Type 1 diabetes mellitus is an autoimmune disease that results in insulin dependence due to failure of secretion of the hormone insulin by beta cells in the pancreas. Type 1 diabetes usually manifests in childhood, < 20 years of age – the reason for which it was formerly termed juvenile diabetes, and is more prevalent in Caucasians then in any other ethnicity (Diabetes Basics, n.d.). The key to proper management is early detection, patient education, and most importantly patient compliance.
The patient will commonly present with multiple symptoms, the most common are the 3 P’s – polyuria, polydipsia, and polyphagia. However, subjective symptoms may include reports of fatigue, abdominal pain, nocturnal enuresis, weight loss, changes in mood, and blurred vision. Objectively the signs will be hyperglycemia, confirmation of weight loss, abnormal lab values such as an elevated hemoglobin A1c (HbA1c) level, and abnormal urine results.
Upon assessment of a patient with, or suspected of, type 1 diabetes ask about recent infections, including yeast, and/or illnesses. Assess whether they have had injuries become more easily infected or take longer to heal. Also ask if they have had any changes in vision or sense of touch (Ignatavicius, 2012, p. 1418).
Diagnosis of Type 1 Diabetes in a child, or adolescent, is usually straightforward and generally requires little diagnostic testing. A good indication of diabetes is an abnormal, or hyperglycemic, blood glucose test: casual glucose test (anytime) ≥ 200mg/dl or fasting glucose test (8 hours after eating) ≥ 126 mg/dl. The HbA1c measures the glycated hemoglobin in the blood to identify the average plasma glucose concentration over a 2 – 3 month period, a result of 6.5% - average blood glucose of 139 mg/dl - or higher indicates diabetes (A1c calculator, n.d.). Glucose permanently binds to hemoglobin, therefore the higher the serum blood glucose the more glycosylated hemoglobin becomes, making the measurement of glycated hemoglobin a reliable – realistic, indicator of diabetes (Ignatavicius, 20120 p. 1420). Urine results for diabetics may also show high levels of glucose – usually negative in a non-diabetic, and ketones. The presence of ketones in the urine is very common in newly diagnosed diabetics; however, ketones may be a sign of diabetic ketoacidosis – an emergent situation.
Diabetic ketoacidosis (DKA), a form of metabolic acidosis, is a life threatening emergency that requires immediate medical intervention. DKA manifests when the body cannot use glucose for energy - generally due to absence of insulin, and uses fat in substitute. Ketones are the byproduct of fat breakdown and can build-up in the body, causing acidosis. The signs and symptoms of DKA are consistent hyperglycemia, thirst, confusion, ketones in the urine, nausea, and vomiting.
The etiology of Type 1 Diabetes is the destruction of the insulin secreting beta cells in the pancreas in a genetically susceptible person (Ignatavicius,...