Type I DM

BY: VIVIAN CEREYN C. MORALES

 Type I DM Type 1 diabetes, once known as juvenile diabetes
or insulin-dependent diabetes, is a chronic condition. In this condition, the
pancreas makes little or no insulin. Insulin is a hormone the body uses to allow
sugar (glucose) to enter cells to produce energy.

Type 1 diabetes is a chronic condition that affects the insulin making cells of
the pancreas. People with type 1 diabetes don't make enough insulin. An
important hormone produced by the pancreas. Insulin allows your cells to
store sugar or glucose and fat and produce energy.

Unfortunately, there is no known cure.

But treatment can prevent complications and also improve everyday life for
patients with type 1 diabetes. Lots of people with type 1 diabetes live a full life.
And the more we learn and develop treatment for the disorder, the better the
outcome.
What exactly causes type 1 diabetes is still unknown. It is believed that it
is an auto-immune disorder where the body mistakenly destroys insulin
producing cells in the pancreas.

Typically, the pancreas secretes insulin into the bloodstream. The insulin
circulates, letting sugar enter your cells. This sugar or glucose, is the main
source of energy for cells in the brain, muscle cells, and other tissues.

However, once most insulin producing cells are destroyed, the pancreas
can't produce enough insulin, meaning the glucose can't enter the cells,
resulting in an excess of blood sugar floating in the bloodstream. This can
cause life-threatening complications. And this condition is called
diabetic ketoacidosis.
 The cause is yet unknow, certain factors that can contribute to the onset
of type 1 diabetes are known.
Family history. Anyone with a parent or sibling with type 1 diabetes has a
slightly increased risk of developing it.
Genetics. The presence of certain genes can also indicate an increased
risk.
Geography. Type 1 diabetes becomes more common as you travel
away from the equator.
•Age, although it can occur at any age there are two noticeable peaks.
The first occurs in children between four and seven years of age and the
second is between 10 and 14 years old.

Other possible causes include:

Exposure to viruses and other environmental factors

 Signs and symptoms of type 1 diabetes
can appear rather suddenly, especially in children.

They may include;

•increased thirst,
•frequent urination,
•bed wetting in children who previously didn't wet the bed.
•Extreme hunger,
•unintended weight loss,
•fatigue and weakness,
•blurred vision,
•irritability,
•other mood changes.
•Hyperglycemia. Hyperglycemia alone may not cause
obvious symptoms, although some children report
general malaise, headache, and weakness; children
may also appear irritable and become ill-tempered.
•Glycosuria. This condition leads to increased urinary
frequency and volume (eg, polyuria), which is
particularly troublesome at night (eg, nocturia) and
often leads to enuresis in a previously continent child.
•Polydipsia. Increased thirst, which may be insatiable, is
secondary to the osmotic diuresis causing dehydration.
•Polyuria. There is a dramatic increase in urinary output,
probably with enuresis.
•Polyphagia. There is an increase in hunger and food
consumption
•Weight loss. Insulin deficiency leads to uninhibited
gluconeogenesis, causing breakdown of protein and fat;
weight loss may be dramatic, although the child’s
appetite usually remains good; failure to thrive and wasting
may be the first symptoms noted in an infant or toddler
and may precede frank hyperglycemia.
•Nonspecific malaise. Although this condition may be
present before symptoms of hyperglycemia or as a
separate symptom of hyperglycemia, it is often only
retrospectively recognized.
•Diabetic ketoacidosis (DKA). DKA is characterized by
drowsiness, dry skin, flushed cheeks, and cherry-red lips,
acetone breath with a fruity smell, and Kussmaul
breathing.
 Treatment
Include:
•taking insulin
•counting carbohydrates, fat, protein, and monitoring glucose frequently
•maintain a healthy weight.

Generally, those with type 1 diabetes will need lifelong insulin therapy. There
are many different types of insulin and more are being developed that are
more efficient. And what you may take may change.
 Diagnostic
Findings
Early detection and control are critical in postponing or minimizing
later complications of diabetes.
•Fingerstick glucose test. Children with a family history of diabetes
should be monitored for glucose using a fingerstick glucose test.
•Urine dipstick test. For ketones in the urine, the child should be tested
using urine dipstick test.
•Fasting blood sugar (FBS). If the blood glucose level is elevated or
ketonuria is present, a fasting blood sugar is performed; an FBS result of
200 mg/dl or higher almost certainly is diagnostic for diabetes when
other signs are present.
•Lipid profile. Lipid profiles are usually abnormal at diagnosis because
of increased circulating triglycerides caused by gluconeogenesis.
• Glycated hemoglobin. Glycosylated hemoglobin derivatives
(HbA1a, HbA1b, HbA1c) are the result of a nonenzymatic
reaction between glucose and hemoglobin; a strong correlation
exists between average blood glucose concentrations over an 8-
to 10-week period and the proportion of glycated hemoglobin.
• Microalbuminuria. Microalbuminuria is the first evidence of
nephropathy; the exact definition varies slightly between nations,
but an increased AER is commonly defined as a ratio of first
morning-void urinary albumin levels to creatinine levels that
exceed 10 mg/mmol, or as a timed, overnight AER of more than
20 mcg/min but less than 200 mcg/min.
additional tests to check for antibodies that are common in type 1
diabetes in the test called C-peptide, which measures the
amount of insulin produced when checked simultaneously with a
fasting glucose. These tests can help distinguish between type 1
and type 2 diabetes when a diagnosis is uncertain.
Insulin is a hormone produced by the
pancreas that has a number of important
functions in the human body, particularly
in the control of blood glucose levels and
preventing hyperglycemia. Insulin also has
an effect on several other areas of the
body, including the synthesis of lipids and
regulation of enzymatic activity.
 Insulin and metabolic
processes
The most important role of insulin in the human
body is its interaction with glucose to allow the
cells of the body to use glucose as energy. The
pancreas usually produces more insulin in
response to a spike in blood sugar levels, as
occurs after eating a meal, for example. This is
because insulin acts as a “key” to open up the
cells in the body to allow for glucose to be
used as an energy source.
• Additionally, when there is excess glucose in the
bloodstream, which is a condition known as
hyperglycemia, insulin encourages the storage of
glucose as glycogen in the liver, muscle, and fat cells.
These stores can then be used at a later date when
energy requirements are higher. As a result of this, there
is less insulin in the bloodstream, and normal blood
glucose levels are restored.

• Insulin stimulates the synthesis of glycogen in the liver;

however, when the liver is saturated with glycogen, an
alternative pathway takes over. This involves the
uptake of additional glucose into adipose tissue,
leading to the synthesis of lipoproteins.
 Results without insulin
• In the absence of insulin, the body is not able to utilize glucose
as energy in the cells. As a result, the glucose remains in the
bloodstream and can lead to hyperglycemia. Chronic
hyperglycemia is characteristic of diabetes mellitus and, if
untreated, is associated with severe complications, such as
damage to the nervous system, eyes, kidneys, and extremities.

• In severe cases, lack of insulin and a reduced ability to use

glucose as a source of energy can lead to a reliance on fat
stores as the sole source of energy. The breakdown of these
fats can release ketones into the bloodstream, which can lead
to a serious condition called ketoacidosis.
What’s the Difference between
Type 1 and Type 2 Diabetes
 CAUSE
Type 1 diabetes is an autoimmune condition
that can develop suddenly and may be
caused by genetics and other unknown
factors. Type 2 diabetes often develops over
time, with obesity and a lack of exercise as
big risk factors. You can be diagnosed with
either at any age.
• Both types of diabetesBoth types of diabetes are chronic diseases
that affect the way your body regulates blood sugar
or glucoseBoth types of diabetes are chronic diseases that affect
the way your body regulates blood sugar or glucose. Glucose is
the fuel that feeds your body’s cells, but to enter your cells it
needs a key. Insulin is that key.

• People with type 1 diabetes don’t produce insulin. You can think of
it as not having a key.

• People with type 2 diabetes don’t respond to insulin as well as they

should and later in the disease often don’t make enough insulin.
You can think of it as having a broken key.

• Both types of diabetes can lead to chronically high blood sugar

levelsBoth types of diabetes can lead to chronically high blood
sugar levels. That increases the risk of diabetes complications.
 Known risk factors include:
•Family history: People with a parent or sibling with type 1 diabetes have a
higher risk of developing it themselves.
•Age: Type 1 diabetes can appear at any age, but it’s most common
among children and adolescents.
Type 2 diabetes risk factors
You’re at risk of developing type 2 diabetes if you:
•have prediabetes, or slightly elevated blood sugar levels
•are carrying excess weight or have obesity
•have a lot of belly fat
•are physically active less than 3 times a week
•are over age 45
•have ever had gestational diabetes, which is diabetes during pregnancy
•have given birth to a baby weighing more than 9 pounds
•are Black, Hispanic or Latino, American Indian, or Alaska Native due
to structural inequities contributing to health disparities
•have an immediate family member with type 2 diabetes
•have polycystic ovary syndrome (PCOS)
Can diabetes be prevented?

•Type 1 diabetes can’t be prevented.

It may be possible to lower your risk of developing typetype 2
diabetes through these lifestyle changes, such as:

maintaining a moderate weight

working with your doctor to develop a healthy weight-loss plan, if
you have overweight
increasing your activity levels
eating a balanced dieteating a balanced diet and reducing your
intake of sugary foodseating a balanced diet and reducing your
intake of sugary foods or overly processed foods

Even if you’re unable to prevent the disease, careful monitoring

can get your blood sugar levels back to standard and prevent
the development of severe complications.
 Pharmacologic Management

Insulin is always required to treat type 1

diabetes mellitus; these agents are used for
the treatment of type 1 diabetes mellitus, as
well as for type 2 diabetes mellitus that is
unresponsive to treatment with diet and/or
oral hypoglycemics.
• Insulin aspart. Rapid-acting insulin; insulin aspart is approved by the
FDA for use in children aged >2 y with type 1 DM for SC daily
injections and for SC continuous infusion by external insulin pump;
however, it has not been studied in pediatric patients with type 2
DM; onset of action is 10-30 minutes, peak activity is 1-2 h, and
duration of action is 3-6 h.
• Insulin glulisine. Rapid-acting insulin; the safety and effectiveness of
SC injections of insulin glulisine have been established in pediatric
patients (aged 4-17 y) with type 1 DM; however, it has not been
studied in pediatric patients with type 2 DM; onset of action is 20-30
minutes, peak activity is 1 h, and duration of action is 5 h.
• Insulin lispro. Rapid-acting insulin; only lispro U-100 is approved by
the FDA to improve glycemic control in children aged >3 y with
type 1 DM; however, it has not been studied in children with type 2
DM; onset of action is 10-30 minutes, peak activity is 1-2 h, and
duration of action is 2-4 h.
• Regular insulin. Short-acting insulin. Novolin R has been
approved by the FDA to improve glycemic control in
pediatric patients aged 2-18 y with type 1 DM; however,
it has not been studied in pediatric patients with type 2
DM; Humulin R is indicated to improve glycemic control
in pediatric patients with diabetes mellitus requiring more
than 200 units of insulin per day; however, there are no
well-controlled studies of use of concentrated Humulin R
U-500 in children.
• Insulin NPH. Intermediate-acting insulin; it is indicated to
improve glycemic control in pediatric patients with type
1 diabetes mellitus; onset of action is 3-4 h, peak effect is
in 8-14 h, and usual duration of action is 16-24 h.
• Insulin glargine. Long-acting insulin; the safety and effectiveness of
glargine U-100 have been established in pediatric patients (6-15 y)
with type 1 DM; however, it has not been studied in pediatric
patients with type 2 DM.
• Insulin detemir. Long-acting insulin. Insulin detemir is indicated for
once- or twice-daily SC administration for the treatment of
pediatric patients (aged 6-17 years) with type 1 DM; however,
detemir has not been studied in pediatric patients with type 2 DM;
onset of action is 3-4 h, peak activity is 6-8 h, and duration of
action ranges from 5.7 h (low dose) to 23.2 h (high dose).
• Insulin degludec. Ultra-long-acting insulin; insulin degludec is
approved by the FDA to improve glycemic control in pediatric
patients aged >1 y with type 1 or type 2 DM; it usually takes 3-4
days for insulin degludec to reach steady state, peak plasma time is
9 h and the durations of action is at least 42 h; it is highly protein
bound, and following SC, the protein-binding provides a depot
effect.
 Nursing Assessment
Nursing assessment for patients with diabetes mellitus type1 involves:
•History. 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; include the child in the interview and encourage him or
her to contribute information.
•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.
 Nursing Diagnoses
Based on the assessment data, the major nursing diagnoses for
diabetes mellitus type 1 are:
•Imbalanced nutrition: less than body requirements related to
insufficient caloric intake to meet growth and development
needs and the inability of the body to use nutrients.
•Risk for impaired skin integrity related to slow healing process
and decreased circulation.
•Risk for infection related to elevated glucose levels.
•Deficient knowledge related to complications of hypoglycemia
and hyperglycemia.
•Deficient knowledge related to appropriate exercise and
activity.
 Nursing Care Planning and
Goals
The major nursing care planning goals for diabetes mellitus
type 1 include:
•Maintaining adequate nutrition.
•Promoting skin integrity.
•Preventing infection.
•Regulating glucose levels.
•Learning to adjust to having a chronic disease.
•Learning about and managing hypoglycemia and
hyperglycemia, insulin administration, and exercise needs for
the child.
 Nursing Interventions
Nursing interventions for diabetes mellitus type 1 are:
•Ensure adequate and appropriate nutrition. The child with diabetes
needs a sound nutritional program that provides adequate nutrition
for normal growth while maintaining the blood glucose at near
normal levels; 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 the skin, such as the groin, axilla, or other skin folds;
emphasize good foot care.
• Prevent skin infection. Diabetic children may be more
susceptible to urinary tract and upper respiratory infections;
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. The child’s 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.
• Provide child and family teaching in the
management of hypoglycemia and
hyperglycemia. If the blood glucose is higher than
240mg/dl, the urine may be tested for ketones; be
aware of the most likely times for an increase or
decrease in the blood glucose level in relation to
the insulin the child is receiving; and teach the child
and family to recognize the signs of both
hypoglycemia and hyperglycemia.
 Evaluation
Goals are met as evidenced by:
•Maintained adequate nutrition.
•Promoted skin integrity.
•Prevented infection.
•Regulated glucose levels.
•Learned to adjust to having a chronic disease.
•Learned about managing hypoglycemia and
hyperglycemia, insulin administration, and exercise
needs for the child.