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Type 1 Diabetes Mellitus by Justine Cole

May 8, 2019

Type 1 Diabetes Mellitus, also known as T1DM, is an autoimmune disease in which Word Bank
Autoimmune Disease:
a patient’s pancreas is unable to effectively use the insulin produced or cannot secrete A disease where the
immune system
enough insulin into the bloodstream to regulate a patient’s blood sugar levels. T1DM attacks the body
Insulin: An important
is a very common disease and is the 7th leading cause of death amongst adolescents hormone that helps
cells take and utilize
(1). Normally, the pancreas’ beta cells monitor blood glucose levels and will release glucose (5)
Blood Sugar: amount
insulin into the bloodstream dependent upon the amount of food that had been of glucose present in
the blood
ingested, but not in the case of T1DM. When insulin is not secreted into the Beta Cells: Special
functioning cells
Glucose: A sugar that
bloodstream, the glucose in your blood is not broken down. When this happens, the
our body uses as an
energy source
sugar builds up in the bloodstream and causes a condition called hyperglycemia and
Hyperglycemia: An
elevation in blood
is shown in urine analyses and lab work. To prevent a buildup of sugar in the sugar levels
Carbohydrate: Simple
bloodstream, patients with T1DM are prescribed insulin injections. Sugar build ups form of sugar

can cause serious complications such as a severely dehydrated state known as Diabetic

Ketoacidosis, also known as DKA. Although T1DM is a very serious and life-threatening

disease, it is extremely manageable through carbohydrate counting, consistent and accurate

insulin injections, and constantly checking blood sugar levels.

Origin

Diabetes has been recognized as a disease for a very long time, one of the first mentions of

diabetes dates back to 1500 B.C., found in ancient Egyptian scriptures (2). One of the very first

indications that arose the discovery of T1DM was frequent urination, excessive thirst, and

constant weight loss (2). More discoveries were made from many other physicians showing these
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characteristics: such as Thomas Willis’ discovery of sweet, sugar filled urine being dispelled and

increased appetite (3). At first, physicians believed that T1DM was a disease of kidney

malfunction due to patient’s urine complications. However, in the late 18th century an English

physician discovered that the symptoms arose after injury to the pancreas occurred (2). Thus, the

conclusion was made that T1DM was a disease caused by damaged cells in the pancreas.

Causes

The physiological cause of Type 1 Diabetes Mellitus is destroyed pancreatic cells that are unable

to effectively secrete insulin into the bloodstream (Figure 1).

The cells are either too damaged to produce and secrete any

insulin or they do not produce enough or functioning insulin.

There is no cause of T1DM, but rather a number of possible

risk factors that could lead to the development of T1DM.

The genetic history of a patient’s close relatives is one of the

Figure 1. When pancreatic cells are destroyed,
most influential risk factors of T1DM (6). If there is no family
they are unable to secret insulin into the
bloodstream. https://g.co/kgs/iJMBSq
history of T1DM in the family, there is a 4% risk of

development of the disease, if both parents of the patient are affected by T1DM, then the percent

risk of development increases to as high as 30% (6). There are also many other risk factors that

have been linked to the development of T1DM such as geological location, diet, lower birth

weights, trauma, and viral infections but not one has been solely detected as the one main cause

(6). More so it is more believed that exposure to one or more of these possible causes is what

leads to an immune response that damages the beta cells that secrete the insulin from the

pancreas (6).

Symptoms
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Type 1 Diabetes Mellitus has many physical characteristics that are usually easy to Word Bank
Polyuria: Excessive
detect. T1DM is mostly presented during the childhood stage, almost half of detected urination with large
amounts of urine
cases presented themselves before the patient is of 10 years old, but is still presented Polydipsia: Intense
excessive thirst
to patients in adulthood (6,7). Nausea: A queasy
feeling that can cause
- One of the most common and primary symptoms a patient will experience is someone to vomit
Anorexia: loss of
polyuria (4). Polyuria occurs when a patient has a high level of glucose in the appetite for food
Hyperglycemia: An
blood and it must be expelled out of the bloodstream in the only way the body elevation in blood
sugar levels
Hypoglycemia: A
knows how, through secretion of waste through urination.
decrease in blood
sugar levels
- Another symptom of T1DM is polydipsia. Diabetic patients suffer from

polydipsia because when the glucose in the bloodstream is not being broken down,

water’s bonds with glucose become stronger and thus make it harder for a patient’s

kidneys to separate the water to supply into your body, therefore making one dehydrated

and suffer from a dry mouth (6).

- A combination of weight loss an increased appetite has also shown in patients with

T1DM. Although these two conditions seem to negate themselves, they come hand in

hand with one another. When the body is unable to secrete insulin efficiently, the body is

unable to utilize glucose in skeletal muscle, this then leads to an excessive breakdown of

the fats and muscle in order to supplement the body with the necessary glucose (6). This

causes an increase in appetite in patients because they are trying to replenish the fats and

muscle that is breaking down, but eventually without management the appetite will

decrease and the extreme thirst will increase, causing nausea and anorexia leading to the

uncontrolled weight loss (6).

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- One of the last most predominant symptoms of

T1DM changes in a patient’s behavior. These

changes include severe fatigue or lethargy,

irritability and mood swings, and excessive

sleeping (2). All of these changes come from

hyperglycemia, the elevated blood sugar levels

cause one to feel as if they’re slightly ill and Figure 2. Normal levels of glucose in the bloodstream
versus the result of too little, hypoglycemia, and too much,
discomforted (6). hyperglycemia, in the bloodstream.
https://www.123rf.com/photo_94569491_stock-vector-
Diagnosis glucose-in-the-blood-vessel-normal-level-hyperglycemia-
high-blood-sugar-hypoglycemia-low-blood-sugar.html
Diagnosing Type 1 Diabetes Mellitus consists of a

number of tests including lab analysis and urine analysis.

- When conducting a lab analysis, there is multiple numbers that are examined, Word Bank
Hemoglobin A1C: the
but the most predominant number examined is the hemoglobin A1C count. number that measures
the levels of glucose
The normal range for an A1C exam is below is 5.7 percent, showing that there present in a body cell
(2)
is still a relatively low percentage of glucose in the bloodstream (5). Having an Fatality: occurrence
of death
A1C of 5.8 to 6.4 percent will classify a patient as a prediabetic, but in patients Ketone: an alternate
source of energy
with T1DM, the A1C percentages are usually well above a 6.5 percent, broken down from
fatty tissue (7)
Synthetic Insulin:
especially seen in unmanaged diabetes (7). Once the A1C reaches a value of 8
insulin made of
bacteria and yeast
percent, the patient is in danger of developing severe physical complications
Carbohydrate: Simple
form of sugar
of diabetes or worse, fatality (8).

- Another examination done in order to diagnose T1DM is a urine analysis and a special

watch on a patient’s ketone levels. When glucose is not broken down in the bloodstream

the body does not receive the accurate amount of glucose needed for proper function, so
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ketones are then utilized in the body (7). A urine analysis is done to monitor ketones

because when ketone levels become too high in the bloodstream, they become more

present in urine and the high levels indicate that insulin is not breaking down glucose (7).

Treatment Word Bank

Synthetic Insulin:
Although T1DM is a serious, complicated disease, there are many methods of coping insulin made of
bacteria and yeast
and managing to have a healthy life. Managing T1DM really depends on having three Carbohydrate: Simple
form of sugar
major lifestyle changes. The first change is dedication to a diet and meal lifestyle. Units of Insulin: the
most basic measure of
Diabetic patients must ensure they have well-balanced-meals all throughout the day insulin, using
measured to 100 units
so that their body continuously has functioning glucose to break down. For some Rapid Acting Insulin:
Insulin for meals
patients this may be difficult over some time because having to deal with during the day in
example (7)
Long Acting Insulin:
hyperglycemia over a long period of time can cause patients to suffer from anorexia,
Insulin for over night
in example (7)
as mentioned before (7). Next, physicians are well aware that when diabetics eat, the

sugars they ingest will not be broken down, so diabetic patients are prescribed to self-

administering insulin injections. In order to ensure the synthetic insulin works correctly, diabetic

patients also have to administer themselves a correct dosage of insulin. To do this, patients must

count the carbohydrates they eat in a meal and then

calculate how many units of insulin are needed to be

injected (7). Along with calculating the correct dosage of

units of insulin, patients also have to give themselves the

correct kind of insulin. Different kinds of insulin vary

from rapid acting insulin to long acting insulin (7). They

administer themselves their injections in fatty parts of their

bodies so that the insulin is easily able to find its way into

Figure 3. An image that depicts the correct sites for

insulin injections on the body and how skin must be
handled so the injection goes into the body properly
https://depositphotos.com/186700662/stock-illustration-
insulin-injections-places.html
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the bloodstream (7, Figure 3). And lastly, diabetic patients must closely monitor their blood

sugar levels. With the assistance of a small gadget, blood sugar levels are easily monitored

through the blood of a pricked finger (7). Blood sugar levels should be monitored at least four

times a day in order to efficiently track a patient’s fluctuations and efficiently manage a patient’s

diabetes (7). With a close watch on these three factors, Type 1 Diabetes Mellitus is a manageable

disease and the ability to have a healthy life is possible, but it is still a very difficult daily

struggle that affects the lives of so many in very severe and demanding ways.
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References

1. Babler, E., & Strickland, C. (2016). Helping Adolescents with Type 1 Diabetes “Figure it

Out”. Journal of Pediatric Nursing, 31(2), 121-131.

2. The History of Diabetes. (2016). The Diabetes Council. Retrieved from

https://www.thediabetescouncil.com/the-history-of-diabetes/

3. Dukan, E., & Milne, I. (2011). History of Diabetes. The Journal of the Royal College of

Physicians of Edinburgh, 41(4). 376-377.

4. Diabetes. (2018). World Health Organization. Retrieved from

https://www.who.int/en/news-room/fact-sheets/detail/diabetes

5. Silverthorn, Dee. (2016). Human Physiology: An Integrated Approach. 7th ed. Pearson.

6. Levtisky, L., Misra, M. (2019). Epidemiology, presentation, and diagnosis of type 1

diabetes mellitus in children and adolescents. UpToDate.

7. Weinstock, R. (2019). Management of blood glucose in adults with type 1 diabetes

mellitus. UpToDate.

8. A1C Test. (218). Mayo Clinic. Retrieved from https://www.mayoclinic.org/tests-

procedures/a1c-test/about/pac.20384643