TYPE 1 DIABETES

BY GRACE BOAMAH
 WHAT IS DIABETES?

Diabetes is a chronic disease associated with abnormally high blood glucose where the
body does not produce sufficient amounts or properly use insulin.
Prevalence
Two types of diabetes
Type 1: develops when the immune system destroys pancreatic beta cells, the only
source of insulin
Type 2: more common form with progressive loss of beta cells insulin deficiency or
insulin resistance
 WHAT IS DIABETES? (continued)

Pathophysiology
Beta cell destruction leading to absolute insulin deficiency
No insulin hyperglycemia no glucose to cells symptoms & complications
Diagnostic criteria:
Many symptoms are similar: hyperglycemia, polyuria, polydipsia
Can differentiate by: age of onset, etiology (autoimmune), risk factors (genetic,
environmental), lab tests, ketoacidosis, significant weight lost, electrolyte
disturbances,
& comorbidities
T1DM presents in three stages with different levels of symptoms, autoantibodies, &
abnormal blood glucose (FBG, CPG, 2-h PG, HgA1C)
There are two forms of Type 1: immune-mediated & idiopathic
 SUMMARY OF CASE STUDY: MG

32 year old Hispanic man admitted with acute uncontrolled

hyperglycemia
Did not feel well, thirst and frequent urination

BG level of 610 mg/dL

Admitting Diagnosis was DKA
PMH/FH: smoker 1ppd x10 yrs., father MI, mother T2DM
Wt. 165 lbs. Ht. 511 BMI 23
BP 78/100 Temp 99.6 Resp. 24
HR 100
INTERPRETATION: METABOLIC EVENTS &
PATHOPHYSIOLOGY
Symptoms are consistent with admitting diagnosis of diabetic ketoacidosis.
DKA is an acute, life-threatening complication especially common with Type 1.
DKA is a complex disordered metabolic state involving hyperglycemia, ketoacidosis, and
ketonuria.
Treated in ER with insulin drip to regain glycemic control and reduce further complications.
Without insulin the cells dont have glucose to use as fuel, so the counterregulatory
hormones try to get or make more glucose which worsens the hyperglycemia
Pt. felt ill - may have had virus that might have been an environmental trigger .
 INSULIN: TYPES and DOSING

Types: rapid, short, intermediate, long, & mixed

Glargine Prescribed: Insulin drip. Eventual insulin regimen for
discharge is total daily dose, TDD, of 30 units divided as
15 units from Glargine in the PM & 15 units from
Novolog bolus prior to meals using ICR of 1:17
TDD = Units x body weight = 0.4 units x 75 kg = 30 units
Name Onset Peak Action Duration
Hypoglycemia need for glucose tablets, juice
Novolog < 0.25 hr 0.5 1.0 hr 3 -5 hr

Glargine 2 - 4 hr Peak less 20 -24 hr

CARB COUNTING PLAN SUGGESTED FOODS
3.5 Servings CHO/meals, 1-2 snacks Healthy carbohydrates: Whole grains
Recommended 240 270 grams of CHO
Fiber rich foods: Vegetables, nuts, beans, peas,
ICR = 1:17 bran
Breakfast = 75 g / 4 servings 4.4 Units
Fish: Salmon, tuna, sardines, and cod
Lunch = 75 g / 5 servings 4.4 Units
Dinner = 75 g / 5 servings 4.4 Units Good fats: Avocados, pecans, olives, walnuts
and almonds
Snack = 30 g / 2 servings 1.8 Units
Total CHOs = 255g / 16 servings 15 Units
PES STATEMENTS

Impaired nutrient utilization (NC- 2.1) related to insufficient insulin level as evidenced by
lab results ( BG 610mg/dl, A1C 10.2, C-peptide 0.09).
Food and nutrition related knowledge deficit (NB-1.1) related to being newly diagnosed
with Type 1 diabetes as evidenced by lack of awareness/knowledge of symptoms, disease,
diet, glucose testing and self-monitoring.
Excessive calorie intake or excessive carbohydrate intake (NI-5.8.2) related to
uncontrolled type one diabetes as evidence by increased blood glucose and HgbA1C.
 NUTRITION CARE PLAN

Intervention Monitoring
Check A1C testing
Short Term Goals
Self monitoring of blood glucose
Monitor food and glucose level
Blood pressure
Exercise
Ketones
Nutrition education
Check weight status
Understand the complications and how to handle problems
Check lipid panel, TGs
To achieve tight glycemic control by matching your carbohydrate to your
insulin; timing and amount Evaluation
Long Term Goals Keep records of what MG eats
To maintain blood glucose level and the AIC See diabetic educator weekly
To improve MGs health and also help reduce any risk of developing Evaluate for a pump in future
hypertension, stroke and CVD
 REFERENCES

American Diabetes Association: Diagnosis and classification of diabetes mellitus, Diabetes Care 37(S1):S5, 2014a.
Chiang JL, et al: Type 1 diabetes through the life span: a position statement of the American Diabetes Association,
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Mahan, L. K., & Raymond, J. L. (2017). Krause's food & the nutrition care process (14th ed.) Pages 586-604.
Atkinson MA, Maclaren NK. The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 1994; 331:1428.
Quinn M, Fleischman A, Rosner B, et al. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years.
J Pediatr 2006; 148:366.
Ziegler AG, Hillebrand B, Rabl W, et al. On the appearance of islet associated autoimmunity in offspring of diabetic
mothers: a prospective study from birth. Diabetologia 1993; 36:402.
Achenbach P, Koczwara K, Knopff A, et al. Mature high-affinity immune responses to (pro)insulin anticipate the
autoimmune cascade that leads to type 1 diabetes. J Clin Invest 2004; 114:589.