Diabetes mellitus type 1 is one of the two categories of diabetes that are common in man. This type of diabetes is characterized by frequent urge to urinate and an unusual insatiable thirst. Destruction of the beta cells that produce insulin has been linked to this disorder as reduced production of insulin destabilizes the blood sugar level. This case study is based on a 37 year old woman who presented clinical features of the disorder. This paper illustrates the pathophysiology of diabetes mellitus type 1, its diagnosis, treatment and interventions.
Signs and symptoms of Diabetes mellitus Type 1
There are a number of symptoms as well as signs that are specific to Diabetes mellitus type 1 namely; polyuria which is characterized with frequent urination or the persistent urge to pass urine yet very little amounts of urine are eliminated. There is also increased thirst otherwise called polydipsia in addition to increased hunger. The patient also expresses abnormal fatigue and unexplained weight loss (Rother, 2007).
Pathophysiology of Diabetes mellitus Type 1
The destruction of beta cells present in the pancreas which are responsible for the production of insulin is the basis of Diabetes mellitus type 1. The human body at times engages in an autoreactive activity that makes the body to develop an autoimmune response against the beta cells. This eventually leads to destruction of a number of cells in addition to the beta cells, the CD4+ and B-cells in the body. Similarly, absence of beta cells hampers the production of insulin hence imbalance of blood sugar level. The body's immune adopts a certain degree of immunity against self thus causing enormous destruction of vital beta cells which are essential in the overall maintenance of the blood sugar level (Bluestone, Herold and Eisenbarth, 2010).
The cause of Diabetes mellitus type 1 has been linked to a number of internal and external factors that trigger a series of hypersensitivity reactions in the body. Genetics has been a major cause especially as diabetes mellitus type 1 is a polygenic disorder. Various genes have been observed to induce histocompatibility that triggers the body to react against the beta cells (Rother, 2007).
The environment has also been observed to trigger autoimmune reactions especially where identical twins were exposed to different environmental factors. This explains why individuals who have migrated to other areas of occupation are more exposed to this type of diabetes as compared to the natives (Bluestone, 2010).
Risk factors in Diabetes mellitus type 1
Presence of a viral infection or any other virus in a body especially the Human Immunodeficiency Virus has been attributed to being a major risk at increasing the chances of getting type 1diabetes. This is because as the body's immune mechanism tries to fight the virus as well as the CD4+ cells that are normally attacked by the virus, the beta cells also become targets of the operation. This culminates into destruction of the beta cells hence making one susceptible to type 1diabetes (Bluestone, 2010).
Diet is another risk factor that is associated with presence and occurrence of diabetes mellitus type 1. This is mainly due to increased growth of normal gut flora as well as production of antibodies for some of the nutrients in the diet. Research has shown that antibodies are often developed in young children against proteins in cow milk hence exposing them to greater levels of having similar antibodies being produced for beta cells (Bluestone, 2010).
Nevertheless, certain drugs and chemicals have been observed to kill pancreatic cells especially the beta cells if consumed intentionally or accidentally. This includes the rodenticide, pyrinuron. Similarly, chemotherapy drugs against pancreatic cancer can at times destroy the cancerous cells as well as the normal cells in the pancreas. The destruction of otherwise normal cells may lead to loss of insulin producing cells hence causing type 1diabetes (Bluestone, 2010).
Clinical assessment and laboratory findings
Testing for diabetes mellitus type 1 involves analyzing the blood/urine glucose levels to determine the inconsistencies as well as hyperglycemia. These tests are carried out in a number of ways namely; determining the plasma glucose level of an individual who is fasting which is estimated to be above 7.0 mmol/L. Similarly, a glucose tolerance test can be carried out exactly two hours after an oral dose of glucose. Results showing more than 11.1 mmol depict hyperglycemia (Rother, 2007).
However, other diagnostics are applied in the course of testing as some symptoms are visible such as poor vision accompanied by unexplained fatigue. It is recommended that the laboratory officer carrying out the test should repeat the test more than once a week so as to obtain consistency. Presence of health situations that are related to the blood glucose level such as poor wound healing and neuropathy indicates presence of type 1 diabetes mellitus (Bluestone, 2010). The patient in this case study had a plasma glucose level of 13 mmol which illustrated an abnormal high amount of glucose in the blood.
Current treatment; clinical management
Insulin therapy is the most commonly used clinical management method for type 1 diabetes. It entails subcutaneous injection of insulin replacement in line with keen monitoring of the dietary components of the patient. This reduces the uptake of carbohydrates while keeping track of the blood sugar levels so as to detect any anomalies. Biosynthetic insulin is used in this therapeutic activity used to manage diabetes mellitus type 1 by retaining the normal amount in blood thus reducing complications that may arise in future (Rother, 2007).
Diabetes mellitus type 1 can also be treated by transplanting a pancreas incase it has being damaged especially in pancreatic cancer. Similarly, the beta cells can be developed from stem cells and later of grafted to form functional insulin producing cells. Current management of diabetes mellitus type 1 also involves subjecting the patient to immunosuppressant which reduces the capacity of the body's immune system to develop immunity against itself (Rother, 2007). Poor management of type 1 diabetes may result in diabetic retinopathy or neuropathy as they have their basis on the immune system.
Dietary intervention such as breast milk and vitamin D earlier in life so as to create immunity against type 1diabetes later. Similarly, immunosuppressive drugs such as Cyclosporine A are given to patients whose beta cells are in the process of destruction so as to cut down on the loss of subsequent cells. T-helper cells are also administered in patients who are almost succumbing to type 1 Diabetes so as to prevent its onset (Rother, 2007).
The patient in this case study had developed Diabetes mellitus type 1 which was still in its early stages. The disorder is characterized by sudden frequencies in urine passage and thirst. However, various diagnostic procedures have been developed to identify the disease before it causes adverse effects on the patient. This has also been made easier by the many interventions that have been developed to manage this type of diabetes.
Despite the frantic efforts to fight the disease, the cause lies in the individual's immune mechanism which plays a key role in the destruction of the beta cells in the pancreas which produce insulin. Similarly, the risk factors that are presented to the individual act as stimuli to trigger the already existing problem demonstrated by absence of insulin in the body.