Intellectual Disability and Diabetes for Down syndrome

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Down syndrome can be described as the set of physical and cognitive symptoms resulting from an extra part or copy of chromosome 21. This extra part of a copy of a chromosome leads to the disruption of the normal line of development resulting in the physical characteristics, as well as, developmental and intellectual disabilities related to this syndrome. The extent of intellectual disability in the individuals with Down syndrome differs but is mostly mild to moderate in nature ("Down Syndrome: Condition Information", 2014). Various research has shown that the prevalence or incidence of diabetes tends to be relatively high in the individuals suffering from an intellectual disability (ID). The management of adults having down syndrome with intellectual disability and chronic disease requires an effective care plan and proper management of the symptoms. Hence, this essay will be focused on several health challenges, as well as, their potential impacts on the patient having down syndrome, intellectual disability, and Type II diabetes. Further, with the help of the ICF Model, this essay will discuss how patient’s activity and participation are impacted by the intellectual disability and a chronic illness. Lastly, it will also identify an intervention and strategy for the management of diabetes II of the patient and different measures with the help of which this intervention could be achieved.

Intellectual disability (ID) is described by considerable limitations occurred in the intellectual functioning, which is IQ less than 75; certain limitations occurring in the adaptive behavior that consists of  three types of skills, i.e., conceptual skills, practical skills, and social skills (Evans & Gallagher, 2016). As in this case, the patient is suffering from intellectual disability with Type II diabetes mellitus chronic illness; there are various health challenges that will impact the lifestyle of the patient. Due to the presence of intellectual disability in the patient, the patient may encounter communication and cognitive difficulties that will impact his ability to recognize, as well as, communicate the discomfort, pain, or any kind of symptoms he might be facing due to the presence of any other kind of ill health. Moreover, he will be prone to be affected by certain medical and health conditions like vision problems, hearing problems, constipation, etc., and will be at a higher risk of life style associated health risks like poor physical fitness and obesity (Krahn, Walker, & Correa-De-Araujo, 2015). Moreover, as the patient also have a chronic illness i.e. diabetes mellitus type II, it will impact the physical, social, and emotional well-being. The presence of diabetes will affect his energy level, his eating habits, his physical activity status, and many other lifestyle activities. The combination of moderate intellectual disability, Down’s syndrome, and diabetes mellitus type II makes the management of the chronic illness more challenging with the greater risk of poor health outcomes. There is a huge chance that there will be no or limited communication between the patient and the health professionals about diabetes and symptoms as the patient is having intellectual disability disorder. Hence, as the patient is affected by the diabetes Type II chronic medical condition and is having intellectual disability problem, it is necessary that there is a well-coordinated support for the patient from the informed healthcare practitioners and diabetes-aware carers (Trip, Conder, Hale, & Whitehead, 2015).   

The International Classification of Functioning (ICF), Disability and Health can be defined as a framework developed for the organisation and documentation of the information on the disability and functioning of the individual. Further, this framework conceptualizes the  functioning of the individual as a dynamic interaction existing between the individual’s health condition, personal factors, and environmental factors (Atkinson & Nixon-Cave, 2011). It has been observed that the individuals having any kind of disabilities are more vulnerable to face the deficiencies in receiving the health care provision and services. Based on the group, as well as, healthcare setting, it has been found that the individuals having disabilities are more prone and vulnerable of developing secondary conditions, age-related health conditions, co-morbid health conditions, and higher rates of morbidities and mortality. As the patient has Down syndrome along with moderate intellectual disability, these conditions will limit his interaction with the social environment like inaccessible to the public buildings and basic transportation, limited social support, as well as, could lead to the development of the negative attitudes. As the patient lives in the community group home, it is possible that he might experience exclusion from the full participation in his community due to the presence of Down syndrome and intellectual disability. The inability or difficulty of the patient to think and understand things will impact the health outcomes (Cardol, Rijken, & van Schrojenstein Lantman-de Valk, 2011). The presence of diabetes with intellectual disability will make him difficult to understand and communicate the symptoms associated with his chronic illness. Moreover, the social exclusion, limited access to the outer world, and modification in his dietary and physical activity status will lead to the lifestyle modifications. He also attends disability program daily on the weekdays, but it is possible that due to the presence of diabetes mellitus type 2 he feels low in energy and suffers from fatigue, which in turn can affect his daily participation. Further, as in diabetes the maintenance of the functional independence, as well as, control of blood glucose levels is very important, the management, in this case, would be challenging as the patient is having moderate intellectual disability, which would make him difficult to understand and recognize the symptoms and treatment plan effectively (Simões & Santos, 2016).

As the patient is suffering from type II diabetes mellitus, it is very important to make dietary modifications along with physical exercises for the better management of his chronic disease. Hence, the intervention plan for the management of diabetes mellitus type II in the patient would be focused on the nutritional therapy, as well as, physical activity. The adherence to a low-fat, as well as, low-carbohydrate dietary intake will reduce the number of consumed calories, which will maintain the lower body fat content. Because fat is found to be naturally resistant towards the insulin, hence reducing the fat will make the body to become more sensitive towards insulin. Hence, the dietary modification would include a reduction in the saturated or trans fats (e.g., cream, fast foods, chocolates, high-fat cheese, meat, sausages, fatty bakery, and spreads). The diet  plan would include consumption of fresh vegetables and fruits (around five servings a day). Whole-grain cereals and bread, pasta, parboiled rice, legumes should be included in the dietary regimen. Sugar is not required to be excluded. However, its consumption should be limited (Toeller & I. Mann, 2007). Secondly, by physical activity and with the adoption of an exercise regimen, the reduction in the blood glucose levels could be achieved when there is more absorption of glucose from the bloodstream. Physical activity is found to be the key intervention plan in the management of the Type 2 diabetes. Physical activity positively affects the different main issues associated with the diabetes mellitus, which are the reduction in the levels of the blood glucose, reduction of insulin required, and increase in the insulin sensitivity (Griffiths, 2016).

The concern, in this case, is not the management of the diabetes mellitus type 2, but the fact that he has intellectual disability along with it, which may hinder the process of effective management of the chronic disease due to inability of the patient to stick to his dietary regimen and physical activities thus exacerbating his condition.  The complexities of diabetes management are intensified in people with intellectual disability. While it is quite evident that the physical activity is beneficial in the management of the diabetes mellitus type II in the individuals having intellectual disability, but to make this physical activity as a part of these individuals is often very difficult (Uysal, Albayrak, Koçulu, Kan, & Ayd?n, 2014).  Problems of communication are the common thing that may arise between the patient and healthcare providers. Hence, the strategy to achieve the intervention plan should be focused on better communication with the patient. The improvement in the communication can be achieved by making adjustments in the interaction approach by the healthcare providers with the patient. During the provision of diabetes education and about the required modification of the diet and physical activities, it is very important there is a development of a sound personal relationship with the patient. Healthcare. This may be achieved with the high degree of patience and empathy and patience. Effective learning is enhanced by following frequent repetitions of concept and data and, and this approach is very important for the individuals with intellectual disability. Hence, a management plan should be given to the patient, as well as, to all the concerned healthcare providers for making the patient recognize and understand what are the dietary modifications and exercises are required for him (Whitehead, Trip, Hale, & Conder, 2016).

The varied tasks included in the daily and effective management of individuals with diabetes are complexed in those having an intellectual disability. Moreover, people having these kinds of condition and ailments often fall in the low-resource population with having only limited health care facilities. Hence, it is very important that these individuals receive the proper and coordinated support of various healthcare providers and carers. The use of effective communication skills with these individuals have been found to show tangible improvements and effective results in the management and care of the individuals with intellectual disability. Hence, by utilizing listening and communication skills, reflection, as well as, critical analysis of the patient’s situation will lead to good nursing practice and management of the people with chronic illness and intellectual disability (Bowers, Webber, & Bigby, 2014).

References

Atkinson, H. & Nixon-Cave, K. (2011). A Tool for Clinical Reasoning and Reflection Using the International Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model. Physical Therapy, 91(3), 416-430.

Bowers, B., Webber, R., & Bigby, C. (2014). Health issues of older people with intellectual disability in group homes. Journal Of Intellectual And Developmental Disability, 39(3), 261-269.

Cardol, M., Rijken, M., & van Schrojenstein Lantman-de Valk, H. (2011). People with mild to moderate intellectual disability talking about their diabetes and how they manage. Journal Of Intellectual Disability Research, 56(4), 351-360.

Down Syndrome: Condition Information. (2014). Nichd.nih.gov. Retrieved 19 August 2016, from https://www.nichd.nih.gov/health/topics/down/conditioninfo/Pages/default.aspx

Evans, J. & Gallagher, S. (2016). Developmental and intellectual disability. Elsevier Inc.

Griffiths, R. (2016). Principles of practice for supportive care: diabetes (pp. 492-513).

Krahn, G., Walker, D., & Correa-De-Araujo, R. (2015). Persons With Disabilities as an Unrecognized Health Disparity Population. Am J Public Health, 105(S2), S198-S206.

Simões, C. & Santos, S. (2016). The Impact of Personal and Environmental Characteristics on Quality of Life of People with Intellectual Disability. Applied Research Quality Life.

Toeller, M. & I. Mann, J. (2007). Nutrition in the Etiology and Management of Type 2 Diabetes.

Trip, H., Conder, J., Hale, L., & Whitehead, L. (2015). The role of key workers in supporting people with intellectual disability in the self-management of their diabetes: a qualitative New Zealand study. Health Soc Care Community, n/a-n/a.

Uysal, A., Albayrak, B., Koçulu, B., Kan, F., & Ayd?n, T. (2014). Attitudes of nursing students toward people with disabilities. Nurse Education Today, 34(5), 878-884.

Whitehead, L., Trip, H., Hale, L., & Conder, J. (2016). Negotiated autonomy in diabetes self-management: the experiences of adults with intellectual disability and their support workers.Journal Of Intellectual Disability Research, 60(4), 389-397.