DM 1

• - Usually diagnosed in children & YA
• - AKA "juvenile diabetes" 
• - Body does not produce insulin (very little, if any insulin) 
• - Insulin required in order for body to properly use sugar
• -Insulin = transport for glucose 

• Insulin's role is to take glucose from blood and carry it into cells where it can be used to provide energy for body to work 

Type 1 usually progressive autoimmune disease disease 

Beta cells produce insulin, but in DM 1 beta cells that produce insulinare slowly destroyed by body's own immune system

Genetics- 10% if first degree relative have DM; father>mother 

Viruses- Cosackie virus, mumps, rubella 

Pancreatic damage

Medications- corticosteroids, BB, and Phenytoin)-- TEMPORARY IDDM

• Polyuria- excessive URINATION
• May present as nocturia, bedwetting, or incontinence in previously continent child 

Polydipsia- excessive THIRST 

Weight Loss- 10-30% 

Prolonged or recurrent candidal infection

• Increased fatigue, lethary
• Muscle cramping
• Irritability/emotional lability
• Headaches, abdominal discomfort, nausea
• Vision changes, such as blurriness 
• Anxiety attacks

• Hyperglyceia = predominant "sign" of DM 
• Chronically uncontrolled, leads to MICROvascular destruction and end organ damage 
• PVD/PAD 
• Cause distal neuropathy

Fasting glucose >126 mg/dL 

Random glucose >200 mg/dL in pt with classic symptoms of hyperglycemia

Oral glucose tolerance test; plasma glucose >20 mg/dL 2 hours after glucose load 

Glycated hemoglobin (HbA1C) levels >6.5%

ORAL hypoglycemics NOT indicated in DM 1 

Basal, long-acting insulin once/twice daily

Microvascular disease (retinopathy, nephropathy, neuropathy)

Hyperlipidemia

Macrovascular disease (coronary and cerebral artery disease) 

Chronic foot ulcers/amputations, diabetic ketoacidosis, excessive weight gain, increased risk for pre-eclampsia, and preterm delivery, driving mishaps, psychologic problems of chronic disease, HYPOGLYCEMIA

Defined as plasma glucose less than 70 mg/dL

• S/S
• -Diaphoresis (excesive sweating)
• -Tachycardia
• -Hunger
• -Shakiness 
• -Slurred speech
• -Altered mental status 
• -Seizure
• -Coma

• MEDICAL EMERGENCY characterized by:
• - Hyperglycemia
• - Ketosis (ketones=acids)
• - Metabolic acidosis 

*fruity odor to breath (acetone smell) 

S/S- HYPOtension, tachycardia, hypothermia, tachypnea, KUSSMAUL respirations, decreased reflexes, abdominal tenderness, dry mucus membranes, poor skin turgor, decreased perspirations, confusion, coma 

Labs- hyperglycemic, hyponatremic, elevated BUN/Cr, serum ketosis, metoblic acidosis or ABG 

• **START ISOSTONIC (0.9 % saline) to rehydrate 
• -Will need supplemental K infusion with IV insulin and sodium bicarbonate to correct acidosis

Insulin lispro (Humalog)

Insulin aspart (NovoLog) 

Insulin glulisine (Apidra) 

• Onset- 1/4-1/2
• Peak action- "
• Effective duration- 3-4
• Max duration- 4-6

• Regular (soluble) 
• Onset- 1/2-1
• Peak- 2-3
• Effective duration- 3-4
• Max- 6-8

• NPH (isophane) 
• Onset- 2-4
• Peak- 6-10
• Effective duration- 10-16
• Max- 14-18

Insulin glargine (Lantus) 

Insulin determir (Levemir) 

• Onset- 3-4 
• Peak- 8-16 (Lantus) and 6-8 (Levemir, but relatively flat)
• Effective duration- 18-20 (Lantus) and 14 (Levemir)
• Max-20-24 (Lantus) and up to 20-24 hours (Levemir)