TYPE I DIABETES MELLITUS

 Type 1 Diabetes  Insulin-Dependent Diabetes Mellitus  Juvenile Diabetes  is a form of diabetes mellitus that results from

autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose.

 This type of diabetes can be further classified as

immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack. There is no known preventive measure against type 1 diabetes
 is fatal unless treated with insulin

 Environment

Environmental factors can strongly influence expression of type 1  Genetics Type 1 diabetes is a polygenic disease, meaning many different genes contribute to its expression.
 happens most often in children and young adults

but can appear at any age

 Scientists do not yet know exactly what causes

type 1 diabetes, but they believe that autoimmune, genetic, and environmental factors are involved. CLASSICAL SYMPTOMS  POLYURIA (frequent urination)  POLYDIPSIA (increased thirst)  POLYPHAGIA (increased hunger).

Destruction of alpha and beta cells of the pancreas Failure to produce insulin Production of excess glucagon Production of glucose from protein and fat stores polydipsia Increase osmolarity due to glucose Polyuria Weight loss Wasting of lean body mass

Elevated blood glucose level

polyphagia

fatigue

Chronic evaluation in blood glucose level

Glycoprotein cell wall deposit Accelerated Atherosclerosis Impaired immune function

Small vessel disease

Diabetic neuropathy Autonomic neuropathy

diabetic nephropathy End of renal stage

Diabetic retinopathy Loss of vision blindness

Delayed wound healing

infection

Hypertension Coronary artery disease

Death

Diagnostic Evaluation
 Diabetes can be diagnosed in any of the

following ways (and should be confirmed on a different day by any of these tests):
FBS of greater than or equal to 126 mg/dL Random blood glucose of greater than or equal to 200 mg/dL with classic symptoms (polyuria, polydipsia, polyphagia, weight loss) OGTT greater than or equal to 200 mg/dL on the 2-hour sample

 Tests for glucose control over time are

glycated hemoglobin and fructosamine assay. These tests are not used for diagnosis.

Laboratory Tests
 Blood Glucose

Fasting blood sugar (FBS), drawn after at least an 8-hour fast, to evaluate circulating amounts of glucose; postprandial test, drawn usually 2 hours after a well-balanced meal, to evaluate glucose metabolism; and random glucose, drawn at any time, nonfasting

 Oral Glucose Tolerance Test

The oral glucose tolerance test (OGTT) evaluates insulin response to glucose loading. FBS is obtained before the ingestion of a 50- to 200-g glucose load (usual amount is 75 g), and blood samples are drawn at , 1, 2, and 3 hours (may be 4- or 5-hour sampling).  Glycated Hemoglobin (Glycohemoglobin, HbA1c) Measures glycemic control over a 60- to 120-day period by measuring the irreversible reaction of glucose to hemoglobin through freely permeable erythrocytes during their 120-day lifecycle.

 C-Peptide Assay (Connecting Peptide

Assay) Cleaved from the proinsulin molecule during its conversion to insulin, C-peptide acts as a marker for endogenous insulin production.  Fructosamine Assay Glycated protein with a much shorter half-life than glycated hemoglobin, reflecting control over a shorter period, approximately 14 to 21 days. May be advantageous in patients with hemoglobin variants that interfere with the accuracy of glycated hemoglobin tests.

Clinical Manifestations
a. Diabetes Mellitus  Polyuria, polydipsia and polyphagia  Weight loss  Fatigue and weakness  Visual disturbances  Recurrent skin, vulva, and UTI

b. DKA  Dehydration  Tachycardia  Kussmaul s respirations  Acetone breath  Decreased level of consciousness  GI disturbances ( nausea, vomiting and abdominal pain)

c. HHNK  Dehydration  Decreased level of consciousness  Tachycardia  Hypotension

d. Hypoglycemia  Cool, moist skin or pallor  Tachycardia  Tremor, paresthesias, confusion  Headache to loss of consciousness to seizures  Clients who consistently have high blood glucose levels (>200 mg/dl) shows sign or symptoms of hypoglycemia as blood glucose levels are decreasing because of treatment, even though the client s blood glucose levels are elevated above normally accepted parameters ( 160 to 180 mg/dl)