Pathophysiology of Type 1 Diabetes Mellitus

Pathophysiology of Type 1 Diabetes Mellitus
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Abstract
As of 2021, there were approximately 8.4 million individuals diagnosed with Type 1 diabetes mellitus (T1DM) with the number expected to reach 13.5- 17.4 million cases of T1DM cases by the year 2040. T1DM is a chronic disease attributed to genetic and environmental factors and is largely characterized by decreased levels of insulin due to damaged beta cells. Consequently, the patient has high blood glucose levels given that insulin plays a major role in the regulation of blood glucose levels. High blood glucose contributes to signs and symptoms such as frequent urination, frequent hunger, and thirst, among others. T1D has short-term and long-term complications. In the short term, the patient experiences confusion, seizures, and tremors due to hypoglycemia. On the other hand, hyperglycemia results in coma, nocturia, ketoacidosis, and externalizing behaviors in the short term. In the long term, hypoglycemia leads to retinopathy, nephropathy, and microvascular diseases while hyperglycemia results in neuropathy, impotence, and pregnancy complications. The diagnostic tests of T1Dm are based on the measurement of one’s blood glucose levels. Insulin injection is the commonly used pharmacological intervention, with regular exercise, diet regulation, and blood glucose monitoring considered effective non-pharmacological interventions for T1DM patients. Patient education can equip T1DM patients with the skills required to manage T1DM. Given the increasing prevalence of T1DM, nurses should be properly equipped with the knowledge and skills required to manage the disease
 
Pathophysiology of Type 1 Diabetes Mellitus
Introduction
Type 1 diabetes mellitus (T1DM) is a chronic disease attributed to environmental and genetic factors characterized by dysfunctional beta-cells that do not produce the sufficient insulin required to regulate blood sugar levels (Chiang et al., 2018). Consequently, patients with Type 1 diabetes have elevated levels of blood sugar. The prevalence of T1DM has been steadily rising with time, a trend that is expected to continue over time. Thus, nurses should be properly equipped with the knowledge and skills required to manage the disease. In this paper, the incidence, etiology, symptomatology, sequalae, diagnostic test, management approaches, and relevant patient education of T1DM will be presented.
Incidence
           T1DM has equal incidence in both males and females in childhood, but it is more prevalent among males in adulthood. Despite the importance of incidence data for shaping public health policies, there is scarce data on the global prevalence of T1DM. Gregory et al. (2022) estimate with 95 percent uncertainty that the number of individuals with T1DM globally is 8.4 million as of 2021. Of the estimated number, individuals aged 20 to 59 years make up the largest segment at 5.4 million, followed by those aged above 60 years at 1.6 million, and those below 20 years following closely at 1.5 million (Gregory et al., 2022). The number of new global T1DM cases worldwide in 2021 was 0.5 million, with the median age of onset being 29 years (Gregory et al., 2022). Notably, there were roughly 35,000 fatalities from undiagnosed cases of T1DM in 2021 (Gregory et al., 2022).
About one-fifth of the T1DM global incidences were reported in low and middle-income earning countries. As of 2021, Gregory et al. (2022) observes that the life expectancy of a 10-year-old diagnosed with T1DM ranged from an average of 13-65 years depending on whether one came from a low or high-income country. Based on 2021 data, it is expected that there shall be 13.5- 17.4 million cases of T1DM cases by the year 2040. The drive of the 60-107 percent increase in T1D cases from 2021 is expected to be new cases reported in lower and middle-income countries (Gregory et al., 2022).
Etiology
The precise cause of T1DM is unclear, but the disease is attributed to genetic and environmental factors. From research, several genes have been found to fit with the modeling of T1DM etiology. First, T1DM has been associated with rare monogenic forms given their tendency to disrupt regulatory pathways. To this end, 20 percent of cases of mutation in the autoimmune regulator AIRE have been observed to cause T1DM due to the resulting inhibition in the expression of molecules such as insulin (Van Belle, Coppieters & Von Herrath, 2011). Second, the onset of T1DM has been associated with the HLA region on chromosome 6p21. Individuals are either more resistant or susceptible to T1DM depending on the alleles present. In their CLA class II genes T1DM prevalence has also been attributed to the mutation in the insulin gene. Other genes associated with the increased prevalence of T1DM include PTPN22, IL2RA, IFIH1, and CTLA-4 (Van Belle, Coppieters & Von Herrath, 2011).
Research has shown that environmental factors contribute to the development of the disease, but the specific mechanism remains unclear. Dietary intake is considered one of the key triggers of T1DM. The albumin component of cow’s milk is one of the environmental factors that has been scrutinized as a causal factor of T1DM. Wheat proteins are another environmental factor that has been attributed to the development of T1DM, with gluten being the focal point. Patients with T1DM record high peripheral blood T-cell reactivity to gluten in the wheat diet compared to healthy controls (Van Belle, Coppieters & Von Herrath, 2011). Lack of vitamin D has also been implicated in the development of T1DM in individuals. 
Infection and vaccination are considered key triggers of T1DM in individuals. Some of the common viral infections that are usually accompanied by the development of T1DM include mumps, influenza B, coxsackie B3, B4, and Rubella (Quinn, Wong, & Narendran, 2021). Countries with nationwide vaccination programs have been observed to report more cases of T1DM in the population compared to countries without such programs. Weight has also been fronted as an environmental trigger in the etiology of T1DM. The disease prevalence has been observed to be higher in children with higher birth weights than in children with medium birth weights in several studies (Quinn, Wong, & Narendran, 2021). Obesity has been identified to cause insulin resistance and increase the pressure on islet cells (Quinn, Wong, & Narendran, 2021). Nonetheless, there is no data establishing causality between weight and T1DM.
Signs and Symptoms
Several signs and symptoms are commonly observed in T1DM patients. Due to the high blood sugar levels associated with the disease, the symptoms of the disease include frequent headaches, excessive thirst, and frequent urination (Kousar, 2019). In an environment where the blood sugar level is high, the kidney struggles to retain excess sugars and ends up dumping them in the urine. Consequently, the patient experiences dehydration as dumping of sugar results in frequent urination.
Insufficient insulin production contributes to weight loss as one of the signs and symptoms. To this end, the body struggles to get the glucose it requires for use as energy and converts muscle and fat into energy (Kousar, 2019). Consequently, the patient experiences weight loss as one of the signs of T1DM. Notably, patients with T1DM experience frequent hunger due to elevated blood levels. However, their stomachs do not empty quickly leading to symptoms such as chest burn and indigestion (Kousar, 2019). 
Sequelae
In the short term, the patient experiences confusion, seizures, and tremors due to hypoglycemia (Prahalad et al., 2018). On the other hand, hyperglycemia results in coma, nocturia, ketoacidosis, and externalizing behaviors in the short term. In the long term, hypoglycemia leads to retinopathy, nephropathy, and microvascular diseases while hyperglycemia results in neuropathy, impotence, and pregnancy complications. The major types of complications associated with T1DM are macrovascular complications and microvascular complications. The microvascular complications include ophthalmological complications, ...