Tara is an 11-year-old girl diagnosed with type 1 diabetes mellitus (DM). She asks her attending nurse why she can’t take a pill rather than shots like her grandmother does. Which of the following would be the nurse’s best reply?
A. “If your blood glucose levels are controlled, you can switch to using pills.”
B. “The pills correct fat and protein metabolism, not carbohydrate metabolism.”
C. “Your body does not make insulin, so the insulin injections help to replace it.”
D. “The pills work on the adult pancreas, you can switch when you are 18.”
Correct Answer: C. “Your body does not make insulin, so the insulin injections help to replace it.”
The child has type 1 DM, indicating a lack of functioning pancreatic beta cells and an absolute insulin deficiency. Type 1 diabetes is an autoimmune condition that leads to the destruction of pancreatic beta cells which in turn causes insufficient insulin production, resulting in hyperglycemia. Type 1 diabetes is a chronic disease requiring insulin replacement and intensive effort by the patient.
Option A: Oral antidiabetics are indicated only for those with some functioning beta cells, as in those with type 2 DM. Therefore, injections are indicated to supply insulin that is lacking in type 1 diabetes.
Option B: Oral antidiabetics do not correct metabolism. Healthcare practitioners encourage patients to combine lifestyle modifications with oral pharmacologic agents for optimal glycemic control, particularly as type 2 diabetes mellitus progresses with continued loss of pancreatic beta-cell function and insulin production.
Option D: A child with type 1 DM cannot substitute an oral antidiabetic for insulin, regardless of age. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.