Type 1 Diabetes Mellitus Nael Hernandez

TYPE 1 DIABETES MELLITUS
Presented By:
NAEL, Jean Claudine
HERNANDEZ, Shermayne M.
Diabetes Mellitus Type 1
• Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes,
is a chronic condition in which the pancreas produces little or no insulin. Insulin
is a hormone needed to allow sugar (glucose) to enter cells to produce energy.
• Different factors, including genetics and some viruses, may contribute to type 1
diabetes. Although type 1 diabetes usually appears during childhood or
adolescence, it can develop in adults.
CLINICAL CHARACTERISTICS AND CLINICAL IMPLICATIONS
• Onset any age, but usually young (<30 yrs)
• Usually thin at diagnosis; with recent weight loss
• Etiology includes genetic, immunologic, or environmental factors (eg, virus).
• Often have islet cell antibodies
• Often have antibodies to insulin even before insulin treatment
• Little or no endogenous insulin
• Need insulin to preserve life
• Ketosis-prone when insulin absent
• Acute complication of hyperglycemia: diabetic ketoacidosis
CLINICAL MANIFESTATIONS
• Polyuria (increased urination)
• polydipsia (increased thirst) occur as a result of the excess loss of fluid associated with osmotic diuresis.
• The patient also experiences polyphagia (increased appetite) resulting from the catabolic state induced by insulin
deficiency and the breakdown of proteins and fats.
• Other symptoms :
– fatigue and weakness,
– sudden vision changes,
– tingling or numbness in hands or feet,
– dry skin,
– skin lesions or wounds that are slow to heal,
– and recurrent infections.
– The onset of type 1 diabetes may also be associated with sudden weight loss or nausea, vomiting, or abdominal
pains, if DKA has developed.
The role of insulin
• Once a significant number of islet cells are destroyed, you'll produce little or no
insulin. Insulin is a hormone that comes from a gland situated behind and
below the stomach (pancreas).
The pancreas secretes insulin into the bloodstream.
Insulin circulates, allowing sugar to enter your cells.
Insulin lowers the amount of sugar in your bloodstream.
As your blood sugar level drops, so does the secretion of insulin from your pancreas.
The role of glucose
• Glucose — a sugar — is a main source of energy for the cells that make up muscles and other
tissues.
 Glucose comes from two major sources: food and your liver.
 Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
 Your liver stores glucose as glycogen.
 When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks
down the stored glycogen into glucose to keep your glucose levels within a normal range.
• In type 1 diabetes, there's no insulin to let glucose into the cells, so sugar builds up in your
bloodstream. This can cause life-threatening complications.
Risk factors
Some known risk factors for type 1 diabetes include:

Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of
developing the condition.
Genetics. The presence of certain genes indicates an increased risk of developing type 1 diabetes.
Geography. The incidence of type 1 diabetes tends to increase as you travel away from the equator.
Age. Although type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first
peak occurs in children between 4 and 7 years old, and the second is in children between 10 and
14 years old.
Pathophysiology
• Type 1 DM is the culmination of lymphocytic infiltration and destruction of
insulin-secreting beta cells of the islets of Langerhans in the pancreas. As beta-
cell mass declines, insulin secretion decreases until the available insulin no
longer is adequate to maintain normal blood glucose levels. After 80-90% of the
beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed.
Patients need exogenous insulin to reverse this catabolic condition, prevent
ketosis, decrease hyperglucagonemia, and normalize lipid and protein
metabolism.
Complications
• Heart and blood vessel disease. Diabetes dramatically increases your risk of various cardiovascular
problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of
the arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that
nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that
usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood
sugar could cause you to eventually lose all sense of feeling in the affected limbs. Damage to the nerves
that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea or
constipation. For men, erectile dysfunction may be an issue.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter
waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to
kidney failure or irreversible end-stage kidney disease, which requires dialysis or a kidney transplant.
• Eye damage. Diabetes can damage the blood vessels of the retina (diabetic
retinopathy), potentially causing blindness. Diabetes also increases the risk of other
serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the
risk of various foot complications. Left untreated, cuts and blisters can become
serious infections that may ultimately require toe, foot or leg amputation.
• Skin and mouth conditions. Diabetes may leave you more susceptible to infections of
the skin and mouth, including bacterial and fungal infections. Gum disease and dry
mouth also are more likely.
• Pregnancy complications. High blood sugar levels can be dangerous for both the
mother and the baby. The risk of miscarriage, stillbirth and birth defects increases
when diabetes isn't well-controlled. For the mother, diabetes increases the risk of
diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high
blood pressure and preeclampsia.
ASSESSMENT AND DIAGNOSTIC FINDINGS
1. Symptoms of diabetes plus casual plasma glucose concentration equal

to or greater than 200 mg/dL (11.1 mmol/L). Casual is defines as any
time of day without regard to time since last meal. The classic
symptoms of diabetes include polyuria, polydypsia, polyphagia and
unexplained weight loss.
or
2. Fasting Plasma Glucose (FPG) or Fasting Blood Sugar (FBS) greater
than or equal to 126 mg/dL (7.0 mmol/L). Fasting is defined as no
caloric intake for atleast 8 hours.
or
3. Two-hour postload glucose equal to or greater than 200 mg/dL (11.1 mmol/dL)
during an oral glucose tolerance test. The test should be performed as
described by the World Health Organization, using a glucose load containing
the equivalent of 75 g anhydrous glucose dissolved in water.
4. In the absence of unequivocal hyperglycemia with acute metabolic

decompensation, these criteria should be confirmed by repeat testing on a
different day. The third measure is not recommended for routine clinical use.
ABNORMAL LABORATORY VALUE FOR GLUCOSE
• Fasting Plasma Glucose (FPG) or Fasting Blood Sugar(FBS)

126 mg/dL (7.0 mmol/L) above
• Random Plasma Glucose (RPG) or Random Blood Sugar (RBS)
200 mg/dL (1.1 mmol/L) above
• NORMAL LABORATORY VALUE FOR GLUCOSE
– Glucose, Fasting: 70-110 mg/Dl
– Glucose, monitoring: 60-110 mg/dL
– Glucose, 2-hr postprandial: < 140 mg/dL
OVERALL MANAGEMENT OF DIABETES
• Five components in Diabetes management:
1. Nutritional therapy
2. Exercise
3. Monitoring
4. Insulin Therapy
5. Education

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TYPE 1 DIABETES MELLITUS

Some known risk factors for type 1 diabetes include:

1. Symptoms of diabetes plus casual plasma glucose concentration equal

4. In the absence of unequivocal hyperglycemia with acute metabolic

• Fasting Plasma Glucose (FPG) or Fasting Blood Sugar(FBS)

• Five components in Diabetes management:

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