Type 1 Diabetes

Type 1 Diabetes

1. Assessment

   • Symptoms
     • Polyuria
     • Polydipsia
     • Polyphagia
     • Weight loss/gain
     • Fatigue and Weakness
     • Irritability
     • Mood changes
     • Blurred Vision
     • Erectile dysfunction in men
   • Risk Factors
     • Family History
     • Age
       • Increased likelihood childhood (ages 4-7) and adolescence (ages 10-14)
       • May occur in adulthood
     • Geography
       • Type 1 Diabetes incidence increase in region further away from equator
   • Etiology
     • No tolerance to self-antigens expressed in the islets of Langerhans
       • Autoimmune destruction of 80-90% of Beta cells
         • Insulin is no longer released by the beta cells
           • Increased blood glucose levels
     • Exposure to a virus
     • Genetics

2. Diagnosis

   • Glycated Hemoglobin (AC1 Test)
     • A1C level of 6.5 or more on two separate tests
     • Shows amount of glucose attached to hemoglobin molecule
     • Diagnostic test
   • Random Blood Sugar
     • Result of 11 mmol/L or greater and symptoms of diabetes
   • Fasting Plasma Glucose
     • normal: 5.6mmol/L prediabetes: 5.6 to 6.9 mmol/L diabetes: 7 mmol/L
   • Oral Glucose Tolerance Test
     • Two-hour OGTT level ≥11.1 mmol/L

3. Treatment

   • Drug therapy
     • Insulin Injections
       • Rapid Acting (Bolus)
         • Lispro
           • Onset: 10- 15 minutes Peak: 1-2 hours Duration: 3- 4.75 hours
         • Aspart
           • Onset: 9- 20 minutes Peak: Apart 1-1.5 Hours Duration: 3.5 hours
       • Intermediate Acting (Basal)
         • Onset: 1-3 hours Peak: 5-8 hours Duration: Up to 18 hours
       • Long Acting
         • Onset: 90 minutes Duration: 16 to 42 hours dependent on the drug No peak action
       • Short Acting (Bolus)
         • Onset: 30- 60 mins Peak: 2- 3 hours Duration: 6.5 hours to 24 hours
       • Problems with insulin therapy
         • Hypoglycemia
         • Lipodystrophy
         • Allergic reactions
     • Continuous Subcutaneous Insulin Infusion Therapy (CSIIT)/ Insulin Pump
       • Manually monitor glucose
       • Catheter inserted subcutaneously in abdomen, lower back, leg and arm
       • Convenient, small, accurate, adjustable
     • Closed Loop
       • Continuous glucose monitors (CGM) linked to insulin pump
         • Help monitors hypoglycemia
           • CGM’s can alert user when blood glucose level is above or below normal level
         • Delivers insulin when needed
           • Dependant on current glucose monitor readings
         • Treatment Complication
           • Bioinstability
             • Sensors can become unstable due to inflammatory and granuloma reaction
           • Lag time of 4-10 minutes for CGM’s blood glucose reading
   • Healthy Lifestyle
     • Nutritional Therapy
       • Nutritious low-fat high-fibre foods
         • Glycemic Index (GI)
           • Consume foods with lower GI (e.g. complex carbohydrates)
             • Sweet Potato
             • Carrots
         • Fats
           • Reduce saturated and trans-fat in diet; include food rich in omega-3 fatty acids
       • Balance with insulin and exercise patterns
       • Count Carbohydrates to identify the amount of insulin needed to metabolize it
     • Exercise
       • Regular Individualized physical activity
         • Increase of insulin receptor sites
         • Decreases blood glucose level
           • Monitor blood glucose level
         • Best done after meals
         • Aerobic exercise 150 minutes/week
           • Swimming
           • Walking
       • Maintain healthy weight
   • Other Treatment
     • Islet-cell Transplantation
       • Transplant new insulin-producing cells from donor pancreas
         • Treatment Complication: Islet cell rejection
       • Minimally invasive
         • Lower Morbidity
     • Pancreas Transplant
       • Greatest risk of complications
         • Chronic graft rejection
         • Pseudocyst
         • Fistula
         • Thrombosis
         • Pancreatitis
     • Gene Transfer using viral/non-viral vectors
       • Transform cells to have insulin secretory machinery
     • Stem Cell Transplant
       • Stem cells convert to beta cells to release insulin
         • Treatment Complication: Rejection of cells

4. Complications

   • Cardiovascular Diseases
     • Stroke
     • Heart Attack
   • Neuropathy
     • Nerve damage in legs & gastrointestinal tract
     • Nerve damage leading to erectile dysfunction
   • Nephropathy (Kidney Disease)
     • Kidney blood vessels damaged leading to kidney failture
       • Treatment
         • Dialysis
         • Kidney transplant
   • Increased susceptibility to bacterial and fungal infections (i.e. gum disease)
   • Retinopathy (Eye Damage)
     • Blindness
   • Pregnancy Complications
   • Ketoacidosis
     • Profound Insulin deficiency
       • Characteristics: Hyperglycemia Ketosis Acidosis Dehydration
       • Causes
         • Illness/Infection
         • Inadequate insulin dosage
         • Poor self-managemnt
         • Undiagnosed Type 1 Diabetes
       • The deficiency in insulin releases hormones that wouldn't otherwise be released, increasing the level of glucose.
     • Symptoms
       • Frequent urination
       • Excessive thirst
       • Confusion
       • Shortness of breath
       • Abdominal pain
       • Nausea and vomiting
     • Body produces high amount of ketones (blood acids)
   • Anxiety
   • Hypoglycemia
     • Low blood sugar
       • Blood glucose level <4 mmol/L
     • Treatment
       • Nursing Care
         • Monitor Physical Activity
           • Physical activity plus insulin causes blood sugar level to decrease significantly
         • Eat fewer carbohydrates
         • Avoid Skipping Meals
     • • Manifestations
         • Diaphoresis
         • Hunger
         • Headache
         • Fatigue
         • Tremors
         • Irritability
         • Rapid irregular heart rate
         • Dizziness
         • Confusion
     • Somogyi Effect
       • Rebound hyperglycemia after Nocturnal hypoglycemia due to Stress hormones being released

5. By Chantalee Dunkley and Ashley Prasad

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