Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin. In type 1 diabetes, insulin is functionally absent because of the destruction of the beta cells of the pancreas. Type 1 DM occurs most commonly in juveniles but can occur in adults, especially in those in their late 30s and early 40s. Unlike people with type 2 DM, those with type 1 DM generally are not obese and may present initially with diabetic ketoacidosis (DKA). In this particular case, Yusuf, a 12-year-old boy was diagnosed with type 1 diabetes after exhibiting some of the following symptoms: weight loss, excessive urinating, and an unquenchable thirst. More recently, Yusuf was again admitted to the hospital after complaining of nausea, vomiting and intense thirst. The doctor observed that he appeared confused and was breathing with difficulty. All of these symptoms are effects of metabolic events within young Yusuf's body, which were playing havoc with his organ systems.

Thirst is due to the hyperosmolar state and dehydration. The weight loss with a normal or increased appetite is due to depletion of water and a catabolic state with reduced glycogen, proteins, and triglycerides. This may be due to muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Nausea, abdominal discomfort...

Acute fatty liver may lead to distention of the hepatic capsule, causing right upper quadrant pain. Persistent abdominal pain may indicate another serious abdominal cause of DKA, eg, pancreatitis. Chronic gastrointestinal symptoms in the later stage of diabetes are due to visceral autonomic neuropathy. Symptoms at the time of the first clinical presentation usually can be traced back several days to several weeks; however, beta cell destruction may have started months, or even years, before the onset of clinical symptoms.
All type 1 DM patients should learn how to self-monitor and record their blood glucose levels with home analyzers and adjust their insulin doses accordingly.

Insulin-dependent patients ideally should test their plasma glucose daily before meals, in some cases 1-2 hours after meals, and at bedtime. In practice, however, patients often obtain 2-4 measurements each day, including fasting levels and at various other times, including preprandially and at bedtime.

Instruct patients with type 1 DM in the method of testing for urine ketones using commercially available reagent strips. Also, advise patients to test for urine ketones whenever they develop symptoms of a cold, flu, or other intercurrent illness; nausea, vomiting, or abdominal pain; polyuria; or if they find an unexpectedly high plasma glucose level…