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...

  1. Fasting blood sugar reading >125
  1. blood sugar >200 within 2 hours of oral glucose tolerance test
  1. Random >200 blood sugar reading w/ presenting symptoms
  1. 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