Type 1 Diabetes (Insulin Dependent Diabetes Mellitus, Juvenile-onset Diabetes)

The Pancreas 2008 Nucleus Medical Art, Inc. Risk Factors A risk factor is something that increases your chance of getting a disease or condition.Studies show that the following may be risk factors for developing type 1 diabetes: Family history (parent, sibling) of type 1 diabetes Age: starts at age 4 with peak at ages 11 to13 Sex: more common in males than females Race: more common in Caucasians, African Americans, and Hispanics than in Asians Ethnicity: Northern European or Mediterranean Bottlefeeding or short duration of breastfeeding Birth weight above 10 lbs Other autoimmune illness, including: Hashimoto's disease Graves' disease Addison's disease Pernicious anemia Celiac disease Vitiligo Hypogonadism Symptoms Symptoms include: Weight loss Increased urination Extreme thirst Hunger Fatigue, weakness Blurry vision Irritability Skin infections Poor wound healing Headaches Weight loss Reduced or no appetite Impotence Numbness and tingling in hands and feet Insulin-producing cell destruction may occur so quickly that ketoacidosis (commonly known as diabetic coma) is the first sign of a problem. Symptoms of ketoacidosis include:

Vomiting and nausea Abdominal pain Dehydration (not enough fluid in the body) Drowsiness Abnormally deep and fast breathing Coma Dry skin and mouth Fruity breath odor Rapid pulse Low blood pressure Flushed face Diagnosis The doctor will ask about your symptoms and medical and family history, and perform a physical exam. Type 1 diabetes is diagnosed based on the results of blood tests and other criteria, including: Symptoms of diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 mg/dL* ( 11.1 mmol/L) Blood sugar tests after you have not eaten for eight or more hours revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days Glucose tolerance test measuring blood sugar two hours after you consume glucoserarely necessary to diagnose type 1 diabetes *mg/dL = milligrams per deciliter of blood, mmol/L = millimole per liter of blood Some children may receive testing for insulin levels or anti-pancreas antibodies to confirm the diagnosis.

Treatment Diabetes treatment aims to maintain blood sugar at levels as close to normal as possible. Regular medical care is essential for preventing or delaying complications. Insulin Insulin is essential for life. Insulin injection replaces what the pancreas would have produced. The doses may be adjusted based on results of blood sugar tests conducted prior to meals and at bedtime. You will need to administer insulin two, three, or more times daily or wear an insulin pump that continually supplies a small amount of insulin. The pump connects to tubing and a small needle or catheter under the skin. Pramlintide Amylin is produced in the pancreatic beta cells like insulin. In type 1 diabetic patients, this hormone is deficient, as well as insulin. It has long been suspected that the post-meal glucose rise in type 2 diabetic patients is somehow related to the amylin deficiency. The drug pramlintide (Symlin) has recently been approved by the US Food and Drug Administration for the treatment of type 1 and 2 diabetes. Diet Follow a balanced meal plan, eating consistent and moderate amounts of food at regular times each day. Do not skip meals. Eat plenty of fruits, vegetables, and fiber. Eat limited amounts of fat. Eat moderate amounts of protein and low-fat dairy products. Avoid foods high in sugar. Eat a bedtime snack with protein and a starchy food. Keep a record of the food you eat to help a dietitian or doctor revise your nutritional needs. Exercise Exercise is encouraged when blood sugar levels are under control and there are no complications. Follow your doctor's recommendations for activity levels and restrictions. You may need to adjust your insulin regimen or diet to compensate for low glucose levels associated with exercise.

Blood Sugar Testing Checking blood sugar levels during the day helps you track the amount of glucose in your blood. Testing is easy with a blood glucose monitor. Keep a record of the results to show the doctor. Your treatment plan may change based on your test results. Pancreatic Transplant This procedure is recommended if you have: Severe kidney disease and have a kidney transplant at the same time as the pancreatic transplant Acute diabetic complications or emergencies not preventable by insulin Severe problems from injecting self with large amounts of insulin Severe and frequent diabetic complications Prevention Researchers are studying immunosuppressive treatments to prevent type 1 diabetes in high-risk patients. RESOURCES: American Diabetes Association http://www.diabetes.org National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov CANADIAN RESOURCES: Canadian Diabetes Association http://www.diabetes.ca

Team Diabetes Canada Canadian Diabetes Association http://www.diabetes.ca/section_donations/TeamDiabetesIndex.asp References: American Association of Clinical Endocrinologists. American college of Endocrinology. Medical guidelines for the management of diabetes mellitus: the AACE system of intensive diabetes self-management. 2002 update. Endocrine Pract . 2002;8(suppl 1)S40-82. American Diabetes Association website. Available at: http://www.diabetes.org . The DCCT/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 2 diabetes four years after a trial of intensive therapy. N Engl J Med . 2000;342:381-389. Diabetes mellitus type 1. EBSCO Publishing Dynamed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?id=116244sid=0c9c3733-81cc-4c2a-9684-cfe4d807b81b@sessionmgr9 . Accessed March 11, 2008. Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117-125.

McMahon GT, Arky RA. Inhaled insulin for diabetes mellitus. N Engl J Med . 2007;356:497-502. McQueen J. Prqmlintide acetate. Am J Heal Pharm . 2005;62:2263-2272 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/ . Nutrition principles and recommendations in diabetes. Diabetes Care . 2004;27(suppl 1)S36-46. Pancreas transplantation in type 2 diabetes. Diabetes Care . 2004;27:S105. Paviakis M, Khwaja K. Pancrease and islet cell transplantation in diabetes. Curr Opin Endocrinol Diabetes Obes. 2007;14:146-150. Physical activity/exercise and diabetes. Diabetes Care . 2004;27(suppl 1)S58-62. Scheid DC, McCarthy LH, Lawler FH, et al. Screening for microalbuminuria to prevent nephropathy in patients with diabetes: a systematic review of the evidence. J Fam Pract . 2001;50:661-668. Last reviewed March 2008 by David Juan, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.