Diabetes I

Type 1 DIABETES MELLITUS
DEFINITION
Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of

sugar (glucose) in the blood characterized by the body’s inability to produce insulin due
to the autoimmune destruction of the beta cells in the pancreas. Although onset
frequently occurs in childhood, the disease can also develop in adults.
CAUSES
Type 1 diabetes can occur at any age. It is most often diagnosed in children,
adolescents, or young adults.
Insulin is a hormone produced in the pancreas by special cells, called beta cells.
The pancreas is below and behind the stomach. Insulin is needed to move blood sugar
(glucose) into cells. Inside the cells, glucose is stored and later used for energy. With
type 1 diabetes, beta cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead of going

into the cells. This buildup of glucose in the blood is called hyperglycemia. The body is
unable to use the glucose for energy. This leads to the symptoms of type 1 diabetes.
The exact cause of type 1 diabetes is unknown. Most likely, it is an autoimmune

disorder. This is a condition that occurs when the immune system mistakenly attacks
and destroys healthy body tissue. With type 1 diabetes, an infection or another trigger
causes the body to mistakenly attack the beta cells in the pancreas that make insulin.
The tendency to develop autoimmune diseases, including type 1 diabetes, can be
inherited from your parents.
Signs and Symptoms
HIGH BLOOD SUGAR
The following symptoms may be the first signs of type 1 diabetes. Or, they may occur
when blood sugar is high.
● Being very thirsty

● Feeling hungry
● Feeling tired all the time
● Having blurry eyesight
● Feeling numbness or tingling in your feet
● Losing weight despite an increased appetite
● Urinating more often (including urinating at night or bedwetting in children who
were dry overnight before)
● For other people, these serious warning symptoms may be the first signs of type
1 diabetes. Or, they may happen when blood sugar is very high (diabetic
ketoacidosis):
● Deep, rapid breathing
● Dry skin and mouth
● Flushed face
● Fruity breath odor
● Nausea and vomiting; inability to keep down fluids
● Stomach pain
LOW BLOOD SUGAR
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are
taking
insulin. Symptoms usually appear when a person's blood sugar level falls below 70
milligrams per deciliter (mg/dL), or 3.9 mmol/L. Watch for:
● Headache
● Hunger
● Nervousness, irritability
● Rapid heartbeat (palpitations)
● Shaking
● Sweating
● Weakness
Risk Factors
Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes.
Known risk factors include:
● Family history: Having a parent, brother, or sister with type 1 diabetes.

● Age: You can get type 1 diabetes at any age, but it usually develops in children,
teens, or young adults.
Diagnostic Studies
Glycated hemoglobin (A1C) test. This blood test shows the average blood sugar level
for the past 2 to 3 months. It measures the amount of blood sugar attached to the
oxygen-carrying protein in red blood cells (hemoglobin). The higher the blood sugar
levels, the more hemoglobin with sugar attached. An A1C level of 6.5% or higher on
two separate tests means have diabetes.
Random blood sugar test. A blood sample will be taken at a random time and may be
confirmed by additional tests. No matter when the last meal was, a random blood sugar
level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
Fasting blood sugar test. A blood sample will be taken after fasting for 8 hours.
Fasting Blood Sugar:

● Healthy - <100 mg/dL (5.6 mmol/L)
● Prediabetes - 100 to 125 mg/dL (5.6 to 6.9 mmol/L)
● Diabetes - 126 mg/dL (7 mmol/L) or higher on two separate tests
Pathophysiology
Type 1 DM is the culmination of lymphocytic infiltration and destruction of insulin-

secreting beta cells of the islets of Langerhans in the pancreas. As beta-cell mass
declines, insulin secretion decreases until the available insulin no longer is adequate to
maintain normal blood glucose levels. After 80-90% of the beta cells are destroyed,
hyperglycemia develops and diabetes may be diagnosed. Patients need exogenous
insulin to reverse this catabolic condition, prevent ketosis, decrease
hyperglucagonemia, and normalize lipid and protein metabolism.
Currently, autoimmunity is considered the major factor in the pathophysiology of type 1

DM. In a genetically susceptible individual, viral infection may stimulate the production
of antibodies against a viral protein that trigger an autoimmune response against
antigenically similar beta cell molecules.
Nursing Management
Assessment
● History taking.
○ When collecting data, ask the caregiver about the child’s symptoms
leading up to the present illness
○ Ask about the child’s appetite, weight loss or gain, evidence of
polyuria or enuresis in a previously toilet-trained child, polydipsia,
dehydration, irritability and fatigue
● Physical Exam
○ Measure the height and weight and examine the skin for evidence
of dryness or slowly healing sores
○ Note signs of hyperglycemia, record vital signs, and collect a urine
specimen
○ Perform a blood glucose level determination using a bedside
glucose monitor.
Interventions
● Ensure adequate and appropriate nutrition.
○ The food plan should be well-balanced with foods that take into
consideration the child’s food preferences, cultural customs, and
lifestyle
○ If a particular meal is going to be late, the child should have a
complex carbohydrate and protein snack.
● Prevent skin breakdown.
○ Teach the caregiver and child to inspect the skin daily and promptly
treat even small breaks in the skin
○ Encourage daily bathing
○ Teach the child and caregiver to dry the skin well after bathing, and
give careful attention to any area where skin touches skin, such as
the groin, axilla, or other skin folds
○ Emphasize good foot care.
● Prevent skin infection.
○ Teach the child and caregiver to be alert for signs of urinary tract
infection
○ Instruct them to report signs of urinary tract or upper respiratory
tract infections to the care provider
○ Insulin should never be skipped during illness
○ Fluids need to be increased.
● Regulate glucose levels.
○ Blood glucose levels must be monitored to maintain it within normal
limits
○ Determine the blood glucose level at least twice a day, before
breakfast and before the evening meal
○ Offer encouragement and support, helping the child to express
fears and acknowledging that the fingerstick does hurt and it is
acceptable to dislike it.
Pharmacological Management
Insulin
Insulin is the most common type of medication used in type 1 diabetes treatment.
There are types of insulin, including:
● · Short-acting insulin. Sometimes called regular insulin, this type starts

working around 30 minutes after injection. It reaches peak effect at 90 to 120
minutes and lasts about 4 to 6 hours.
● · Rapid-acting insulin. This type of insulin starts working within 15 minutes. It
reaches peak effect at 60 minutes and lasts about 4 hours. This type is often
used 15 to 20 minutes before meals. Because they work quickly, they are used
most often at the start of a meal. Rapid-acting insulin acts most like insulin that is
produced by the human pancreas.
● · Intermediate-acting insulin. Also called NPH insulin, this type of insulin
starts working in about 1 to 3 hours. It reaches peak effect at 6 to 8 hours and
lasts 12 to 24 hours.
● · Long- and ultra-long-acting insulin. This type of insulin may provide
coverage for as long as 14 to 40 hours.
Cholesterol-lowering drugs (Statins) Cholesterol guidelines are stricter for people

with diabetes because of their higher risk of heart disease.
Medical-Surgical Management
Islet Cell Transplant
Islets are the cells in the pancreas that make insulin. This procedure takes healthy islet
cells from a donor and injects them into a vein. The cells will make insulin. It will need to
be done more than once. It can help a person manage their blood glucose. They may
even be able to stop insulin injections.
Pancreas Transplant
A pancreas transplant allows people with type 1 diabetes (insulin-treated diabetes) to

produce insulin again. It's not a routine treatment because it has risks, and treatment
with insulin injections is often effective.
The operation is performed under general anesthetic.
A cut is made along the abdomen. The donor pancreas is then placed inside and
attached to nearby blood vessels and bowels.
The new pancreas should start producing insulin straight away. The old, damaged
pancreas will be left in place and will continue to produce important digestive juices after
the transplant.

Diabetes I

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Diabetes I

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Type 1 DIABETES MELLITUS

Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of

Without enough insulin, glucose builds up in the bloodstream instead of going

The exact cause of type 1 diabetes is unknown. Most likely, it is an autoimmune

Signs and Symptoms

HIGH BLOOD SUGAR

● Being very thirsty

● Family history: Having a parent, brother, or sister with type 1 diabetes.

Fasting Blood Sugar:

Type 1 DM is the culmination of lymphocytic infiltration and destruction of insulin-

Currently, autoimmunity is considered the major factor in the pathophysiology of type 1

There are types of insulin, including:

● · Short-acting insulin. Sometimes called regular insulin, this type starts

Cholesterol-lowering drugs (Statins) Cholesterol guidelines are stricter for people

Islet Cell Transplant

A pancreas transplant allows people with type 1 diabetes (insulin-treated diabetes) to

The operation is performed under general anesthetic.

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