Scenario: Sam Wood is 18-years-old and has been admitted to the ward with a new diagnosis of Type 1 Diabetes and a skin infection.
On arrival, his observations are as follows:
- Temperature 38.8° C
- Heart Rate/Pulse 120 BPM
- Respiratory Rate 26
- Blood Pressure 100/60
- BGL 22 mmol/L
- Blood Ketones 2.1 mmol/L (N=<0.6)
- pH 7.30 (N=7.35)
Sam enjoys sports and plays football every weekend for his local team. He socializes with a group of friends he has known since school and usually goes clubbing on the weekends. Sam smokes 10 cigarettes every day and frequently buys lunch from fast food outlets.
On admission to the ward, Sam’s skin is dry and hot to touch. He is flushed and has a productive cough (i.e. the cough produces phlegm/mucus, clearing it from the lungs). He is 180cm tall and weights 62kg. He is complaining of thirst and tiredness.
Sam has been commenced on, IV normal saline 250mls/hr over 4 hours, an IV Insulin Infusion and IV antibiotics.
1. Analyse Sam’s observations and state whether he is presenting with Hyperglycaemia, Hypoglycaemia, Diabetic Ketoacidosis or Hyperosmolar Non-Ketotic Coma/HHNS. Provide a rationale for your conclusion.
2. Detail how you would explain ketoacidosis to Sam, and outline four steps he can take to avoid this complication in the future.
3. Sam states that he is frightened that he will have a hypoglycaemic episode. What advice can you offer him to reduce the risk of hypoglycaemia?
4. Discuss how Sam’s self-esteem could potentially be affected by the effort required to manage his diabetes.
5. Discuss the possible psychosocial issues that Sam may experience due to his diagnosis of Type 1 Diabetes.
6. Sam states that he wants to use ‘Continuous Glucose Monitoring’ (CGM) and an Insulin Pump following discharge. Provide specific advice to Sam in relation to accessing diabetes resources and support in the community after he is discharged from hospital.
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