219 Nursing Assessment, Management and Treatment of Autoimmune Diseases
Pathophysiology In T1D, the beta cells of the pancreas are destroyed or suppressed. The dis- ease is divided into two types: idiopathic and immune-mediated. Idiopathic T1D causes a permanent insulin deficiency with no evidence of autoimmunity. In im- mune-mediated T1D there is an autoim- mune attack on beta cells. This type of attack causes an inflammatory response known as insulitis (Rebar et al., 2019). EVIDENCE-BASED PRACTICE Research shows that by the time signs and symptoms are evident, 80% of beta cells have been destroyed (Rebar et al., 2019). Although signs and symptoms occur rather abruptly, it can take months or even years for enough beta cells to be de- stroyed before these signs and symptoms appear. Signs and symptoms, once evi- dent, can be severe (Centers for Disease Control and Prevention (CDC)), (2021c). | NURSING CONSIDERATION Symptoms of T1D are similar to those of other health conditions. Nurses must encourage patients to immedi- ately seek medical help if signs and symptoms develop. Untreated T1D can lead to severe, even fatal, health conditions (CDC, 2021c). The development of T1D typically oc- curs in three stages (Lucier & Weinstock, 2021): ● Stage 1 : Stage 1 is characterized by a lack of symptoms and a normal fasting glucose, normal glucose tolerance, and the presence of greater
be referred to support groups and coun- seling as needed (Rebar et al., 2019). Type 1 diabetes James Patten is a 25-year-old who has recently accepted his first position as a clinical engineer. He has worked hard to earn this job and is eager to excel. He has developed annoying symptoms over the past 4 weeks. These include severe thirst, extreme hunger, frequent urination, and unintentional weight loss. James’ health- care provider told him he has type 1 dia- betes. His first response is, “That can’t be right. Only kids get this kind of diabetes! You have made a mistake.” James’s re- sponse is not unusual. However, experts now know that type 1 diabetes can also develop in adults. Type 1 diabetes (T1D) is an autoim- mune disease that develops when the pancreas stops producing insulin. People can be diagnosed with T1D at any age, but it is the most common childhood en- docrine disorder (Meadows-Oliver, 2019). An estimated 1.6 million Americans are living with T1D, including about 200,000 youth (people less than 20 years of age) and 1.4 million adults (people 20 years of age and older; JDRF, n.d.). Statistics that indicate the probable future development of T1D and its significance include the following (JDRF, n.d.): ● About 64,000 people in the US are diagnosed with T1D each year. ● It is expected that five million people in the US will have T1D by 2050, including almost 6,000,000 youth. ● In the US, there are $16 billion in T1D- associated healthcare costs and lost income annually. ● Less than 33% of people with T1D in the US are consistently achieving target blood-glucose control levels.
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