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DIABETES MELLITUS: Type 1. "Juvenile", Authors: Brittany…
DIABETES MELLITUS: Type 1.
"Juvenile"
Pathophysiology
: Immune-mediated or idiopathic Insulin deficiency, leading to fat metabolism, glycogenolysis and gluconeogenesis.
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
Coma and/or death
Symptoms
:
Unexplained weight loss
Nonspecific malaise, fatigue, weakness
Symptoms of ketoacidosis
Irritability/mood changes
"3 P's
: polyuria, polydipsia, polyphagia.
Treatment/Management
short acting and rapid acting insulin
(SA-Reg): Humulin R, Novolin R
Therapeutic in 30 minutes, lasting 4-8 hours
(rapid) NovoLog, HumaLog
Therapeutic in 15 minutes, lasting up to 5 hours
long acting insulin, intermediate acting insulin
(Long) "Lantus"
Therapeutic in 6-14 hours. Lasting 20-24hrs
(Intermediate) Novolin N, Humulin N
Therapeutic in 2-6 hours, lasting 14-20 hours
frequent blood sugar monitoring.
Carbohydrate, protein, and fat counting
Intensive insulin therapy using a basal-bolus approach, whether as multiple daily injections or pump therapy
Regular Exercise
Complications
DKA, Coma, Death, microvascular/Macrovascular damage
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.
Sxs: ketonuria, acetone breath (fruity), ketonemia (low blood pH = ketoacidosis),
Kussmaul's Respirations
, excessive thirst w/ dehydration, emesis, drowsiness/LOC, sudden weight loss
Tx: slow insulin drip (<100gtt/hr), w/ Bag A & Bag B system, IVF (K+, Na+, glucose)
Macro/Micro vascular damage includes heart/vessel damage, neuropathy, retinopathy, kidney damage, foot injury
Diagnosed
: <20 years old.
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%
Risk factors:
Family History, genetics, geography, age
Authors
: Brittany Fuemmeler, Brett Somogye, Christian Rice