Type 1 Diabetes

Assessment
1. Symptoms
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Weight loss/gain
  5. Fatigue and Weakness
  6. Irritability
  7. Mood changes
  8. Blurred Vision
  9. Erectile dysfunction in men
2. Risk Factors
  1. Family History
  2. Age
    1. Increased likelihood childhood (ages 4-7) and adolescence (ages 10-14)
    2. May occur in adulthood
  3. Geography
    1. Type 1 Diabetes incidence increase in region further away from equator
3. Etiology
  1. No tolerance to self-antigens expressed in the islets of Langerhans
    1. Autoimmune destruction of 80-90% of Beta cells
      1. Insulin is no longer released by the beta cells
        Increased blood glucose levels
  2. Exposure to a virus
  3. Genetics
Diagnosis
1. Glycated Hemoglobin (AC1 Test)
  1. A1C level of 6.5 or more on two separate tests
  2. Shows amount of glucose attached to hemoglobin molecule
  3. Diagnostic test
2. Random Blood Sugar
  1. Result of 11 mmol/L or greater and symptoms of diabetes
3. Fasting Plasma Glucose
  1. normal: 5.6mmol/L prediabetes: 5.6 to 6.9 mmol/L diabetes: 7 mmol/L
4. Oral Glucose Tolerance Test
  1. Two-hour OGTT level ≥11.1 mmol/L
Treatment
1. Drug therapy
  1. Insulin Injections
    1. Rapid Acting (Bolus)
      1. Lispro
        Onset: 10- 15 minutes Peak: 1-2 hours Duration: 3- 4.75 hours
      2. Aspart
        Onset: 9- 20 minutes Peak: Apart 1-1.5 Hours Duration: 3.5 hours
    2. Intermediate Acting (Basal)
      1. Onset: 1-3 hours Peak: 5-8 hours Duration: Up to 18 hours
    3. Long Acting
      1. Onset: 90 minutes Duration: 16 to 42 hours dependent on the drug No peak action
    4. Short Acting (Bolus)
      1. Onset: 30- 60 mins Peak: 2- 3 hours Duration: 6.5 hours to 24 hours
    5. Problems with insulin therapy
      1. Hypoglycemia
      2. Lipodystrophy
      3. Allergic reactions
  2. Continuous Subcutaneous Insulin Infusion Therapy (CSIIT)/ Insulin Pump
    1. Manually monitor glucose
    2. Catheter inserted subcutaneously in abdomen, lower back, leg and arm
    3. Convenient, small, accurate, adjustable
  3. Closed Loop
    1. Continuous glucose monitors (CGM) linked to insulin pump
      1. Help monitors hypoglycemia
        CGM’s can alert user when blood glucose level is above or below normal level
      2. Delivers insulin when needed
        Dependant on current glucose monitor readings
      3. 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
2. Healthy Lifestyle
  1. Nutritional Therapy
    1. Nutritious low-fat high-fibre foods
      1. Glycemic Index (GI)
        Consume foods with lower GI (e.g. complex carbohydrates)
        Sweet Potato
        Carrots
      2. Fats
        Reduce saturated and trans-fat in diet; include food rich in omega-3 fatty acids
    2. Balance with insulin and exercise patterns
    3. Count Carbohydrates to identify the amount of insulin needed to metabolize it
  2. Exercise
    1. Regular Individualized physical activity
      1. Increase of insulin receptor sites
      2. Decreases blood glucose level
        Monitor blood glucose level
      3. Best done after meals
      4. Aerobic exercise 150 minutes/week
        Swimming
        Walking
    2. Maintain healthy weight
3. Other Treatment
  1. Islet-cell Transplantation
    1. Transplant new insulin-producing cells from donor pancreas
      1. Treatment Complication: Islet cell rejection
    2. Minimally invasive
      1. Lower Morbidity
  2. Pancreas Transplant
    1. Greatest risk of complications
      1. Chronic graft rejection
      2. Pseudocyst
      3. Fistula
      4. Thrombosis
      5. Pancreatitis
  3. Gene Transfer using viral/non-viral vectors
    1. Transform cells to have insulin secretory machinery
  4. Stem Cell Transplant
    1. Stem cells convert to beta cells to release insulin
      1. Treatment Complication: Rejection of cells
Complications
1. Cardiovascular Diseases
  1. Stroke
  2. Heart Attack
2. Neuropathy
  1. Nerve damage in legs & gastrointestinal tract
  2. Nerve damage leading to erectile dysfunction
3. Nephropathy (Kidney Disease)
  1. Kidney blood vessels damaged leading to kidney failture
    1. Treatment
      1. Dialysis
      2. Kidney transplant
4. Increased susceptibility to bacterial and fungal infections (i.e. gum disease)
5. Retinopathy (Eye Damage)
  1. Blindness
6. Pregnancy Complications
7. Ketoacidosis
  1. Profound Insulin deficiency
    1. Characteristics: Hyperglycemia Ketosis Acidosis Dehydration
    2. Causes
      1. Illness/Infection
      2. Inadequate insulin dosage
      3. Poor self-managemnt
      4. Undiagnosed Type 1 Diabetes
    3. The deficiency in insulin releases hormones that wouldn't otherwise be released, increasing the level of glucose.
  2. Symptoms
    1. Frequent urination
    2. Excessive thirst
    3. Confusion
    4. Shortness of breath
    5. Abdominal pain
    6. Nausea and vomiting
  3. Body produces high amount of ketones (blood acids)
8. Anxiety
9. Hypoglycemia
  1. Low blood sugar
    1. Blood glucose level <4 mmol/L
  2. Treatment
    1. Nursing Care
      1. Monitor Physical Activity
        Physical activity plus insulin causes blood sugar level to decrease significantly
      2. Eat fewer carbohydrates
      3. Avoid Skipping Meals
  3. 1. Manifestations
      1. Diaphoresis
      2. Hunger
      3. Headache
      4. Fatigue
      5. Tremors
      6. Irritability
      7. Rapid irregular heart rate
      8. Dizziness
      9. Confusion
  4. Somogyi Effect
    1. Rebound hyperglycemia after Nocturnal hypoglycemia due to Stress hormones being released
By Chantalee Dunkley and Ashley Prasad

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Type 1 Diabetes

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