A young patient with Type 1 diabetes

A young boy is brought to the emergency department. His parents recently noticed that he has been drinking large amounts of water and urinating frequently. He then developed a minor cold last week, and over the past few days he has become very ill. This morning, his parents had a difficult time waking him, which caused them to call an ambulance. In the emergency department the boy’s blood glucose level is measured to be 527 mg/dL (normal: 60 – 125 mg/dL), and he was diagnosed with type 1 diabetes mellitus.

Type 1 diabetes mellitus is an autoimmune disease that affects the pancreas’s ability to produce insulin. Insulin is a hormone that helps regulate the body’s energy supply. It works by driving a series of metabolic reactions that help the body convert and store the energy in foods into glycogen, triglycerides and protein. On the other hand, glucagon is a hormone that has the opposite effect of insulin. It increases the concentration of glucose in the bloodstream. Since individuals with type 1 diabetes mellitus do not produce enough insulin, they are required to take insulin injections in order to properly regulate the body’s energy supply.

The boy recovers after a few days of treatment in the hospital and is discharged home with a new medication, insulin, which he is told to take at bedtime and before each meal in order to help his body regulate his blood glucose levels. Two weeks later he returns to the emergency department, with a blood glucose level of 35 mg/dL (normal: 60 – 125 mg/dL). Figure 1 depicts his blood glucose level throughout the day prior to coming to the emergency department.

Figure 1: The boy’s blood glucose levels over the 24 hours prior to arriving in the emergency department.