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Type 1 Diabetes Mellitus (Treatment Plan (Maintain lean weight, stop…
Type 1 Diabetes Mellitus
Pathophysiology
Results from autoimmune destruction by autoantibodies of the pancreatic insulin-secreting Beta Cells in the Islets of Langerhans
This causes insulin deficiency and thus the continued breakdown of liver glycogen (producing glucose and ketones) leading to glycosuria and ketonuria as more glucose is in the blood
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Investigations
Random plasma glucose > 11.1 mmol/L = DIABETES DIAGNOSIS
Fasting plasma glucose > 7mmol/L = DIABETES DIAGNOSIS
- One abnormal value is DIAGNOSTIC in symptomatic individuals
- Two abnormal values are required in asymptomatic individuals
Haemoglobin A1c
- Measures amount of glycated haemoglobin - thus tells us blood glucose concentration
6.5% (48mmol/mol) = DIABETES DIAGNOSIS
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FBC, U&Es, liver biochemistry, fasting blood sample for cholesterol and triglycerides
Raised blood pH to look for metabolic acidosis (high H and low HCO3, due to ketoacidosis)
Treatment Plan
Maintain lean weight, stop smoking and take care of feet (to reduce gangrene risk)
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Good glycemic control with good diet - low in sugar, high in starchy carbohydrates with low GI, high in fibre, low in fat
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Insulin is always indicated in a patient who has been in ketoacidosis and is usually required in lean patients who present under the age of 40
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Epidemiology
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Increased in those of Northern European ancestry, especially in Finland
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Typically manifests in childhood, reaching a peak incidence around the time of puberty - but can present at any age
Latent autoimmue diabetes in adults (LADA):
- A slow burning variant with slower progression to insulin deficiency occurs in later life
- May be difficult to differentiate from T2DM - leaner build, rapid progression to insulin therapy
Causes
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Usually primary but may be secondary to other conditions such as:
- Pancreatic pathology
- Endocrine diseases e.g. acromegaly
- Drug induced e.g. corticosteroids
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Risk factors
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Associated with other autoimmune diseases
- Autoimmune thyroid
- Coeliac disease
- Addison's disease
- Pernicious anaemia
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Environmental factors
- Dietary constituents
- Enteroviruses
- Vitamin D deficiency
- Cleaner environment
Complications
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Microvascular
Danger in the retina, glomerulus and nerve sheath
Diabetic retinopathy, nephropathy and neuropathy