The symptoms of Type 1 diabetes mellitus are vague and the causes may be related to several factors. Type 1 diabetes affects approximately 5% to 10% of people with the disease; it is characterized by an acute onset, usually before 30 years of age (CDC, 2008). Type 1 diabetes is characterized by destruction of the pancreatic beta cells. Combined genetic, immunologic, and possibly environmental (eg. Viral) factors are thought to contribute to beta cell destruction.
Although the events that lead to beta-cell destruction are not fully understood, it is generally accepted that a genetic susceptibility is a common underlying factor in the development of type 1 diabetes. People do not inherit type 1 diabetes itself but rather a genetic predisposition, or tendency has been found in people with certain human leukocyte antigen (HLA) types. There is also evidence of an autoimmune response in type 1 diabetes.This is an abnormal response in which antibodies are detected against normal tissues of the body, responding to these tissues as if they were foreign. Autoantibodies against islet cells and against endogenous (internal) insulin have been detected in people at the time of diagnosis and even several years before the development of clinical signs of type 1 diabetes. In addition to genetic and immunologic components, environmental factors, such as viruses or toxins that may initiate destruction of the beta cell are being investigated.
Regardless of the specific cause, the destruction of the beta cells results in decreased insulin production by the liver, and fasting hyperglycemia.In addition, glucose derived from food cannot be stored in the liver but instead remains in the bloodstream and contributes to postprandial hyperglycemia. If the concentration of glucose in the blood exceeds the renal threshold for glucose, usually 180 to 200 mg/dL (9.9 to 11.1 mmol/L), the kidneys may appears in the urine (glycusuria). When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluid and electrolyte.
This is called osmotic dieresis. Because insulin normally inhibits glycogenolysis and gluconeogenesis, these process occur in an unrestrained fashion in people with insulin deficiency and contribute further to hyperglycemia.In addition, fat breakdown occurs, resulting in an increased production of ketone bodies, which are the byproducts of fat breakdown. Increased thirst and frequent urination, Extreme hunger, Weight loss Fatigue, Blurred vision, Dizziness and Body weakness are the common signs and symptoms of type 1 diabetes mellitus.
Diabetic ketoacidosis occurs when a person with diabetes becomes dehydrated. As the body produces a stress response, hormones (unopposed by insulin due to the insulin deficiency) begin to break down muscle, fat, and liver cells into glucose (sugar) and fatty acids for use as fuel. These hormones include glucagon, growth hormone, and adrenaline. These fatty acids are converted to ketones by a process called oxidation.
The body consumes its own muscle, fat, and liver cells for fuel.In diabetic ketoacidosis, the body shifts from its normal fed metabolism (using carbohydrates for fuel) to a fasting state (using fat for fuel). The resulting increase in blood sugar occurs, because insulin is unavailable to transport sugar into cells for future use. As blood sugar levels rise, the kidneys cannot retain the extra sugar, which is dumped into the urine, thereby increasing urination and causing dehydration. Commonly, about 10% of total body fluids are lost as the patient slips into diabetic ketoacidosis.
Significant loss of potassium and other salts in the excessive urination is also common.HistoryA.R., a 61years old female with a medical history of Chronic Renal Failure and had undergone hemodialysis in March 10, 2012.
She was diagnosed with Type I diabetes mellitus on March 12, 2012.When the patient had her follow up check up and at her stitches be removed at the OPD (Out Patient Department) of PNPGH. She suddenly fell to the ground. She was immediately rushed at Emergency Room where she was taken RBS (Random Blood Sugar) that revealed 18 mg/dL. The patient was pale and cold clammy skin. She was given D50 50cc IV “stat” upon waking up she complained of severe dizziness and body weakness hence decides for admissionNursing Physical AssessmentA.
R., was unconscious and incoherent. The patient’s temperature 35.7 C, pulse rate was 75, respirations were 16, blood pressure was 100/50, O2 saturation in 98%, lungs was clear, Skin is pale, moist, and very gold. With intra jugular cannula in left jugular vein for hemodialysis.
Noted swelling of both lower extremities. The urine output in 0800H – 1000H was 300cc. The patient was placed on NPO then was advised to have diabetic diet once stable. According to relatives the patient cannot perform activities & daily living because of her condition.Related TreatmentPatient was treated with insulin replacement therapy via subcutaneous injection, along with attention to dietary management, typically including carbohydrate tracking, and careful monitoring of blood glucose levels using glucose meters. According to the most common insulin’s are biosynthetic products produced using genetic recombination techniques; formerly, cattle or pig insulin’s were used, and even sometimes insulin from fish.
Untreated type 1 diabetes commonly leads to coma, often from diabetic ketoacidosis, which is fatal if untreated. Continuous glucose monitors have been developed and marketed which can alert patients to the presence of dangerously high or low blood sugar levels, but technical limitations have limited the impact these devices have had on clinical practice so far.Treatment of diabetes focuses on lowering blood sugar or glucose (BG) to the near normal range, approximately 80–140 mg/dl (4.4–7.8 mmol/L).] The ultimate goal of normalizing BG is to avoid long term complications that affect the nervous system (e.
g. peripheral neuropathy leading to pain and/or loss of feeling in the extremities), and the cardiovascular system (e.g. heart attacks, vision loss). Hypoglycemia is a very common occurrence in people with diabetes, usually the result of a mismatch in the balance among insulin, food and physical activity, although the non-physiological method of delivery also plays a role.
Oxygen Inhalation was given via nasal cannula at 2-3L per minute. She was also given Metformin tablet as her maintenances dose.Nursing Care PlanA.R., Nursing diagnosis altered: Disturbed thought process relates to inadequate glucose for cellular brain function and effects of endogenous hormones activity as evidenced by dizziness. According to Benjamin Wedro (2006) Dizziness is a common complaint in persons with diabetes, and may be caused by low blood sugar (hypoglycemia), high blood sugar (hyperglycemia), or autonomic dysfunction.
Patients appearance is pale and cold clammy skin with severe perspiration. The short term goal is to atleast reduce or totally relief patient from dizziness.Nursing intervention for the patient in including placing the patient into semi to high fowlers position, provides safety precaution as indicated like safer, chocolates, high intake of carbohydrates and fats. The rationale behind this is to secure the health of patient is stated that he/she was relieve or was no longer dizziness, he/she still complained of weakness or unable to move faster.
The patient was responsive to educational regarding safety measures and proper nutrition and requested with nutritionist or discharge.
