DIABETES MELLITUS: Type 1. "Juvenile"
Pathophysiology: Immune-mediated or idiopathic Insulin deficiency, leading to fat metabolism, glycogenolysis and gluconeogenesis.
Symptoms:
Treatment/Management
Complications DKA, Coma, Death, microvascular/Macrovascular damage
Diagnosed: <20 years old.
short acting and rapid acting insulin
long acting insulin, intermediate acting insulin
Criteria...
- Fasting blood sugar reading >125
- blood sugar >200 within 2 hours of oral glucose tolerance test
- Random >200 blood sugar reading w/ presenting symptoms
- HgA1c >6.5%
Glycogenolysis and gluconeogenesis along with liver dysfunction lead to the classic triad of polydipsia, polyuria and weight loss.
Ketogenesis is caused by fat metabolism which leads to ketonemia and subsequent metabolic acidosis.
Glucose cannot enter cells without insulin causing cellular starvation and systemic catabolism. A combination of ketonemia, polydipsia, polyuria and weight loss lead to electrolyte and fluid imbalances, hypovolemia, renal failure and reduced cerebral blood flow
frequent blood sugar monitoring.
Carbohydrate, protein, and fat counting
Diabetic Ketoacidosis (DKA) = medical emergency & admission into ICU. caused by the body breaking down fats into fatty acids d/t unavailable glucose stores from absence of insulin within the body.
Macro/Micro vascular damage includes heart/vessel damage, neuropathy, retinopathy, kidney damage, foot injury
Sxs: ketonuria, acetone breath (fruity), ketonemia (low blood pH = ketoacidosis), Kussmaul's Respirations, excessive thirst w/ dehydration, emesis, drowsiness/LOC, sudden weight loss
Coma and/or death
Intensive insulin therapy using a basal-bolus approach, whether as multiple daily injections or pump therapy
Tx: slow insulin drip (<100gtt/hr), w/ Bag A & Bag B system, IVF (K+, Na+, glucose)
Regular Exercise
Unexplained weight loss
Nonspecific malaise, fatigue, weakness
Symptoms of ketoacidosis
Irritability/mood changes
"3 P's: polyuria, polydipsia, polyphagia.
Risk factors:
Family History, genetics, geography, age
(Long) "Lantus"
(SA-Reg): Humulin R, Novolin R
(rapid) NovoLog, HumaLog
(Intermediate) Novolin N, Humulin N
Therapeutic in 6-14 hours. Lasting 20-24hrs
Therapeutic in 2-6 hours, lasting 14-20 hours
Therapeutic in 30 minutes, lasting 4-8 hours
Therapeutic in 15 minutes, lasting up to 5 hours
Authors: Brittany Fuemmeler, Brett Somogye, Christian Rice