1. Type 1 diabetes
By Grace Boamah

2. 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

3. 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

4. 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 

5. 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 .

6. 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 hr

7. 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 Units
Lunch = 75 g / 5 servings Units
Dinner = 75 g / 5 servings Units
Snack = 30 g / 2 servings Units
Total CHOs = 255g / 16 servings 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

8. 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.

9. 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

10. 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
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.