The major complication for a patient who has type I diabetes is the:

• A. The requirement to take insulin
• B. Cessation of pancreatic function
• C. Risk of death from hyperglycemia
• D. Long term implications

Answer: (D)

Type I diabetes stems from autoimmune destruction of insulin-producing beta cells, so patients will need insulin for life and the disease process is the loss of pancreatic function. The major concern over time, however, is not this treatment requirement or the cause itself but the long-term consequences that result from chronic hyperglycemia. Persistently elevated blood glucose damages blood vessels and nerves, leading to retinopathy, nephropathy, neuropathy, and higher cardiovascular risk. These long-term complications are what most affect quality of life and survival, making them the central issue in the patient’s prognosis. Acute emergencies like ketoacidosis or severe hypoglycemia are serious, but they are episodic events; the enduring problem is the long-term implications of ongoing hyperglycemia.