Diabetes Mellitus Type I

Diabetes Mellitus Type I

1. Diagnosis

   • Diagnostic Studies (one or more of the following)
     • Fasting Plasma Glucose (FPG) Test
       • Plasma glucose levels measured after food has been withheld for at least 8 hours
         • FPG value must be ≥126 mg/dL (7.0 mmol/L) for diagnosis of diabetes
     • Oral Glucose Tolerance Test (OGTT)
       • The body's ability to remove glucose from the blood within 2 hours of consuming 75g of glucose in 300mL of water
         • OGTT value must be ≥200 mg/dL (11.1 mmol/L) for diagnosis of diabetes
     • Hemoglobin A1C
       • Three month average plasma glucose concentration
         • HbA1c value must be ≥6.5% for diagnosis of diabetes
     • Autoantibody testing
       • Insulin autoantibodies (IAAs)
       • Glutamic Acid Decarboxylase (GAD)
       • Tyrosine Phosphatase (IA-2)
     • Nursing intervention: education on the value of proactive health seeking behaviors such as regular check-ups
     • Random plasma glucose ≥200 mg/dL (11.1 mmol/L) in addition to classic hyperglycemia symptoms
   • Pathophysiology
     • T-lymphocyte mediated hypersensitivity reaction against pancreatic beta cells (Type 1A Immune-Mediated Diabetes)
       • Progressive destruction of insulin-secreting beta cells within pancreas
         • Severely decreased or no endogenous insulin production
           • Blood glucose levels cannot be maintained
             • Glucose cannot enter cells
             • Hyperglycemia
     • Idiopathic Type 1B Diabetes

2. Treatment

   • Pharmacology
     • Exogenous insulin
       • Injections into high adipose sites: belly, triceps, buttocks
         • Rapid Acting (eg. Lispro)
         • Short Acting (eg. Regular)
         • Intermediate: NPH
         • Long Acting (eg. Lantus)
       • Nursing intervention: education of blood glucose monitoring and insulin benefits and application
     • Insulin pump
       • Provides continuous glucose monitoring and administration; cannula inserted under skin and held in place by infusion set
   • Lifestyle Modifications
     • Nutrition
       • High fiber diet (25 to 30 grams per day)
         • Controls blood sugar levels as well as HbA1c
       • Always read nutrition labels carefully
         • Products that are "sugar-free" or "fat-free" may not indicate reduced calories or carbohydrates
       • Carbohydrate Counting
         • If a serving contains >5 grams of fiber, the grams of fiber can be subtracted from grams of carbohydrates to calculate the insulin dose
         • Multiply the number of servings by the number of carbohydrates to calculate total package carbs
         • 45 to 65 percent of the total daily calories should come from carbohydrates
         • Essential for determining how much insulin is needed to metabolize the carbohydrates
     • Exercise
       • Increased insulin sensitivity and improved control over blood sugar levels and body weight

3. Assessment

   • Contributing Factors
     • Autoimmune
     • Environmental
     • Viral
     • Genetic
   • Clinical Manifestations
     • Polyuria
     • Polydipsia
     • Polyphagia
     • Children and adolescents may first present with diabetic ketoacidosis (DKA)
       • Insulin not present to breakdown fatty acids
         • Fatty acids converted to ketones in liver causing ketosis

4. Complications

   • Micro-angiopathy: thickened and weakened blood vessels leak resulting in lack of blood
     • Retinopathy
     • Nephropathy
     • Neuropathy
   • Macro-angiopathy: clots and fat reduce blood supply
     • Hypertension
     • Coronary Artery Disease
     • Peripheral Vascular Disease: excess glucose in bloodstream causes vascular damage
       • Non-traumatic lower limb amputations
     • Cerebrovascular Disease
   • Nursing intervention: education of client on the benefits of lifestyle changes to minimize damage of the vasculature

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