Type I Diabetes Mellitus

Question 1

When is type I most common?

Answer 1

In childhood and adolescence

Question 2

What factors can contribute to having type I?

Answer 2

• Environmental, infection (usually viral) in people w/ genetic predispostion
• Immune-mediated (most common); autoimmune destruction of β cells or circulating insulin antibodies
• Idiopathic (unknown cause, arises spontaneously)

Question 3

Name characteristics of type I

Answer 3

Abrupt onset, insulin dependence, tendency to ketosis (insufficient CHO’s from diet, burns fat instead), genetically related, 85-90% have ≥ 1 type(s) of autoantibodies

Question 4

What are the signs and symptoms of type I

Answer 4

Polyuria, polydipsia, polyphagia, rapid weight loss, extreme fatigue, frequent skin infections, slow healing injuries, tingling/numbness in hands/ feet, blurred vision, mental confusion, possible loss of consciousness, diabetic ketoacidosis (hyperventilation, hypotension)

Question 5

Lab findings of type I

Answer 5

Hyperglycemia, glucosuria (>10.0mmol/L) due to saturation of tubules, increased serum and urine osmo, increased urine specific gravity

Question 6

Lab findings in ketoacidosis

Answer 6

• Higher tendency to produce ketones (ketonemia and ketonuria)
• Decreased blood and urine pH, dehydration due to osmotic diuresis, electrolyte disturbances
• Lactate, fatty acids and other organic acids may contribute (less)

Question 7

What is the affect of ketoacidosis on HCO3 and CO2?

Answer 7

Both decreased:
HCO3- Buffering capacity being used up
tCO2 (pCO2)- due to Kussmaul respiration, trying to compensate

Question 8

Describe the electrolyte disturbances during ketoacidosis

Answer 8

• AG may be elevated
• Decreased Na (possible); polyuria, shift of water from cells fr. hyperglycemia, may have pseudohyponatremia fr. sever hypertriglyceridemia
• Increased plasma K (usually); displaced fr. cells due to acidosis, lack of insulin, kidney exchanges for H+

Question 9

Symptoms and causes of ketoacidosis

Answer 9

• Nausea and vomiting = more fluid loss
• Reduced blood volume fr. uncorrected fluid loss = decreased blood flow to kidneys = less excretion of gluc
• Possible acute renal failure (increased urea and creat)

Question 10

Treatment for ketoacidosis

Answer 10

Fluid replacement w/ isotonic saline, insulin, K replacement, possible bicarb infusion if pH < 7.00

Question 11

What are some long-term complications w/ type I?

Answer 11

Microvascular probs; nephropathy, neuropathy, renal disease, amputations, blindness
Macrovascular; heart disease

Question 12

Describe idopathic type I

Answer 12

• Strongly inherited
• No β-cell autoimmunity
• Episodic requirements for insulin therapy