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What is type 1 diabetes?

The most common type found in children and
young adults. This condition occurs when the
pancreas doesnt make enough insulin.
These people are insulin-dependent for life.

What is insulin?
Insulin allows sugar to pass into our cells so
that it can be converted for our energy
Our bodies constantly needs energy for all of
our body functions

How we get sugar

Sugar comes from two places:
Internal The liver produces or releases stored
sugar into the bloodstream
External Comes from the food we eat. It
enters the stomach and moves to the
intestines where it is absorbed

Causes
Inherited (or genetic) factors

Self-allergy (autoimmunity)

Environmental damage (virus, chemical, etc.)

Inheritance
Children from a family w/a history of diabetes
have a greater chance of developing it.
Type1 diabetes is a polygenic disease,
meaning many different genes contribute to
its expression.
It can be dominant, recessive, or somewhere
in between.

Punnett Square

Self-allergy
The immune system produces antibodies that
attach to the beta cells in the pancreas.
The beta cells destroyed were the cells that
made insulin.
The trigger that causes this response is
unknown.

Environment
Environmental factor may either be:
A virus
Something in the food we eat
Something we do not yet know about.

Maintenance
Types of insulin:
Rapid-acting
Regular
Intermediate-acting
Long-acting

Rapid-acting insulin
Humalog/NovoLog or Apidra
Onset of activity 10-15 minutes
Peak activity 30-90 minutes
Duration is 3-4 hours

Regular insulin
Onset of activity 30-60 minutes
Peak activity 2-4 hours
Duration is 6-9 hours

Intermediate-acting
insulin
Cloudy insulin
Neutral Protamine Hagedorn (NPH) is made a with
protein that allows it to be absorbed in the body more
slowly.
Onset activity is 1 hour after administration
Peak activity is 4-8 hours
Duration is 13 hours

Intermediate-acting
insulin
Pre-mixed insulin:
70/30 and Mixtard: Combination of 70% NPH
and 30% Regular insulin
Humalog mix 75/25 (Lilly): 25% Rapid and
75% Intermediate-insulin

Long-acting insulin
Lantus:
Onset activity is 1 hour after administration
Almost no peak
Duration is 24 hours

Long-acting insulin
Insulin detemir (Levemir):
Duration 24 hours
Cannot be mixed with a Rapid-acting insulin

Treatment
There is no cure
It is encouraged to check you blood sugar,
take your medications, eat healthy, and
exercise regularly to prevent any
complications.

Nursing Care Plans

Risk for infection
Risk for disturbed sensory perception
Powerlessness
Imbalanced nutrition less than body requirements
Deficient fluid volume
Fatigue
Risk for unstable blood glucose level

Risk for unstable blood glucose level r/t hyperglycemia or

hypoglycemia AEB hunger, extreme thirst, frequent
urination, blurred vision, shaking, dizziness, weakness
Nursing Interventions

Rationale

Observe for signs of hypoglycemia

Once carbohydrate metabolism resumes, blood

glucose level will fall, and as insulin is being
adjusted, hypoglycemia may occur. If client is
comatose, hypoglycemia may occur without
notable change in LOC. This potentially
lifethreatening emergency should be assessed
and treated quickly per protocol.

Observe for signs of hyperglycemia

Hyperglycemia results when inadequate insulin

is present to facilitate glucose transport across
the cell membrane. Excess glucose in the
bloodstream creates an osmotic effect that
results in polydipsia, polyphagia, polyuria. The
patient may also report nonspecific symptoms
of fatigue and blurred vision.

Risk for unstable blood glucose level r/t hyperglycemia or

hypoglycemia AEB hunger, extreme thirst, frequent urination,
blurred vision, shaking, dizziness, weakness
Nursing Interventions

Rationale

Perform fingerstick glucose testing. Ascertain

whether client and SO(s) are adept at blood
glucose monitoring and are testing according to
plan.

All available glucose monitors will provide

satisfactory readings if properly used and
maintained and routinely calibrated. Note:
Unstable blood glucose is often associated with
failure to perform testing on a regular schedule.

Teach the patient about taking prescribed

medications to lower blood glucose.

The patient with diabetes mellitus needs to

learn about taking insulin or oral hypoglycemic
drugs to lower blood glucose.

Outcome:
Patient maintains blood glucose levels within defined target
ranges

Risk for infection r/t hyperglycemia AEB decreased leukocyte

function, alterations (decrease) in circulation, preexisting
infection
Nursing Interventions

Rationale

Observe for signs of infection and

inflammation, e.g., fever, flushed
appearance, wound drainage, purulent
sputum, cloudy urine.

Patient may be admitted with infection,

which could have precipitated the
ketoacidotic state, or may develop a
nosocomial infection.

Teach the patient, family, and caregiver

the sign and symptoms of infection,
and when to report these to the
physician or nurse.

Patients need to be able to recognize

important signs and changes in their
condition so early treatment can be
initiated.

Maintain aseptic technique for IV

insertion procedure, administration of
medications, and providing
maintenance/site care. Rotate IV sites
as indicated.

High glucose in the blood creates an

excellent medium for bacterial growth.

Administer antibiotics as appropriate.

Early treatment may help prevent sepsis.

Risk for infection r/t hyperglycemia AEB decreased leukocyte

function, alterations (decrease) in circulation, preexisting
infection

Outcomes
Identify interventions to prevent/reduce risk of
infection.
Demonstrate techniques, lifestyle changes to
prevent development of infection.
Infected is recognized early to allow for prompt
treatment.

Prevalence/Focus area
Every 17 seconds, someone is diagnosed with diabetes in the United States.
Between 2000 and 2010, the prevalence of adult diabetes increased from
5.2% to 8.3% in Hawaii.
In 2012, 9.7% of the US adult population reported diagnosed diabetes. Here
in Hawaii it is 7.8%
Diabetes is the 7th leading cause of death in the US and here in Hawaii
(2010).
In 2004-2006 Native Hawaiians had the highest diabetes mortality rate
followed by Filipinos and Japanese in Hawaii. Nationally, African Americans,
American Indians and Alaska Natives, and Hispanics had higher age-adjusted
diabetes mortality rates compared to Whites in 2010.

-Any time a person has received a

shot of insulin, there is a chance of
a low blood sugar. <60 mg/dl
-Give simple sugar in some form as
fast as possible. If the reaction is
not severe, do a blood sugar test
first
-Give 15 carbs and check in 15
minutes
-Liquid sugar (juice, soda) will be
absorbed more quickly if the

- Anytime a persons blood

sugar is >150 mg/dl
- Check for Ketones (Indicator
there is not enough insulin and
your body is breaking down fat
for energy)
- Hyperglycemia can cause longterm complications (eye,
kidney, feet problems, etc.)

Complications
Blindness
Kidney Failure
Nerve Damage
Amputation of Limbs
Heart Disease

Looking towards the

future
Research is being done to find a cure
Scientists are exploring different methods of
destroying manipulated T cells that block the
insulin producing cells of the pancreas
Artificial Pancreas
Pancreas transplants

Resources
Diabetes.org/hawaii
American Diabetes Association
Understanding Diabetes 11th Edition, Peter
Chase MD, Barbara Davis Center for Childhood
Diabetes
Nursing Care Plans 8th Edition, Meg Gulanick &
Judith L. Myers