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The RollerCoaster of Type 1 Diabetes Mellitus

Lilian Lu Nursing Inglés

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Etiology & Pathophysiology
- Autoimmune Disease
  - Pancreas
    - Destruction of Pancreatic Beta Cells
      - Little or no insulin being produced
        Hyperglycemia
        Body begins to use fat source for energy
        Diabetic Ketoacidosis aka DKA
        Signs and Symptoms
        Confusion
        Fruity smelling breath
        Abdominal pain
        Nausea & vomitting
        High levels of ketones in urine
        Body produces high levels of blood acids called ketones. DKA develops when body cannot produce enough insulin
        Warning Signs
        Blood sugar is over 240mg/dL
        Symptoms of dry mouth, feeling thirsty, or peeing alot
        If Ignored
        Diabetic Coma
        Death
        Treatment
        Fluid replacement
        Insulin administration intravenously (IV)
        Nursing Intervention: Assess skin turgor, mucous membrane and thirst. Monitor intake and output. Assess vital signs especially for orthostatic hypotension.
        Monitor blood glucose and, ketones
        Ongoing clinical assessment of patient
        Educate patient
        LIFE THREATENING
  - Genetic Predisposition
    - Human Leukocyte Antigens (HLAs)
  - Exposure to a Virus
- Diagnostic Studies
  - A1C Blood Test > 6.5%
  - Random Plasma Glucose >11mmol/L
  - Fasting Plasma Glucose >7mmol/L
  - 2hr OGGT level after a 75g oral glucose load >11.1mmol/L
- Risk Factors
  - Family History
  - Genetics
  - Geography
  - Age
  - Environmental
    - IMPORTANT FACT: Researchers have noticed that more type 1 diabetes are diagnosed in northern climates, leading to suggest that environmental triggers play a role
    - Viral infection
- About one third of all people with diabetes do not know they have the disease
Complications
- Nephropathy
  - Glomeruli of Kidney
    - Damage to small blood vessels
- Neuropathy
  - Damages Nerve Fibers
- Macrovascular Angiopathy
  - Cerebrovaascular Disease
  - Cardiovascular Disease
- Integumentary
  - Necrobiosis Lipoidica Diabeticorum
  - Granuloma Annulare
- Foot
  - Risks
    - Sensory Neuropathy
    - Peripheral Artery Disease
      - Possible Amputation
  - Caring for your feet
    - Check feet everyday
    - Be acive
    - Keep skin soft and smooth
    - Wash feet everyday
    - wear shoes and socks at all times
    - Trim toe nails
- Microvascular Angiopathy
  - Thickening of blood vessel membranes
    - Can lead to
      - Retinopathy
        Damage to Retina
      - Dermopathy
      - Nephropathy
      - Neuropathy
- Long- term complications develop gradually. Good blood glucose management can help lower risk of complications
- Diabetes complications are all related to poor blood glucose control. Must work closely with health care team, to correctly manage your blood sugar
Nursing Management
- Health Promotion
  - Monitoring
  - Educating the Client and Family
  - Evaluation
    - Expected Client Outcomes
  - Risk Reduction
    - Wear Medical Alert Identification
    - Lower Stress
  - Who can help?
    - Family Physician
    - Diabetes Educator
    - Nurse
    - Endocrinologist
    - Pharmacist
    - Foot Care Specialist
    - Eye care Specialist
  - Help prevent or delay the development of complications by keeping blood sugar in a target range (4-6 mmol/L).
  - Attend regular checkups
- Planning
  - Maintenance of Normal Blood Glucose Levels
  - Prevent, Minimize, or Delay Chronic Complications
  - Overall Goals
    - Reduce Symptoms
    - Promote Well-being
- Support Groups
  - Connecting with others living with diabetes, that understands
  - Community support groups
Treatment
- Drug Therapy
  - Insulin Injection
    - Route: Abdomen, arm, thigh, buttock
    - Problems
      - Somogyi Effect
        Hormones released that increase glucose levels (Hyperglycemia)
        Blood glucose level < 4mmol/L
        Treatment for hypoglycemia:
        If you are conscious: 15 grams of simple carbohydrates
        Glucose tablets
        2 tablespoons of raisins
        8 ounce of nonfat or 1% milk
        1 tablespoon sugar, honey or corn syrup
        Glycemic Index (GI)
        If you are unconscious:
        Someone call 911
        Patient MUST be given an injection of 1 mg of glucagon
        Severe hypoglycemia: Blood glucose < 2.8 mmol/L
        Glucose level drops too low in early morning hours (hypoglycemia)
        Nursing Intervention: lower insulin dose in P.M or increase food intake in A.M
      - Dawn Phenomenon
        Early- morning (4 a.m to 8 a.m) rise in blood glucose level
        Steps that may help: 1) Eat dinner earlier in the evening 2) Do something active (such as going for a walk)
        Nursing Intervention:Educate patient about diet, exercise and insulin regimens
      - Lipodystrophy
        Educate patient about routing injection sites
      - Allerigic Reactions
    - Lispro
      - Rapid Acting onset: 10-30 minutes
    - Regular
      - Short Acting onset: 30 minutes to 1 hr
    - NPH
      - Intermediate- Acting Onset: 1.5-4 hrs
    - Lantus Levemir
      - Long Acting Onset: 0.8- 4 hrs
  - Insulin Pump
    - Insulin travels into body through flexible tube that ends with a tiny needle called a "cannula" inserted just under the skin
      - Diabetes is so called Juvenile-onset diabetes, but this is no longer called that as more adults are being diagnosed.
    - Insulin is injected into the subcutaneous tissue aautomatically by the pump
- Nutritional Therapy
  - Plate Method
    - Helps maintain body weight
    - Helps maintain blood glucose
- Physical Activity
  - Benefit of exercise
    - More Energy
    - Stronger Bones
    - Leaner, stronger muscles
    - Better Control of weight
    - Lower Blood Pressure
  - Types of Exercise
    - Aerobic
      - Walking
      - Jogging
      - Tennis
      - Swimming
      - Biking
    - Strength Training
      - 20-30mins, 2-3 times a week
    - Recommend: 150mins Moderate intensity
    - Flexibility Training
- Self Monitoring
  - Track trends and patterns
  - Can detect hypoglycemia and hyperglycemia
Clinical Manifestations
- Weight loss
- Poor Healing
- Fatigue
- Polyuria
  - Urination
- Polyphagia
  - Thirst
- Polydipsia
  - Hunger
- Blurred Vision
  - Diabetes is the leading cause of blindness in working age adults
By: Khamoy Kitson
- & Lilian Lu
- Welcome to the Type 1 Diabetes Express! Thank you for joining us on this exhilarating ride!