DIABETES MELLITUS TYPE 1 AND DKA
UNFOLDING REASONING COMPLETE STUDY
GUIDE 2026
◉ prevalence of diabetes in the US. Answer: 2021 data:
-38.4 million adults in the US living with diabetes (2019,
diabetes.org) (29.7 million diagnosed, 8.7 million undiagnosed)
-8th leading cause of death in the US (2021)
-Reduces life expectancy by 5 - 10 years
-60% of non-traumatic lower-limb amputations occur in people with
diabetes
-$412.9 billion (total cost of care for diagnosed US patients in 2023)
($306.6 billion in medical costs, $106.3 billion in reduced
productivity)
-affects 1 in 3 adults
-It is estimated that people can be undiagnosed with type 2 dm for
up to 10 years:
-pre-diabetes - allows chronic hyperglycemia to silently damage
blood vessels and organs - by time of diagnosis, 1 in 3 people already
show signs of vascular tissue complications
,>35% of all people diagnosed with type 2 DM already have some
form of diabetic tissue disease this can include:
-Cardiovascular disease
-Cerebrovascular disease
-Peripheral vascular disease
-Eye complications (retinopathy)
-Kidney complications (nephropathy)
-Nerve complications (neuropathy)
-early screening, lifestyle intervention, and patient education is
important
◉ social determinants of health and diabetes. Answer: -Diversity,
Equity, and Inclusion
-social determinants of health (income, housing stability, education,
access to healthcare, social support) play a significant role in
development and outcomes of diabetes
-these factors influence glycemic control, risk for early
complications, and long term morbidity (esp among young adults
and vulnerable populations)
-individuals with mental illness can achieve comparable disease
diabetes treatment targets when appropriate support systems are in
place
,-need to understand and address these factors to improve equity
and diabetes outcomes among populations
◉ normal physiology. Answer: -Insulin secreted from beta cells of
pancreas in response to rising blood glucose levels
-Glucose enters cell / metabolized - for energy
-Stored as glycogen in liver, muscle
-Fat stored in adipose tissue
-Protein synthesized into amino acids
-Plasma glucose WDL (within defined limits) - Between 70 and 100
mg/dl - tight hormonal regulation
-if glucose levels drop too low, glucagon is released (stimulates
glycogenolysis and gluconeogenesis) to maintain balance
◉ diabetes mellitus: pathophysiology. Answer: -Insufficient / absent
insulin - decreased cellular glucose uptake
-Hyperglycemia - blood glucose exceeds renal threshold
-Fluid shift - intracellular to extracellular - glucose spills into urine -
causes osmotic diuresis, polyuria / polydipsia
-Glyconeogenesis - fats & protein metabolized for energy
-POLYPHASIA - excessive hunger (weight loss) - and diabetic
ketoacidosis
, ◉ glucose metabolism. Answer: -regulated through a balance
between insulin and glucagon to maintain homeostasis
-when blood glucose levels rise, pancreatic beta cells release insulin
to stimulate glucose uptake by cells and storage as glycogen in the
liver
-when blood glucose levels fall, alpha cells release glucagon,
stimulating the liver to break down the glycogen and releasing
glucose back into the bloodstream
◉ type I diabetes. Answer: -insulin dependent diabetes mellitus
-10%
-autoimmune condition common in adolescent - characterized by
destruction of pancreatic beta cells and absolute insulin defficiency
-Younger client, < 20
-Sudden onset
-Beta cell destruction
-(no insulin) - bec there is no endogenous insulin production,
patients are at a high risk for hyperglycemia and diabetic
ketoacidosis, especially at initial presentation of the disease
-Normal / weight loss
-lifelong insulin therapy is required for survival - without adequate
management, complications will occur
UNFOLDING REASONING COMPLETE STUDY
GUIDE 2026
◉ prevalence of diabetes in the US. Answer: 2021 data:
-38.4 million adults in the US living with diabetes (2019,
diabetes.org) (29.7 million diagnosed, 8.7 million undiagnosed)
-8th leading cause of death in the US (2021)
-Reduces life expectancy by 5 - 10 years
-60% of non-traumatic lower-limb amputations occur in people with
diabetes
-$412.9 billion (total cost of care for diagnosed US patients in 2023)
($306.6 billion in medical costs, $106.3 billion in reduced
productivity)
-affects 1 in 3 adults
-It is estimated that people can be undiagnosed with type 2 dm for
up to 10 years:
-pre-diabetes - allows chronic hyperglycemia to silently damage
blood vessels and organs - by time of diagnosis, 1 in 3 people already
show signs of vascular tissue complications
,>35% of all people diagnosed with type 2 DM already have some
form of diabetic tissue disease this can include:
-Cardiovascular disease
-Cerebrovascular disease
-Peripheral vascular disease
-Eye complications (retinopathy)
-Kidney complications (nephropathy)
-Nerve complications (neuropathy)
-early screening, lifestyle intervention, and patient education is
important
◉ social determinants of health and diabetes. Answer: -Diversity,
Equity, and Inclusion
-social determinants of health (income, housing stability, education,
access to healthcare, social support) play a significant role in
development and outcomes of diabetes
-these factors influence glycemic control, risk for early
complications, and long term morbidity (esp among young adults
and vulnerable populations)
-individuals with mental illness can achieve comparable disease
diabetes treatment targets when appropriate support systems are in
place
,-need to understand and address these factors to improve equity
and diabetes outcomes among populations
◉ normal physiology. Answer: -Insulin secreted from beta cells of
pancreas in response to rising blood glucose levels
-Glucose enters cell / metabolized - for energy
-Stored as glycogen in liver, muscle
-Fat stored in adipose tissue
-Protein synthesized into amino acids
-Plasma glucose WDL (within defined limits) - Between 70 and 100
mg/dl - tight hormonal regulation
-if glucose levels drop too low, glucagon is released (stimulates
glycogenolysis and gluconeogenesis) to maintain balance
◉ diabetes mellitus: pathophysiology. Answer: -Insufficient / absent
insulin - decreased cellular glucose uptake
-Hyperglycemia - blood glucose exceeds renal threshold
-Fluid shift - intracellular to extracellular - glucose spills into urine -
causes osmotic diuresis, polyuria / polydipsia
-Glyconeogenesis - fats & protein metabolized for energy
-POLYPHASIA - excessive hunger (weight loss) - and diabetic
ketoacidosis
, ◉ glucose metabolism. Answer: -regulated through a balance
between insulin and glucagon to maintain homeostasis
-when blood glucose levels rise, pancreatic beta cells release insulin
to stimulate glucose uptake by cells and storage as glycogen in the
liver
-when blood glucose levels fall, alpha cells release glucagon,
stimulating the liver to break down the glycogen and releasing
glucose back into the bloodstream
◉ type I diabetes. Answer: -insulin dependent diabetes mellitus
-10%
-autoimmune condition common in adolescent - characterized by
destruction of pancreatic beta cells and absolute insulin defficiency
-Younger client, < 20
-Sudden onset
-Beta cell destruction
-(no insulin) - bec there is no endogenous insulin production,
patients are at a high risk for hyperglycemia and diabetic
ketoacidosis, especially at initial presentation of the disease
-Normal / weight loss
-lifelong insulin therapy is required for survival - without adequate
management, complications will occur
