Diabetes Mellitus Type 1

 

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Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Abbye Senn, Colleen Nalley, Lucinda hampton, Rachael Lowe, Elaine Lonnemann, WikiSysop, Fasuba Ayobami, Kim Jackson, Vidya Acharya, Amanda Ager and Evan Thomas  

Definition/Description

Diabetes Mellitus (DM) Type 1 is a chronic disorder that is characterized by hyperglycemia (high blood sugar) and disruption in metabolism of carbohydrates, fats, and proteins. It occurs because of little or no insulin being produced in the body. It occurs in children or young adults, usually before the age of 30. It has an abrupt onset usually and most individuals have a thin or normal body weight at onset. It is managed by diet, exercise, and insulin injections. It can result in serious vessel vascular complications and neuropathies. It can be a major cause of cardiovascular disease and strokes, due to the effect it has on vessels and nerves. It is also the leading cause of end-stage renal (kidney) disease, non-traumatic amputations in the lower extremity, and new cases of blindness. Autoimmune, environmental, and genetic causes may put individuals at more risk than others of developing Type 1 DM.

Prevalence

• ~10% of all Diabetes cases are Type 1 DM
• 29.1 million Americans had Diabetes (2012)
• 1.25 million Americans had Type 1 DM (2012)
• 208,000 Americans under the age of 20 estimated to have Diabetes, which is 0.25% of the population
  

Characteristics/Clinical Presentation

• Polyuria (increased urination)
• Polydipsia (increased thirst)
• Polyphagia (Increased appetite)*
• Glycosuria (glucose in urine)
• Weight loss despite polyphagia*
• Hyperglycemia (increased blood glucose)
• Ketonuria (ketones in urine)
• Fatigue
• Generalized weakness
• Blurred vision
• Irritability
• Recurring skin, gum, bladder, vaginal, or other infections
• Numbness or tingling in hands or feet
• Cuts, scrapes, or bruises that are difficult or slow to heal
• Periarthritis (especially shoulder)*
• Hand stiffness
  

• = Occurs primarily in Type 1 Diabetes 

Associated Co-morbidities

• Hypoglycemia
• Hypertension
• Dislipidemia
• Cardiovascular Disease
• Blindness/Eye problems
• Kidney Disease
• Increased risk for cognitive decline/dementia (including Alzheimer’s disease)
• Sensory neuropathy, which can lead to trauma or ulceration, causing infection and ultimately may cause an amputation
• Charcot’s joint or neuropathic arthropathy (especially shoulder, hands, or feet)
• Diabetic Neuropathy
• Diabetic Ketoacidosis, resulting from high blood glucose levels that are not treated with increased insulin (usually in special circumstances of stress, trauma, surgery, pregnancy, puberty, or infectious states)
  

Medications

• Insulin Injections

       -Do not inject into site of active extremities within one hour of exercise because the insulin will be absorbed more quickly

• Insulin Pump
• If patient is on epinephrine, glucocorticoids, or growth hormone, there may be an increase in blood glucose levels
  

Diagnostic Tests/Lab Tests/Lab Values

Diagnostic Criteria:

• Fasting plasma glucose (FPG) ≥ 126 mg/dl on two different days
• A1C Levels≥ 6.5 % on two separate occasions (but must be confirmed by FPG)

Other Information:

• FPG >100mg/dl is a risk factor for future diabetes
• A1C is a measure of how diet, exercise, and/or medication/insulin have been controlling glucose over a period of time 
• Normal FPG= 80-120 mg/dl
• Want to keep A1C levels below 7%
• >10%=medical attention immediately

Etiology/Causes

Etiology: 

• Impaired insulin: Glucose is increased in the circulating blood because it is not being taken up by the liver or other tissues, which causes a glusose accumulation. This leads to impaired protein synthesis because amino acids need insulin for transport through the body. It also leads to fat breakdown in order to free more glucose, which can lead to ketone formation. The accumulation of glucose in the blood can also lead to a hyper osmotic condition.
• Islet cell destruction occurs 

Possible Cause:
Could be possibly due to viral or autoimmune causes

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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