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Diabetes Mellitus I


Becoming a nurse is considered to be a quite serious choice. Therefore, it is important to realize and accept the level of responsibility put on one's shoulders as soon as this choice is made. First of all, to be a nurse means to be a high quality professional that knows and uses all the necessary information about human illnesses, ways of treatment, possible medical situations and particular processes. Secondly, a nurse needs to be attentive and tolerant no matter what happens. Thirdly, a nurse has to understand patients and do everything it takes to help them overcome the hardships they experience.

A nurse is a medical professional who particularly knows the profiles of diseases. This aspect is exceedingly important in nursing, since wrong and ill-informed decisions and actions may cause serious illness complications and lethal consequences.

The present research is focused on type 1 diabetes mellitus as one of the most commonly known illnesses. The nature and particular characteristics of type 1 diabetes mellitus are defined and closely considered and its major and minor causes, symptoms and impacts on health are analyzed. Prevailing tendencies of development and spread of type 1 diabetes mellitus are presented on the basis of the statistical data. Moreover,  the  research contains the ways of treatment which are currently used and provides further suggestions for possible changes in fundamental treatment approaches. Therefore, the present study is dedicated to type 1 diabetes mellitus forms and reveals a detailed profile of the given illness which can help see and understand its common features in order to provide professional care for patients.

General Overview

Many people all over the world are diagnosed with type 1 diabetes mellitus. This is a complex chronic autoimmune metabolic illness that afflicts multiple organ systems. Generally, it is characterized by abnormally high levels of glucose (a simple sugar) in blood. Type 1 diabetes mellitus, which was previously known as juvenile onset diabetes, or insulin dependent diabetes, occurs when the body stops producing enough hormone insulin that normally controls the level of glucose in blood.

Those who have this illness should administer injections of insulin every day in order not to develop any serious multisystem complications which can lead to premature death. People usually get such diagnosis when they are very young. However, there are a lot of cases when diabetes mellitus is diagnosed during adolescence as well. Also, sometimes adults even in their 40s can develop a mild form of this disease.

In order to understand how type 1 diabetes mellitus affects our health, we need to define what processes take place when there is not enough production of insulin in blood.  First of all, insulin is a hormone produced by the pancreas. The pancreas is an organ that  lies close to the stomach. Our body needs a simple sugar (glucose) to entry into the body's cells for converting protein, fats and carbohydrates directly from food that we eat into energy.

People who have type 1 diabetes mellitus suffer from it because their pancreas does not produce enough of this type of hormone. This happens because the body's immune system has destroyed the cells that can produce insulin. Therefore, without insulin glucose is not transported from blood to the cells. This way people get hyperglycemia because all glucose remains in the blood.

Gradually, the level of unused glucose in the blood starts to go beyond the established norm. This causes failure in the functions of the kidneys. As a result, the kidneys excrete glucose with urine, and large quantities of urine start to come out. Such process is called polyuria, and causes body dehydration. So, a person starts to suffer from thirst. Here is another medical term for the thirst mechanism. It is polydipsia. Therefore, in the situation when there is too much glucose in blood and it doesn't enter the body's cells, human organism starts to require food in order to compensate for the missing glucose.

It has already been proven that there is a special category of people who can be genetically predisposed to have type 1 diabetes mellitus. At this point, the illness could be triggered by an environmental agent, or infection destroying the pancreas' beta cells. In case when there is no response to metabolic stimuli by beta cells of the pancreas, people with this type of illness need to get daily injections of insulin which the body fails to produce (Winter, 2002). It will help decrease an excessive level of glucose in the blood and, as a result, prevent various harmful acidic states, such as diabetic ketoacidosis, or DKA.

Another important aspect is that peripheral vascular disease often goes along with type 1 diabetes mellitus. It does not happen in all cases, but sometimes it is identified as  comorbidity with type 1 diabetes mellitus. These are certain common symptoms, such as pain in legs and feet while walking. There is also a high risk of complications, such as an  increased host susceptibility and sensory limbs decrement. Peripheral vascular disease, along with type 1 diabetes mellitus, can lead to various foot ulcerations and infections. The result may be very negative. For example, a person may get gangrene, and there would be a necessity to amputate the affected extremity.

There are several potential risks of getting a type 1 diabetes mellitus, and one of them is autoimmunity. This is the most significant factor for this type of illness as people who have some other autoimmune disorders, such as Addison's disorder, Graves' disorder, or Hashimoto's thyroiditis are more vulnerable to the development of this illness. Destruction of beta cells is considered to be caused by various viruses, such as rubella virus, Coxsackie B4, or mumps.

Age is believed to be the factor for type 1 diabetes mellitus as well. It is known that illness is generally diagnosed for children aged between 4 and 14 years. Other age category that is considered to be vulnerable to type 1 diabetes mellitus is represented by individuals who are in their late thirties, or forties. Moreover, males are more at risk to have this disease than females.

Some ethnical groups are considered to be more susceptible to type 1 diabetes mellitus than others. There goes a belief that the illness is more common among Whites than Hispanics, or African Americans. Asian Americans are rarely diagnosed with type 1 diabetes mellitus. The statistical data has shown that in 2007 over 15 million non-Hispanic blacks aged more than 20 years suffered from type 1 diabetes mellitus.

Therefore, we can see that type 1 diabetes mellitus is a very complicated disease which requires continuative attention of a patient as well as care on the part of nurse. People who have it should realize all the possible risks and directly follow doctor's instructions. In case the prescriptions are not followed, an individual can experience serious complications, which may consequently lead to premature death. This way, the mentioned above abnormal processes in the body that are commonly caused by a high level of glucose in blood but not in the body cells have shown the severety of type 1 diabetes mellitus.

Statistical Data

Type 1 diabetes mellitus was studied by many medical companies and statistical organizations. According to the report made in 2011 by the United States Center for Disease Control and Prevention more than one million people were diagnosed with type 1 diabetes mellitus. Every year, 2002 through 2006 included, this disease was found in more than 16 700 young adults. The annual rate of new cases among children aged younger than 10 years was over 20 per cent per 100 000 people. Among children aged 10 years and older this rate was nearly 19 per cent per 100 000 people (Poretsky, 2010).

Looking at this data, we can state that children are the most potentially vulnerable to this metabolic disease group. Type 1 diabetes mellitus is found in about one in every 450 children and adults. Among the latter this type of illness constitutes over 6 per cent of all the diagnosed cases of diabetes. Type 1 diabetes mellitus is slowly spreading internationally. For example, taking the data about Australia, Middle East and Europe, the per cent of increasing the rate of type 1 diabetes mellitus has been over 2 to 5 per cent from year to year.The highest rate of illness has been estimated in Scandinavia (over 20 per cent), and the lowest in Japan and China (less than 1 per cent).


Symptoms of type 1 diabetes mellitus are divided into classic and optional. The classic symptoms are polydipsia (when a person is frequently thirsty), polyphagia (when a person is frequently hungry), polyuria (when a person is frequently urinating), and, sometimes, unexplained weight loss (Chronolab, 2009). Other symptoms that may be present include dry mouth, itchy skin (sometimes dry), fatigue, blurred vision, recurrent infections, such as groin rash, impotence in males, poor wound healing, headaches, muscle cramps, muscle wasting, nausea, constipation, anxiety, vomiting, diarrhea, feeling of numbness in feet and hands etc. All the symptoms usually vary widely from individual to individual. They can develop suddenly or gradually taking days or months.

Nursing Diagnosis

There are several risks related to type 1 diabetes mellitus. These risks should be highly taken into consideration by a nurse. First of all, this is risk for infection. If a patient has respiratory infections along with high levels of glucose, nursing interventions must include the following actions:

  • identify symptoms of inflection if there is any;
  • make good handwashing;
  • provide catheter care;
  • provide skin care;
  • minimize infection spread;
  • administer necessary medications (antibiotics if needed).

Another important factor is sensory perception. In this case, for a nurse a desired outcome is identify and compensate for sensory impairments. Nursing interventions are:

  • look after mental status of a patient;
  • address a patient by name;
  • make a specific schedule fo nursing time;
  • help a patient participate in daily activities;
  • protect a patient from any possible injuries;
  • investigate and look for pressure points, ulcers etc.;
  • assist with position changes;
  • monitor glucose level etc.

Physical examination depends on the severity of the disease onset. Some of the findings may include hypotension (low blood pressure), weak rapid pulse, blurred vision and dry mucous membranes (usually in mouth). Patients who suffer from type 1 diabetes mellitus are often thin because they may lose a lot of their weight. However, in some cases this does not happen, and patients keep maintaining their natural weight.

There is a general diagnostic criteria developed by American Diabetes Association. It consists of the following factors:

  • level of glucose in blood under fasting condition equals or more than 127 mg/dL;
  • 2-hour level of glucose in blood equals or more than 201 mg/dL;
  • contingent glucose in blood equals or more than 201 mg/dL in an individual who has common symptoms of hyperglycemic crisis.

Every patient who has type 1 diabetes mellitus needs to take a finger-stick glucose test. In order to determine a particular diagnosis, all finger-stick levels of glucose must be corroborated in plasma or serum. A clinical situation of an individual may require series of other laboratory studies which could confirm or confute the diagnosis. Therefore, it is a decision of a physician whether or not run other tests. In cases when all the classical symptoms of type 1 diabetes mellitus are absent but there is a strong assumption of a potential development of the given illness, it is recommended the HbA1c assay for diagnosing by a special expert committee established by the International Diabetes Association, the European Association for the Study of Diabetes, and the American Diabetes Association.

Nursing Priorities

  • Bring into compliance the level of glucose in blood;
  • Reverse abnormal metabolic processes;
  • Identify particular causes of disease and help a patient with appropriate management of it;
  • Preclude any complications;
  • Give all the information about a disease, its prognosis and management to a patient (NursesLabs, 2012).

Treatment and Management

Individuals who have type 1 diabetes mellitus are in a strong need of lifelong insulin therapy. Many of them need more than two injections of insulin a day to keep a stable level of glucose in blood. There are different types of insulin available nowadays. A physician decides which type is appropriate for a patient based on the response of the patient's body to insulin.

As soon as individuals get to know that they have type 1 diabetes mellitus, they  get a necessary help from a nurse who teaches them how to control the appropriate level of glucose in their blood. In fact, it is one of the most important aspects. Physician measures blood glucose level and sets specific guidelines to adjust dosages of insulin for a patient. Also, a patient should learn how to administer this hormone and realize how important it is to comply with the treatment.

There are many ways to administer insulin injections. Some of them include vial and syringe methods, continuous subcutaneous insulin pump, or smaller convenient pen devices. Brand new 24 hour insulin has become available these days as well. This is the insulin that needs to be injected only once in a period of 24 hours.

Not only injections of insulin are considered to be a way of treatment for people who have type 1 diabetes mellitus. There are also possibilities to control a level of glucose in blood through specific diets (for example, it is recommended to get 21 per cent of daily calories for breakfast, 34 per cent for lunch, 29 per cent for dinner, and 16 per cent for a late dinner; moreover, a consumption of sugar must be minimized), physical exercises, or various stress reduction techniques (MDGuidelines, 2009).

But in some cases these methods of treatment are not sufficient. That's why for these people it is advisable to use an insulin pump, a mechanical device for administering the level of insulin that a patient programs by his own according to the schedule prescribed. This device delivers a defined dose of insulin to the blood throughout the day.  The insulin pump is not an automatic device, which means that it does not measure the insulin level. But what it does is deliver of insulin at the scheduled times. That's why a patient should keep monitoring the levels of glucose in blood during the day. For optimal control, it is generally supposed to be done 4 to 6 times. All patients who have type 1 diabetes mellitus should do these procedures without any exceptions.

Further physical examination should be performed 4 to 6 times a year in order to control the disease course. It will help see if any complications take place, or other specific symptoms appear. This way, it will be easier to prevent progression of the disease prescribing an appropriate method of treatment. Generally, a patient takes a glycosylated hemoglobin test, which can provide particular information about glucose level for the physician. Also, a patient will need dilated retinal exams at least once in a year. Therefore, it will be easier for physicians to minimize harmful influence of the disease on a patient's health.

Patient Teaching

  • Monitor glucose level in your blood in order to see how well diabetes is being controlled.
  • Look after your feet every day. If there are any unappropriate changes, such as red spots, or swelling, go and see your doctor for further instructions.
  • Do exercises in order to help control your level of glucose.
  • Learn your prescribed dosages and specific injection techniques.
  • Do not smoke.
  • Be more active.
  • Look after your skin. Use lotion on your feet.
  • Try to drink lots of water in order to prevent dehydration process.
  • Follow instructions for a specific diet (eat low fat and low sodium food).


There are various complications that can appear during the course of the given disease. Sometimes, a strict control of glucose level in blood can't prevent disease progression. Among the most common complications there are the following: high susceptibility to different types of infections, diabetic glomerulosclerosis (a disease of kidney), glaucoma, diabetic retinopathy, artherosclerosis, hyperlipedemia, ketoacidosis, coma etc. Moreover, there is a high risk of hypertension and hypercholesterolemia development. In some cases, it may lead to heart attacks.


Type 1 diabetes mellitus is a lifelong disease. For some patients it is quite difficult to adjust to the treatment methods without changing their lifestyle. But many of them easily get used to it with assistance of a nurse. They pay attention to monitoring, keep controlling of the level of glucose in their blood and do some medical exams several times in a year. As a result, the outcome is potentially good (MedScape, 2013). In cases of serious complications the situation can  become crucial. As statistical data shows, people who have type 1 diabetes mellitus have a shorter life expectancy than those who do not have this desease. It is explained by the complications which these people go through during the course of the illness.


Unfortunately, nowadays there is no way to prevent type 1 diabetes mellitus. But to find a particular answer to the issue is one of the priorities for researches.These days this is one of the most active areas of various studies. Researchers pay their attention and work on the following:

  • Brand new vaccines, which can have an effect on the immune system, and make it stop destroying the cells of the pancreas. For now, such vaccines have been quite effective in mice. But there is no tests taken in humans;
  • Start to give individuals who have any member of their family suffering from type 1 diabetes mellitus injections of insulin before this disease can develop. This way of preventing type 1 diabetes mellitus has been tried in mice. Currently, it is tested in humans. This is a trial named the Diabetes Prevention Trial – Type 1 (DPT-1).

Both of these methods are meant to prevent type 1 diabetes mellitus and still remain at the experimental stage.


Type 1 diabetes mellitus is one of the most common diseases which can be diagnosed in young people. Generally, these are children aged 4 to 8 years. However, adults in their thirties and forties, especially males, can have a potential to get this illness, too. Looking at the diagnostic profile of the disease we can see that it requires continuous attention and control from physicians as well as patients themselves. It can help monitor the course of the disease and prevent serious complications, which in some cases may even lead to death.

The present study has included particular descriptions of specific features, symptoms and causes of type 1 diabetes mellitus in order to see how real a chance to have this disease is, and how it should be administered by a nurse.  The statistical data presented above manifests the tendency of type 1 diabetes mellitus development among Americans and other nations. A special emphasis has been placed on the ways of treatment and further suggestions for future approaches. Therefore, a substantiated conclusion states that the given disease is quite complex and needs special nursing care.

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