Diabetes and its Main Types

Diabetes is a disorder of the endocrine system, which messes with the metabolism of carbohydrates, fats, and proteins. The metabolism is compromised because of a lack of insulin, either from destruction of the beta cells, which secrete insulin, or because of insulin resistance. Insulin is secreted by beta cells and it is what enables the cells to use glucose. Type 1 diabetes was formerly called juvenile diabetes because mostly kids were diagnosed with it. It is now changed to be type 1 diabetes because more and more children are becoming diagnosed with type 2 diabetes (Taylor, 2018).

Disease/Physiological Process

Type 1 diabetes occurs because there is an autoimmune destruction of beta cells, which means the person makes no insulin. They body's immune system mistakenly destroys the beta cells and islets of Langerhans in the pancreas. These are needed to produce insulin. There is no insulin production, which insulin is needed enable to cells to use the glucose. Whenever the patient eats and has a rise in blood glucose, there are no pancreatic beta cells, therefore there is no insulin. Without any insulin, the body will not be able to uptake the glucose in its cells for energy. The patient will become hyperglycemic, which means there is high sugar or glucose in their bloodstream (Taylor, 2018).

Etiology, Risk Factors

Most patients with Type 1 diabetes have autoimmune destruction of pancreatic beta cells. Their body contains insulin and islet cell autoantibodies, which destroy these structures. There immune, genetic, and environmental factors that come into play. Porth (2015) states, "Type 1A diabetes is an autoimmune disorder that is thought to result from a genetic predisposition (i.e., diabetogenic genes); an environmental triggering event, such as an infection; and a T-lymphocyte mediated hypersensitivity reaction against some beta cell antigens" (p. 801). Some research has pointed to inherited major histocompatibility complex genes on chromosome 6 and an insulin gene on chromosome 11. Idiopathic Type 1 diabetes has no known cause. It can be seen that there is pancreatic beta cell destruction, but there is no autoimmune complex present. Porth (2015) states, "Only a small number of people with Type 1 diabetes fall into this category; most are of African or Asian descent. Type 1B diabetes is strongly inherited" (p. 802). Type 1 diabetes can be diagnosed at any age, but children under the age of 18 are more likely to have this disease. Atkinson (2013) states, "Peaks in presentation occur between 5-7 years of age and at or near puberty. Whereas most autoimmune disorders disproportionately affect women, type 1 diabetes is slightly more common in boys and men" (p. 2). Type 1 diabetes does not include the risk factors like type 2, such as obesity and physical inactivity.

Clinical Manifestations

Classic symptoms for diabetes type 1 and type 2 are polyuria, or excessive urination, and polydipsia, or excessive thirst. These occur because of the inability to produce or use insulin, which causes hyperglycemia. With high blood glucose levels and the inability of the cells to uptake the glucose, the body tries to find other ways to rid the blood of glucose. It does this through urination and by pulling water out of the cells into the blood. It pulls the water into the blood to try to dilute the glucose contents of the blood, or else the blood will begin to move slowly and have a higher risk of forming clots. Symptoms that will strictly point to type 1 diabetes are polyphagia, or excessive hunger, weight loss, fatigue, and weakness. The patient will be excessively hungry because the cells are unable to take up the glucose for energy. Even though they may be eating a lot, their cells will keep sending signals that they are starving because they do not have the glucose and energy the need to function. Other clinical manifestations that align with type 1 diabetes are those of diabetic ketoacidosis, which is an acute complication of type 1. Some of these symptoms are hyperglycemia, dehydration, metabolic acidosis, and ketones in their urine and blood. The ketones will try to escape the body in any way possible; therefore their breath will smell like alcohol (Taylor, 2018).

Nursing Implications, Patient Education

Whenever a patient is diagnosed with diabetes type 1, the nurse should have two main priorities to teach the patient and family members about the symptoms of diabetic ketoacidosis and the importance of insulin injections. Diabetic ketoacidosis is a life-threatening complication. If the family identifies that the patient's breath smells like alcohol, but they have not drank anything, they should call 911. They should be aware of if the patient goes to the bathroom more than usual, is dehydrated, confused, fatigued, nauseous, or vomiting. Patients with type 1 diabetes require insulin injections daily. The nurse should educate the patient or patient's family on how to give the injection, where to give it, and how much the dose needs to be. Hamilton (2017) states, "This requires diabetes education for both child and family regarding insulin administration, carbohydrate counting, and maintaining a healthy lifestyle" (p. 1). Children first diagnosed with diabetes may need social support as this will change their life forever. The nurse will need to educate the patient on the importance of monitoring their blood glucose and what ranges it should be within. The nurse should educate the patient on what to do if these numbers are higher or lower than normal.

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