Diabetes Mellitus Type 1- Signs & Symptoms
(Mnemonic)
Outline
Miss Matthews is a 16-year-old female who is brought to the emergency department after collapsing at school. She is currently alert, but pale and weak. A blood glucose performed by the paramedics read meter Max or high.
Critical Thinking Check
Bloom's Taxonomy: Application
What additional nursing assessments should be performed at this time?
Has she been told previously that she has diabetes?
Does she take any medications on a daily basis?
Upon further questioning, the parents report that their daughter has been weak a lot lately. Miss Matthews reports but she’s always hot and exhausted. She reports a 10-pound weight loss over the last 2 months despite eating all the time and agrees that she has been thirsty and peeing a lot.
The nurse notes Kussmaul respirations and fruity breath.
Critical Thinking Check
Bloom's Taxonomy: Analysis
What diagnostic tests should be run for Miss Matthews?
A serum glucose revealed that Miss Matthews’ blood glucose is 523 mg/dL, and her urine was positive for ketones. The provider explains that she is likely a diabetic. Her parents are shocked as she has always been a healthy and athletic child. The parents ask the nurse “ How can she be diabetic when she is so skinny and exercises all the time?
Your daughter has Type 1 diabetes, which means that she has an autoimmune disorder that attacks the cells in her pancreas that make insulin. Type 1 diabetes typically has nothing to do with diet and lifestyle and usually has more to do with genetics.
Your daughter’s healthy lifestyle will continue to help her control her blood sugar levels, but unfortunately, there is no cure for type 1 diabetes at this time.
Critical Thinking Check
Bloom's Taxonomy: Analysis
What treatments do you expect to be ordered for Miss Matthews at this time?
Miss Matthews will need intensive insulin therapy and IV fluids to counteract the ketoacidosis and bring her blood sugars down.
She will then need to be started on long-acting insulin like Lantus and short-acting insulin-like NovoLog for correction with meals.
Miss Matthews is treated for diabetic ketoacidosis over the next 2 days and is now feeling much better. The diabetic nurse educator comes by to teach Miss Matthews how to self-administer SubQ insulin using an insulin pen. Miss Matthews says “I can’t stand needles, isn’t there a pill I can take instead?”
Critical Thinking Check
Bloom's Taxonomy: Comprehension
What is the most appropriate response by the nurse?
Miss Matthews is able to demonstrate proper technique for glucose monitoring and self-administration of insulin with the insulin pen. Her blood glucose levels are stable between 140 and 180 mg/dL, and the provider has said that she could go home today.
Critical Thinking Check
Bloom's Taxonomy: Application
In addition to the insulin education, she has already received, what other education topics should be included in discharge teaching for Miss Matthews?
Miss Matthews should be taught how to count carbohydrates to determine the amount of insulin required.
She should be given a prescribed sliding scale or insulin protocol to follow.
Miss Matthews should also be instructed on when to take her long-acting insulin and when to take regular insulin in relation to meal times. It is important that she does not take short-acting insulins without being ready to eat.
Miss Matthews should be educated on the possibility of morning hyperglycemia due to the Somogyi effect or Dawn phenomenon, and be given suggestions to try an evening dose of insulin or an evening snack.
The importance of follow-up appointments with her primary care provider and/or endocrinologist should be stressed. She should have her Hgb A1c checked every 3 months to start with.
She should also be educated on foods to avoid, such as desserts and sweets, and foods that are beneficial, such as fruits and vegetables and high-quality proteins.
Miss Matthews should carry some candy or glucose tablets with her in case of a hypoglycemic reaction.
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.
Miriam Wahrman, MSN/Ed, RNC-MNN 
Chance Reaves, MSN-Ed, RN 