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. 5’11” 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 don’t 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 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 Hypoglycemia – need for glucose tablets, juice Glargine Name Onset Peak Action Duration 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 Healthy carbohydrates: Whole grains 3.5 Servings CHO/meals, 1-2 snacks Recommended 240 – 270 grams of CHO ICR = 1:17 Breakfast = 75 g / 4 servings 4.4 Units Lunch = 75 g / 5 servings 4.4 Units Dinner = 75 g / 5 servings 4.4 Units Snack = 30 g / 2 servings 1.8 Units Total CHOs = 255g / 16 servings 15 Units Healthy carbohydrates: Whole grains Fiber rich foods: Vegetables, nuts, beans, peas, bran Fish: Salmon, tuna, sardines, and cod Good fats: Avocados, pecans, olives, walnuts and almonds

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

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, Diabetes Care 37:2034, 2014. 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.