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Diabetes mellitus type 1

Background knowledge ๐Ÿง 

Definition

  • Type 1 diabetes mellitus (T1DM) is an autoimmune condition characterized by destruction of insulin-producing beta cells in the pancreas
  • Leads to absolute insulin deficiency and hyperglycemia
  • Requires lifelong insulin therapy
  • Previously known as juvenile-onset diabetes

Epidemiology

  • Incidence: approximately 10-20 per 100,000 per year in the UK
  • More common in Caucasians
  • Typically presents in childhood or early adulthood
  • Slightly more common in males than females
  • Increasing incidence worldwide

Aetiology and Pathophysiology

  • Autoimmune destruction of pancreatic beta cells
  • Genetic predisposition (e.g., HLA-DR3 and HLA-DR4)
  • Environmental triggers (e.g., viral infections)
  • Results in absolute insulin deficiency
  • Leads to hyperglycemia, ketoacidosis, and other metabolic disturbances

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Polyuria (frequent urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (increased hunger)
  • Weight loss
  • Fatigue
  • Blurred vision
  • Recurrent infections
  • Ketoacidosis (in severe cases)

Signs

  • Signs of dehydration (e.g., dry mucous membranes, reduced skin turgor)
  • Ketotic breath (fruity smell)
  • Rapid, deep breathing (Kussmaul respirations)
  • Tachycardia
  • Hypotension (if dehydrated)
  • Altered mental status (in severe cases)
  • Weight loss and muscle wasting

Investigations ๐Ÿงช

Tests

  • Fasting blood glucose (โ‰ฅ7.0 mmol/L)
  • Random blood glucose (โ‰ฅ11.1 mmol/L with symptoms)
  • HbA1c (โ‰ฅ48 mmol/mol)
  • Urinalysis (glucosuria, ketonuria)
  • C-peptide levels (low or undetectable)
  • Autoantibody testing (e.g., GAD, IA-2, ZnT8)
  • Venous blood gas and capillary ketones (if DKA is suspected)
  • Electrolytes and renal function tests

Management ๐Ÿฅผ

Management

  • Lifelong insulin therapy (basal-bolus regimen or insulin pump)
  • Regular blood glucose monitoring
  • Dietary management and carbohydrate counting
  • Education on hypoglycemia recognition and management
  • Management of diabetes-related complications (e.g., retinopathy, nephropathy)
  • Regular follow-up with a diabetes care team
  • Sick day rules and management of intercurrent illnesses
  • Psychological support and counselling
  • Exercise advice and support

Complications

  • Diabetic ketoacidosis (DKA)
  • Hypoglycemia
  • Microvascular complications (retinopathy, nephropathy, neuropathy)
  • Macrovascular complications (cardiovascular disease, stroke)
  • Infections (e.g., candidiasis, skin infections)
  • Foot problems (ulcers, infections)
  • Psychological issues (e.g., depression, anxiety)

Prognosis

  • With appropriate management, individuals with T1DM can lead normal, healthy lives
  • Lifelong monitoring and treatment are necessary
  • Risk of complications increases with poor glycemic control
  • Early detection and management of complications improve outcomes
  • Support from a multidisciplinary team is crucial
  • Advances in technology (e.g., continuous glucose monitors, insulin pumps) have improved quality of life

Key Points

  • Type 1 diabetes mellitus is an autoimmune condition leading to absolute insulin deficiency
  • Management includes lifelong insulin therapy, regular monitoring, and lifestyle modifications
  • Early recognition and treatment of complications are essential to prevent long-term morbidity
  • Patient education and support from a multidisciplinary team are crucial for optimal management
  • With appropriate management, individuals with T1DM can lead normal, healthy lives

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