type 1 diabetes mellitus

type 1 DM

also known as juvenile-onset diabetes; characterized by no insulin production by pancreas, impaired cell uptake of insulin, or combination of both

type 1 DM symptoms

polyuria, nocturia, polydipsia, polyphagia, weight loss, drowsiness, nausea, blurred vision (retinopathy)

type 1 DM complications

hypertension, cardiovascular disease due to hyperglycemic vascular damage, impaired circulation, poor wound healing, increased infection severity and duration, numbness and tingling (neuropathy), nephropathy, retinopathy

diabetic ketoacidosis (DKA)

acute complication of type 1 DM; due to buildup of ketones from fat/protein breakdown; may result in dec LOC, severe dehydration, nerve damage, oliguria, coma, K+ changes, shock and organ damage

4-8 mmol/L

reference range for blood capillary glucose; checked before meals and HS for somogyi effect

less than 7%

reference range for hemoglobon A1C; measures amount of sugar attached to hemoglobin in RBC

4-6.5 mmol/L

reference range for fasting blood sugar (FBS); checks low range of blood glucose, fasted

short acting insulin

humulin R (regular); may be scheduled prior to meals and may be sliding scale

onset: 30-60 min

peak: 2-4 hours

duration: 5-8 hours

sliding scale insulin

may be humulin R or lispro insulins; administered based on CBG; generally given before meals and bedtime, or at indicated times; if CBG below 4 → follow hypoglycemic procedure; if CBG above 20 → contact physician

rapid acting insulin

lispro; fastest acting insulin, may be used in some sliding scale orders; give when meal is in front of patient, and make sure patient can eat; cannot be mixed with other insulins

onset: 10-15 mins

peak: 60-90 mins

duration: 3-5 hours

intermediate acting insulin

humulin N or NPH insulin; generally scheduled at a set time each day once or twice; longer onset, peak and duration; maintains blood sugars during the day

onset: 1-3 hrs

peak: 6-8 hrs

duration:12-16 hrs

mixed insulins

30% humulin R and 70% humulin N in the same vial; easier to draw up and less confusing; generally given once or twice a day

long acting insulin

glargine and determir; slow release insulin; low risk of hypoglycemia due to no peak; cannot be mixed with other insulins

onset: 1-2 hours

peak: none (slow release)

duration: 24 hours

hypoglycemia symptoms

trembling, diaphoresis, nausea, hhunger, weakness, fatigue, irritability, pallir, dizziness, headache, confusion, slurred speech, muscle wekness/drowsiness

hypoglycemia risk factors

risk greatest when first recieving insulin, dose changes or new insulin added, patient not eating, too much exercise, alcohol consumption, infection

somogyi effect

hypoglycemia at night due to too much insulin; counter regulatory hormones are released while sleeping and blood glucose spikes → hyperglycemia in morning; HS insulin needs to be reduced

dawn phenomenon

hyperglycemia in the morning due to cortisol and growth hormone released pre dawn; severe in teens and young adults; importance of HS snack; adjust insulin doses at time of administration