Thursday, April 19, 2012

Diabetes mellitus type 1

What is type 1 diabetes?
Two major forms of diabetes are type 1 (formerly known as diabetes mellitus or insulin dependent diabetes, which occurs in the youthful age) and type 2 (formerly known as diabetes mellitus or insulin-independent diabetes that occurs in adulthood). Both forms share a basic feature: elevated blood sugar (glucose) levels due to absolute or relative deficiency of insulin, a hormone produced by the pancreas. The pancreas is an elongated, tapered gland behind the stomach that secretes digestive enzymes and the hormones insulin and glucagon. Insulin secreted by the so-called. beta cells arranged in clusters called islets of Langerhans. Insulin is a key regulator of body metabolism. After the meal, the food is digested in the stomach and intestines, carbohydrates are broken down to sugar molecules one of which is glucose, and proteins are broken down into amino acids. Glucose and amino acids are absorbed directly into the bloodstream and blood glucose concentration increases. Under normal conditions an increase in blood glucose stimulates beta cells of the pancreas to secrete insulin, which overflows into the bloodstream. Insulin allows the penetration of glucose into body cells (especially muscle cells) with the other hormones determine if these nutrients into energy to burn, or will be stored for future use. When the blood sugar level back to level before meals, reduced production of insulin in the pancreas and the body uses stored energy to the next meal in which acquires new nutrients.

Diabetes mellitus type 1 - a description of the disease
In type 1 diabetes is gradually declining pancreatic beta cells that produce insulin to the absolute lack of insulin.Without insulin, which moves glucose into cells, blood sugar levels become excessively high and the resulting hyperglycemia. Because the body can not use sugar in the urine goes on, with which it is excreted. Weakness, weight loss, excessive hunger or thirst are some of the consequences of this "starvation in plenty." Patient's life begins to depend on insulin. (Sometimes with type 1 diabetes leads to remission and patients stop taking their insulin, but that period "honeymoon" is almost never last long, occur soon after diagnosis and quick stop).

Why is type 1 diabetes occurs?
Type 1 diabetes is usually preceded by asymptomatic phase known as inzulitis, when the T cells of the immune system, a type of white blood cells begin to infiltrate and destroy pancreatic beta cells. Typically, these so-called killer T cells fight infection, but with diabetes by a mechanism known as an autoimmune response turns against its own tissues in the body. It is not known what triggers this phenomenon, but there is evidence of genetic predisposition and environmental factors (eg viruses). Progression of disease inzulinitisa to full-blown diabetes can take even longer than a few years.

Who gets type 1 diabetes?
Type 1 diabetes is less common than type 2 and is only 7 to 10% of all diabetes cases. Type 1 can occur at any age but usually appears between infancy and 30 age, often during childhood and adolescence. Diseases are subject to the same boys and girls.

What are the symptoms of type 1 diabetes?
The process of deterioration of beta cells that produce insulin may be a long and treacherous. However, when insulin production is reduced to a minimum, type 1 diabetes usually appears suddenly and progresses rapidly.Signs warning of the occurrence of type 1 diabetes are: frequent urination, urination in children back to bed after the child has a habit, unusual thirst, particularly the need for sweets and cold drinks, extreme hunger, sudden and sometimes dramatic weight loss, weakness , genital itching, extreme fatigue, blurred vision or other vision changes and irritability. Children who suffer from Type 1 diabetes are often restless, apathetic, and may have difficulty in school. In acute cases of type 1 diabetes may develop nausea and vomiting. In severe cases, diabetic coma may be the first sign of diabetes mellitus type 1

How serious is diabetes type 1?
Type 1 diabetes mellitus reduces the normal lifespan by an average of 5 years. The risk is the same regardless of ethnic origin, and the disease is more severe in some women.


Diabetic ketoacidosis is a life-threatening complication of diabetes mellitus type 1 Not only is commonly found in the blood of excessive amounts of glucose, fat burning, but also accelerates the production of fatty acids, and it is converted into substances called ketone bodies, and are toxic in high concentrations. Symptoms of ketoacidosis include nausea and vomiting and, in children, abdominal pain. Breathing deeply and can be accelerated by frequent sighs. Heart rate is usually rapid. If the condition persists, coma may occur, and eventually death, although during the past 20 years, mortality caused by ketoacidosis was reduced to about 2% of all cases. First aid consists of giving insulin to correct the metabolism of glucose and ketones, and quickly nadomjeĊĦtavanje fluids and electrolytes.

Intensive insulin therapy or medication that stimulates insulin secretion, such as sulfonylureas, increases the risk of hypoglycemia that occurs when blood glucose falls below normal values. Hypoglycemia may occur due to insufficient food intake, exercise, or alcohol. It is usually treatable, but sometimes the situation difficult and life threatening, especially if the patient does not recognize the symptoms. Mild symptoms occur in low and moderately easy to correct blood glucose levels, and include sweating, trembling, hunger, and rapid heartbeat.Very low concentrations of glucose in the blood can accelerate neurological symptoms - confusion, weakness, disorientation, aggression, and in rare and worst cases coma and death. Patients who suffer from frequent episodes of hypoglycemia can become insensitive to the symptoms. Even a single recent episode of hypoglycemia may make it difficult to detect the next episode. Strict avoidance of low blood glucose levels such patients can regain the ability to recognize symptoms. Most experts recommend that patients more often to control blood glucose concentrations, even four or more times a day. This is especially important for those who have not noticed the symptoms of hypoglycemia before the onset of mental changes. People with diabetes should always have a hard candy, juice and sugar packets. Family and friends had to know the symptoms. The patient should be given three to five pieces of hard candy, two to three packets of sugar or half a cup (more than 1 oz) of fruit juice (provided you can swallow). If no adequate response within 15 minutes, he should be given more sugar or provide emergency medical assistance, including provision of intravenous glucose. Family members and friends can learn how to give an injection of glucagon, a hormone that unlike insulin increases the concentration of glucose in the blood. Hypoglycemia often occurs during sleep, especially in children, even those not in intensive insulin therapy.(In any case, children are exposed to high risk of hypoglycemia). Light meals at the time of going to sleep can be effective.

Long-term complications of diabetes
Main complications of diabetes occur due to disturbances in the blood vessels and the nerve damage (neuropathy). Damage to major blood vessels endangers the heart, especially in heart patients and people with high blood pressure and can cause circulation problems in legs. Changes in small blood vessels (microvascular) are particularly dangerous for the eyes and kidneys.

Complications of cardiovascular system
In a large percentage of cases the cause of death in patients with diabetes is heart attack, stroke and the cause of death in 25% of patients. Both types of diabetes accelerate atherosclerosis, a process in which the layers of yellow deposits of cholesterol, fat and other substances accumulate on the walls of arteries. Arteries constrict, blood flow slows down and can lead to blocked blood vessels. Thus a disease of coronary arteries (supplying blood to the heart) and as a result of a heart attack (myocardial infarction). In type 1 diabetes high blood pressure is usually due to kidney damage. Hypertension is also a major cause of heart attack, stroke or heart failure.

Neuropathy and amputation
In 60% to 70% of patients Diabetes causes neuropathy, nerve damage, especially sense. Symptoms include tingling, burning sensation, usually begins in the fingers and then spreads to the arms and legs. Patients sometimes do not feel pain and will not feel that there is an infection of small blisters or ulcers especially on the feet. This problem becomes even greater because of the problems with blood circulation caused by damage to blood vessels.Even minor infections can cause deep tissue injury. Sometimes it requires a major surgical procedure, and in extreme cases, even amputation of feet or legs. Early and proper treatment of people exposed to particular problems with feet and leg amputations can be prevented in 50% of cases.
If diabetes interventions autonomic nervous system may occur in pathological changes in blood pressure control, bowel and bladder function and sexual function in men. In some cases, neuropathy can block anginoznubol in the chest that draws attention to heart disease and heart attack (myocardial infarction). People with diabetes should recognize other warning signs of heart attack, including sudden fatigue, sweating, shortness of breath, nausea and vomiting.

The complications of the eyes
Diabetes is a major cause of blindness in adults aged 20 to 74 years. Due to the long duration of disease, particularly if it is not disciplined treated nearly all patients with diabetic retinopathy occurs, pathological changes in retinal blood vessels, but only a small number of cases occur in severe vision loss or blindness. Damage to the retina performs 50% of patients with type 1 diabetes after seven years, and after 14 years of changes in the retina occur in more than 90%. Patients are exposed to increased risk of developing cataracts and certain types of glaucoma.

Kidney damage (nephropathy)
Kidney disease occurs in nearly one third of patients suffering from type 1 diabetes and is the main cause of disability and death. The risk of this complication increases with high blood pressure and disturbances in the function of the urinary tract. Symptoms include swelling of the feet and joints, fatigue and pale skin. It is often irreversible kidney damage and must be treated with hemodialysis.

Other complications
Patients with diabetes are more susceptible to flu and its complications, including pneumonia, probably because this disorder neutralizes the effects of protective proteins on the surface of the lungs. In people long suffering from diabetes may experience peeling skin, itching and rough skin.

Specific complications in women
Diabetes in pregnancy (gestational diabetes)
Approximately 0.5% of pregnant women, there is type 2 diabetes in the third trimester of pregnancy. It is called gestational diabetes. After delivery, blood glucose levels usually return to normal, but in one third to one half of these women within 10 years of type 2 diabetes occurs
In women with type 1 diabetes mellitus unregulated disease may increase the risk of birth defects. Because glucose passes through the placenta maternal hyperglycemia affects the child is usually higher than it should be for their age and duration of pregnancy. The fetus responds to high concentrations of glucose excretion of large amounts of insulin. This combination of high concentrations of insulin and glucose causes excessive growth of the fetus. It can also slow the development of lung and cause fetal death. Diabetes also threatens the pregnant woman. Women who suffer from diabetes and wanting to get pregnant should diligently to control blood glucose levels before pregnancy and want to plan a pregnancy in consultation with the doctor .. During pregnancy, blood glucose should be maintained at values ​​that are optimal for the fetus and check regularly for your pregnancy gynecologist.

How is it diagnosed type 1 diabetes? What tests can I do?

Glucose was measured in plasma glucose
Measurement of plasma glucose has become a standard diagnostic test. This is simply a blood test carried out after eight hours of fasting, usually in the morning on an empty stomach. Concentration to 6.0 mmol / l (110 mg / dl) is considered normal. Diabetes is diagnosed if this test two different days show the concentration of plasma glucose of 7.0 mmol / l (126 mg / dl) or higher. O concentrations between 6.0-7,0 mmol / l (110-126 mmol / L) speaks as the deranged fasting glucose, which is considered a risk factor for diabetes and its complications. The test is not always reliable. If a person has normal blood glucose levels, and symptoms of diabetes and family history or other risk factors, then you should turn off diabetes, but to do other tests.

Glucose tolerance test. First, make a test concentration of fasting glucose, and then drink a special glucose solution and after two hours of repeated measure glucose concentration in blood. It is normal blood sugar levels moderately increase after drinking the glucose beverage and decreases after two hours. In diabetics, the excessive increase in the beginning, and its concentration remains high and later.

Testing glukoziliranog hemoglobin. This test examines the concentration of hemoglobin A1c (HbA1c) and hemoglobin glukoziliranog. Hemoglobin is a protein molecule in red blood cells that changes when glucose binds to it. To what extent will change depends on the average concentration of sugar in the blood protein that is exposed to during their lifetime. This test is used to monitor treatment efficacy.

Tests to detect complications
The earliest symptom of kidney damage is microalbuminuria, in which very small amounts of protein called albumin (30 to 300 mg per day) found in urine. Microalbuminuria is also a sign of other complications related to vascular damage. You should check your blood pressure and tested cholesterol and lipids, and possibly do an electrocardiogram test of thyroid function.

What are the general guidelines for the treatment of type 1 diabetes?
Insulin is necessary for survival and is a mainstay in the treatment of diabetes mellitus type 1 It is extremely important to planning a child to compensate for insulin and a source of healthy food. Until now sufficient evidence in the large trials that intensive insulin treatment and strict control of blood glucose concentration inhibits the occurrence of major complications of diabetes, including neuropathy nefropatijui. In addition, intensified treatment of early disease helps to maintain residual insulin secretion for at least two years. The primary complication of intensified insulin therapy is a greater susceptibility to hypoglycaemia. A large number of patients develop a weight which reflects negatively on the pressure and cholesterol levels and is important to control cardiovascular risk factors that may arise as a result of intensified treatment.

Way of life in type 1 diabetes

The majority of patients suffering from diabetes diet is the key to treating this complex disease. But diet is extremely difficult to implement. Today, the diabetic child is changing and no one to match the needs of all diabetics. In type 1 diabetes need insulin to align giving with calorie intake. It is recommended to take three meals a day at regular intervals, and snacks are often required. Patients should take insulin 30 minutes before a meal, and although it may vary depending on the form of the disease. Diabetic patients are advised to maintain a healthy lipid (cholesterol and triglycerides) and blood pressure control. Caloric intake should be adjusted to the needs of normal growth in children, increased needs during pregnancy and during recovery from illness. General rules of a healthy diet apply to everyone: to limit your fat intake (particularly saturated fats and trans fatty acids), protein and cholesterol, and take a lot of fiber and fresh vegetables. Reducing salt intake is also important. Patients would have to consult with a professional dietitian to plan an individualized diet for all their needs.

Weight control
Weight gain is a possible side effect of intensified insulin therapy. In one study it was found that 37% of women with diabetes skip or reduce insulin intake in order to avoid receiving a weight. Disturbances in eating the food became a serious problem among the general population and are particularly dangerous in patients with diabetes.

Physical Activity
Aerobics is shown very effective in patients with diabetes. Aerobics increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels and reduce body fat. Since the concentration of glucose dramatically change during exercise, patients should carefully monitor the concentrations before, during and after training. To avoid hypoglycemia, insulin should be injected at sites distant from the active muscles during exercise. It should also drink plenty of fluids. As in patients with diabetes heart disease quiet possible (without warning pain) should always consult your physician before strenuous exercise.

Daily foot care
Preventive foot care could reduce the risk of amputation by 44% to 85%. Patients should review your feet daily and keep track of changes in color, texture and the smell and the appearance of strong and hardened parts, which may indicate the occurrence of infection or the potential damage. Water used to peru legs must be warm (not hot), and the areas between the toes should be thoroughly dried after washing. Using the wet cream, but not between the toes. Corns and calluses should be gently scrape and toenails cut short and turpijati edges so as not to hurt the neighboring fingers. Patients are not advised to use medicated patches or try to cut corns. Avoid high heels, sandals, straps and should not walk barefoot. Shoes during the day should be changed often, and avoid tight socks and clothes that squeeze your legs and feet. If you experience any problems should consult a physician.

Highly recommended annual vaccination against influenza.

Daily provision of low-dose aspirin is recommended to patients at risk of cardiac disease.

What is insulin and how it is used to treat diabetes?

The regimes of intensified insulin treatment
The goal of intensive therapy to maintain glucose levels as close to normal values. Intensive treatment typically consists of three or more insulin injections daily or use an insulin pump. In addition to the patient during the day should make four or more measurements of blood glucose concentration. The patient should also follow a well planned diet and should visit once a month a team of doctors, nurses and dietitians who care about their health.Due to the increased risk of hypoglycaemia, caution is advised for intensive treatment of children younger than 13 years, while in young children such treatment is not recommended at all.

Insulin can not be used orally because it destroys the digestive juices. Injections of insulin under the skin provides its slow absorption and prolonged effect. Time and frequency of giving insulin injections depends on many factors, such as the type of insulin, the amount and type of food that is taken and how much physical activity the patient. For example, eating raises blood glucose levels while exercising and alcohol affect the decrease in the concentration.

Control of diabetes mellitus type 1

The measurement of blood glucose concentration
Patients on insulin problem is hypoglycemia and hyperglycemia. It is therefore important to carefully monitor blood glucose levels. In general the patients suffering from type 1 diabetes should measure glucose four or more times a day. Their goal should be a pre-meal glucose levels between 4.5 and 6.5 mmol / l (80 and 120 mg / dl) and bedtime between 5.5 to 7.5 mmol / l (100-140mg/dl). Target value in specific cases are different, such as pregnant women, very old or very young patients and those with accompanying serious medical conditions.Usually a drop of blood from a finger smear the bar containing the chemical. Blood glucose is measured on a standard gauge or portable device with a digital display. Home monitors are less accurate than the laboratory.Some simple actions can contribute to greater accuracy: Testing device for measuring and periodically comparing the results with laboratory results

Measurement of hemoglobin glukoziliranog
Periodically measure hemoglobin A1c (Hb A1c) or glukozilirani hemoglobin to determine the average concentration of blood sugar over the life of red blood cells, which is 8 to 10 weeks. Hb A1c should be below 7%.These tests are done roughly twice a year in patients who maintain the concentration of sugar in the blood, and more often in those who have difficulty or change therapy.

Testing urine
Urine testing is useful in detecting the presence of ketones and it should always be done during illness or stress, it is probable that the diabetes out of control. The patient should also be tested annually in urine microalbuminuria (small amounts of protein in urine), which is a risk factor for future kidney disease.

Eye Views
For those on intensive insulin therapy experts recommend eye examination at baseline and then every three months to one year.

How to prevent complications of type 1 diabetes?
In patients with controlled high blood pressure, regular doctor visits and strictly adhere to insulin therapy, the rate of complications may be a third lower than in patients not taking these measures. When intensive treatment is weight gain commonly, due to which patients are at risk of high blood pressure and unhealthy cholesterol.Everyone, especially patients suffering from diabetes should live a healthy life. 

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