Diabetes mellitus type 1
Definition
A chronic condition, caused by death of the insulin producing cells in the islets of langerhans. The commonest side effect of this is high blood sugar.
Epidemiology
Around 7% of all diabetes sufferers have type 1. In the general population, about 0.4% of people have it. It generally presents in the teenage years, often around the age of 13.
Pathophysiology
Like nearly all the well known diseases, we don't really know what is going on. The general consensus is that the beta cells in the Islet of Langerhans (in the pancreas) are attacked by autoimmune processes.
There have been some links made with cow's milk. It can also be caused by viral attack, pancreatic problems and chemotherapy.
Risk Factors
- Family History
- Not being breast fed
- Other endocrine disorders
- Coeliac disease
Clinical Features
- Excessive urination (polyuria)
- Excessive thirst (polydipsia)
- Weight loss
- Coma
- Diabetic ketoacidosis (worth reading about, especially in paeds)
Investigations
You do two fasting glucose tests. If, on two occasions, they have a blood sugar over 7mmol/l, they have diabetes. If they present with ketoacidosis, you do a fair few blood and urine tests.
Management
There are 4 main areas of treatment:
- Insulin - you will need to inject this in order to keep blood sugar in check.
- Diet - eating sensibly is important, or at least, being aware of when and what you've eaten is important.
- Exercise - exercise uses blood sugar, so this has to be taken into account with swimming and eating.
- Blood sugar monitoring - both short term, to prevent hyperglycaemia and hypoglycaemia, and long them HbA1c, to ensure that long term control is good.