Type 1 Diabetes Mellitus
Type 1 Diabetes Mellitus is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow glucose to enter cells to produce energy. This paper explores the aspects of the disease as it relates to the pathophysiology, clinical manifestations, diagnostic testing, collaborative care, and nursing care.Type 1 Diabetes Mellitus Type 1 Diabetes, previously referred to as “juvenile diabetes” most often occurs in people under 30 years of age. Diabetes mellitus is a multisystem disease with both biochemical and structural consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin, which results from the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. Pathophysiology
Type 1 diabetes is the end result of a long-standing process in which the body’s own T cells attack and destroy pancreatic beta cells, which are the source of the body’s insulin. A genetic predisposition and exposure to a virus are factors that may contribute to the pathogenesis of type 1 diabetes mellitus. “The pathogenesis of the autoimmune β-cell destruction involves incompletely understood interactions between susceptibility genes, autoantigens, and environmental factors” (Crandall). Clinical Manifestations
The onset of type 1 diabetes mellitus may be sudden and commonly can present with diabetic ketoacidosis (DKA). A rapid onset of symptoms in a young, lean person with ketoacidosis has been considered diagnostic of type 1 diabetes mellitus. The most common symptoms of type 1 diabetes mellitus are polyuria, polydipsia, and polyphagia, along with a lack of energy, nausea, and blurred vision, all of which are primarily due to the hyperglycemia. The first clinical presentation of a person with type 1 diabetes can typically be traced back several days to several weeks; “however, beta cell destruction may have started months, or even years, before the onset of clinical symptoms” (Khardori). The symptoms characteristic of DM develop when the person’s pancreas can no longer produce insulin. The patient usually has a history of recent and sudden weight loss which occurs because the body is in a catabolic state as it cannot get glucose and turns to other energy sources, such as fat and protein. The polyuria is due to osmotic diuresis and thirst is due to the hyperosmolar state and dehydration. Fatigue and weakness are also common symptoms experienced which may be due to the muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Blurred vision is due to the effect of “the hyperosmolar state on the lens and vitreous humor; glucose and its metabolites cause dilation of the lens, altering its normal focal length.” Peripheral neuropathy presents as numbness and tingling in both hands and feet, in a glove and stocking pattern; it is bilateral, symmetric, and ascending neuropathy, which results from many factors, including the accumulation of sorbitol in peripheral sensory nerves due to sustained hyperglycemia” (Khardori). Diagnostic and Laboratory Testing
Correctly determining whether a patient has type 1 or type 2 diabetes mellitus is an important diagnostic and therapeutic concern because patients with type 1 DM are dependent on a continuous source of exogenous insulin and carbohydrate for survival. If a patient presents with symptoms of diabetes mellitus, common diagnostic and laboratory testing performed may include: fingerstick blood glucose, urinalysis, WBC, fasting plasma glucose level, random plasma glucose level, two-hour OGTT level, and the fasting plasma glucose (FPG) test. A fingerstick blood glucose test would typically be done in the emergency department, however levels must be confirmed in serum or plasma to make a diagnosis. A urinalysis is performed to determine if ketones are in the urine, but...
References: 1. Crandall, J. (2007). Diabetes Mellitus (DM). The merck manuals online medical library. Retrieved April 10, 2011, from http://www.merckmanuals.com/professional/sec12/ch158/ch158b.html?qt=diabetes&alt=sh#sec12-ch158-ch158b-1109
2. Khardori, R. (2011). Type 1 Diabetes Mellitus. Medscape reference. Retrieved April 11, 2011, from http://emedicine.medscape.com/article/117739-overview
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4. Mayo Clinic Staff, . (n.d.). Type 1 Diabetes . Mayo clinic. Retrieved April 11, 2011, from http://www.mayoclinic.com/health/type-1-diabetes/DS00329
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