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Type 1 Diabetes - Case Summary

1. Insulin-Dependent Diabetes Mellitus (IDDM), also categorized as Type I diabetes, is an autoimmune disease of children in which the body's immune system attacks the insulin-producing beta cells on the pancreas. It is theorized that this immune response may be triggered during a viral infection in those with a genetic predisposition to the disease.

2. The symptoms of undiagnosed diabetes include excessive hunger and thirst, weight loss, frequent urination, and fatigue.

3. The diagnoses of diabetes, in this case, was made by the endocrinologist based upon elevated levels of glucose in the blood and urine. Ali was not seen until her disease had progressed to diabetic ketoacidosis. DKA was diagnosed based on the arterial blood gas results showing a pH of less than 7.3, large amounts of ketones in the urine, elevated potassium, and physical symptoms such as rapid heart rate and rapid breathing.

4. The goal of treatment of Type I diabetes is to regulate the patient's blood glucose so that it does not rise too high (hyperglycemia) or drop too low (hypoglycemia). This is done by insulin injections, a controlled diet, and exercise. Insulin pumps function much more like a normal pancreas and are being used increasingly more. Because of the complexity of operating insulin pumps, they are generally not recommended until the teenage years.

5. There is no cure for Type I Diabetes Mellitus, except for a pancreas transplant. Because of the highly volatile nature of the pancreas, a transplant is generally done as a last resort. Studies have now proven that diabetics who remain in tight control may prevent or slow the start of diabetic complications.

6. There is no known prevention of Type I diabetes. Animal research and small studies in people have indicated that type 1 diabetes can be delayed in those at high risk for the disease by regular, small doses of insulin. This is currently under study.

7. Healthcare workers depend on each other in treating a diabetic patient. Laboratory personnel report critical laboratory values including blood chemistry, CBC, and urinalysis results. The respiratory therapist monitors arterial blood gasses in the diabetic patient in DKA. Diabetic educator nurses have a responsibility to not only show the patient how to give injections but to educate the diabetic about all aspects of their disease. It should be noted that in many cases staff nurses may work to educate patients about diabetes. The diabetics overall control relies heavily on their diet. The dietician plays a key role in developing a meal plan and educating the patient about the importance of diet. Social changes and adjustments by the patient and family are facilitated by the medical social worker. The endocrinologist has the ultimate responsibility for the diabetics health. He prescribes insulin based on the patient's diet and lifestyle. He must be ready to make key decisions for the day to day health of the diabetic as well as for life-threatening complications.