Page 33 - TSAB Adult B FINAL (1)

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Appendix Two
Type 1 Diabetes Mellitus (Extract from Acute Hospital Trust Report)

Diabetes Mellitus is a syndrome characterised by raised blood glucose level associated with a
deficiency or lack of effectiveness of insulin (a hormone secreted by the pancreas). Insulin secretion is
dependent on the level of glucose in the blood. Following the ingestion of food, glucose levels rise,
and insulin is secreted facilitating the glucose to enter the cells to be utilised for energy. Excess
glucose is stored in the liver, muscles and as body fat. With insufficient insulin, a body cannot utilise
its glucose which accumulates in the blood, spilling over into urine. In Type 1 diabetes mellitus a
person is dependent on insulin medication and without it would eventually die, conversely in Type 2
diabetes mellitus a person may or may not be receiving some insulin, but could live without it.

Insulin as a medication is a solution which is injected just beneath the skin; it may be long acting
delivering a steady background level over a 24 hour period; short acting over several hours to cover
food ingestion or a mixture of both. Storage of insulin that is not in use should be in the refrigerator;
in the absence of a refrigerator it can be kept at room temperature (15-25 degrees Celsius) for 28 days
to remain effective. In use insulin cartridges should not be refrigerated and may be kept at room
temperature for 28 days.

Long term complications of diabetes can be divided into small vessel disease (affecting eyes, kidneys
and sensory loss to peripheral nerves) and large vessel disease (affecting circulation to heart, brain
and feet). Damage to the skin of the feet in the presence of both small and large vessel disease is one
reason for amputations in people with diabetes.

There are two diabetic emergencies; 1. Hypoglycaemia which occurs when blood glucose fall low; this
could be caused by the administration of too much insulin, missed or delayed meals, alcohol or
excessive exercise. Treatment for hypoglycaemia is either oral glucose or intravenous (IV) dextrose.
Glucagon may be given intramuscularly (IM) in the absence of IV dextrose; this a hormone produced
by the pancreas that causes stored glucose to be released; 2. Diabetic ketoacidosis (DKA) which occurs
when there is insufficient insulin in the body and fat stores have to be utilised for energy which
produces a chemical called ketones. DKA can be caused by illness increasing a person’s insulin
requirement, vomiting, uncontrolled or undiagnosed diabetes. Treatment for DKA is IV infusion of
fluids and insulin in response to the regularly monitored level of glucose. Without treatment for DKA a
person will become drowsy and then fall into a coma and potentially die.

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