Mind map

Type 1 Diabetes

Ashley Prasad English

Map content

Type 1 Diabetes

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
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
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
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
By Chantalee Dunkley and Ashley Prasad