subcutaneously, the NovoRapid insulin is quickly absorbed and can begin acting by lowering blood glucose levels. Because it is administered before meals it successfully controls postprandial blood glucose levels rather effectively and avoids hyperglycemia in patients. Its duration of action is short. It has an additional aspartic acid at position 28 on the B chain, this helps its rapid absorption when injected subcutaneously. It lowers blood glucose levels by binding to insulin receptors on cells so that uptake of glucose by cells occurs. This leads to a lower hepatic glucose output (Novonordisk).

NovoRapid is a recombinant insulin produced using the Saccharomyces. It is a rapid-acting insulin and begins acting 10-20 minutes after it has been injected. Its effect lasts for 1 to 3 hours and it stops working after 3 to 5 hours. It is also called insulin aspart and gives good postprandial control of blood sugar. Since it is a rapid acting insulin it is usually administered before meals (Bullock & Manias, 2016).

Hypoglycemia is defined as ''the occurrence of a wide variety of symptoms in association with a plasma glucose concentration of 50 mg per dl or less'' (Field, 1989). Hypoglycemia is a complication that occurs due to medication used to control blood sugar levels. Hypoglycemia increases the risk of mortality among patients with diabetes. 92% patients perceived autonomic symptoms of hypoglycemia whereas 88% patients experience neuroglycopenic symptoms (Hendrieckx, et al., 2017). It is possible to reduce the risk of diabetes by checking blood glucose levels more frequently. Hypoglycemia can be treated by taking oral glucose to restore the blood sugar levels. It occurs in diabetes patients irrespective of age, gender, and duration since onset of diabetes (Hendrieckx, et al., 2017).

It is important to understand the medication and schedule of administration before administering so that the correct dosage, timing and effects of the medication are understood in advance. In case of an adverse effect of the drug the nurse is prepared with follow up action (NHS). 

The five rights of medication use and administration should be followed by all health practitioners including nurses because the rights ensure safe medication of patient and if followed correctly will avoid errors in medication (Grissinger, 2010). The rights include- the right patient, followed by the right drug at the right time in the right dose through the right route. 

A 4 mm insulin pen needle is adequate for Ben irrespective of his BMI (O’Neal, Johnson, & Swar, 2015). 

Prior to administration of NovoRapid insulin to Ben it is important to check his blood sugar level, confirm whether he is ready for a meal just after the administration, because it is a fast acting insulin. The site for injection should be checked for lipodystrophy (Theofanidis, 2017). 

The site for injecting insulin in Ben's case would be abdomen and the injection can be given at an angle of 45 degree, because he has recently lost weight. The site will be adequately rubbed with alcohol for disinfection (Theofanidis, 2017). 

The dose, timing and site of injection should be recorded soon after injecting insulin and initialled. The documentation should be done on the patient chart (NHS). post administration of insulin, when you would provide it and why. Support your answer with academic references. (5 marks)

After administration of insulin it is important to remain alert for any signs of hypoglycemia or hyperglycemia. Once blood glucose is checked and in case either hypoglycemia or hyperglycemia is observed it should be immediately reported to the healthcare team by the nurse (McCall, 2012). 

Discuss the potential impact of type 1 diabetes on Ben. 

Living with diabetes for a young person can be challenging. Although it is possible to lead an active life, the patient has to be very punctual with regard to taking insulin. Even if care is taken, a missed dose or slight variation in food can cause hypoglycemia or hyperglycemia. The patient and the family have to remain alert for such an eventuality. Initially the injection of insulin dose before every meal and monitoring the blood glucose levels several times a day may cause concern. Constantly watching one's own diet can also prove difficult. Issues with non-adherence may cause poor glycemic control. This can lead to higher morbidity (Borus & Laffel, 2010). 

Controlling blood sugar levels for type 1 diabetes patients is a life-long challenge. The constant need for medication, blood sugar monitoring, controlling diet and balancing an exercise regime into the daily routine can affect the patient psychologically and cause emotional distress. If the patient suffers from emotional stress, it can also affect the control of blood sugar. In such cases counseling or cognitive behavior therapy can help the patient to resolve emotional distress (Ashraff, Siddiqui, & Carline, 2013).

Reference list

Ashraff, S., Siddiqui, M. A., & Carline, T. E. (2013). The Psychosocial Impact of Diabetes in Adolescents: A Review. Oman Medical Journal, 28(3):159–162.

Borus, J. S., & Laffel, L. (2010). Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Current Opinion in Pediatrics, 22(4): 405–411.

Bullock, S., & Manias, E. (2016). Fundamentals of Pharmacology, 8th Edition. Pearson.

Field, J. (1989). Hypoglycemia. Definition, clinical presentations, classification, and laboratory tests. Endocrinology and Metabolic Clinics of North America, 18(1):27-43.

Grissinger, M. (2010). The Five Rights: A Destination Without a Map. Pharmacy and Therapeutics, 35(10):542.

Hendrieckx, C., Hagger, V., Jenkins, A., Skinner, T., Pouwer, F., & Speight, J. (2017). Severe hypoglycemia, impaired awareness of hypoglycemia, and self-monitoring in adults with type 1 diabetes: Results from Diabetes MILES-Australia. Journal of diabetes and its complications, 31(3):577-582.

McCall, A. L. (2012). Insulin Therapy and Hypoglycemia. Endocrinology and Metabolism Clinics of North America, 41(1):57–87.

NHS. (n.d.). Diabetes%20Clinical%20Guidelines/Documents/Guideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf. Retrieved from https://www.nhslanarkshire.org.uk: https://www.nhslanarkshire.org.uk/Services/Diabetes/Diabetes%20Clinical%20Guidelines/Documents/Guideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf

Novonordisk. (n.d.). www-novonordisk-au/Health%20Care%20Professionals/Documents/NovoRapid-NovoMix%20pi4a_MarketingVersion.pdf. Retrieved from https://www.novonordisk.com.au: https://www.novonordisk.com.au/content/dam/australia/affiliate/www-novonordisk-au/Health%20Care%20Professionals/Documents/NovoRapid-NovoMix%20pi4a_MarketingVersion.pdf

O’Neal, K. S., Johnson, J., & Swar, S. (2015). Nontraditional Considerations With Insulin Needle Length Selection. . Diabetes Spectrum?: A Publication of the American Diabetes Association, 28(4):264–267.

Paschou, S. A., Papadopoulou-Marketou, N., Chrousos, G. P., & Kanaka-Gantenbein, C. (2018). On type 1 diabetes mellitus pathogenesis. Endocrine Connections, 7(1):R38–R46.

Theofanidis, D. (2017). In-Hospital Administration of Insulin by Nurses in Northern Greece: An Observational Study. Diabetes Spectrum?: A Publication of the American Diabetes Association, 30(3):175–181.