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==Overview==
==Overview==
Diabetes mellitus type 1 (Type 1 diabetes, Type I diabetes, T1D, IDDM) is a form of [[diabetes mellitus]]. Type 1 diabetes is an [[autoimmune]] disease that results in the permanent destruction of [[insulin]] producing [[beta cells]] of the pancreas. Type 1 is lethal unless treatment with exogenous insulin via [[injections]] replaces the missing [[hormone]]. Type 1 diabetes (formerly known as "childhood", "juvenile" or "insulin-dependent" diabetes) is not exclusively a childhood problem: the adult incidence of Type 1 is significant — many adults who contract Type 1 diabetes are misdiagnosed with [[Diabetes mellitus type 2|Type 2]] due to the misconception of Type 1 as a disease of children — and since there is no cure, Type 1 diabetic children will grow up to be Type 1 diabetic adults. The principal treatment of type 1 diabetes, even from the earliest stages, is replacement of insulin combined with careful monitoring of blood glucose levels using blood testing monitors. Without insulin, [[diabetic ketoacidosis]] can develop and may result in coma or death. Emphasis is also placed on lifestyle adjustments (diet and exercise) though these can do absolutely nothing to reverse the loss. Apart from the common [[subcutaneous]] injections, it is also possible to deliver insulin by a [[insulin pump|pump]], which allows continuous infusion of insulin 24 hours a day at preset levels, and the ability to program doses (a [[Bolus (medicine)|bolus]]) of insulin as needed at meal times. An inhaled form of insulin, [[Exubera]], was approved by the FDA in January 2006, although Pfizer discontinued Exubera in October 2007. <ref>{{cite web |url=http://www.fda.gov/bbs/topics/news/2006/NEW01304.html |title=FDA Approves First Ever Inhaled Insulin Combination Product for Treatment of Diabetes |accessdate=2007-09-09 |format= |work=}}</ref> Type 1 treatment must be continued indefinitely. Treatment does not significantly impair normal activities, if sufficient patient training, awareness, appropriate care, discipline in testing and dosing of insulin is taken. However, treatment is burdensome for patients, chronic and insulin is replaced in a non-physiological manner, and is therefore is far from ideal. The average glucose level for the type 1 patient should be as close to normal (80–120&nbsp;mg/dl, 4–6&nbsp;mmol/l) as is ''safely'' possible. Some physicians suggest up to 140–150&nbsp;mg/dl (7-7.5&nbsp;mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200&nbsp;mg/dl (10&nbsp;mmol/l) is sometimes accompanied by discomfort and frequent urination leading to [[dehydration]]. Values above 300&nbsp;mg/dl (15&nbsp;mmol/l) usually require treatment and may lead to [[ketoacidosis]], although is not immediately life-threatening. However, low levels of blood glucose, called [[hypoglycemia]], may lead to seizures or episodes of unconsciousness and absolutely must be treated immediately.
Term Diabetes was first decribed in the literature by a Egyptian scientist Eberes papyrus in 1500BC. Friedrick Banting discovery of insulin in 1921-22, was considered as an important landmark in understanding the nature of disease.Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels.Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors that ultimately lead to the destruction of the pancreatic beta cells and insulin deficiency. American Diabetic Association(ADA), classifies type 1 DM based on etiology into 1) Immune mediated and 2) Idiopathic. The exact cause of type 1 DM remains unknown. Studies have found that cause of Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors.The exact cause of type 1 DM remains unknown. Studies have found that cause of Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors. Epidemiology and demographics of type 1 DM varies with geography, age, race and genetic susceptibility. Risk factors for type 1 DM include family history, genetics, geography, congential rubella infection, maternal entero-viral infection, cesarean infection, higher birth weight, older maternal age, low maternal intake of vegetables, enteroviral infection, frequent respiratory or enteric infections, early exposure to cereals, root vegetables, eggs and cow's milk, infant weight gain, persistent or recurrent entero-viral infections, overweight or increased height velocity, high glycemic load, fructose intake, dietary nitrates or nitrosamines, puberty, psychological stress and low vitamin D levels. According to the American Diabetic Association, screening for type 1 DM is not recommended. If left untreated, patients with [type 1 DM] may progress to develop complications of the hyperglycemia state, which commonly include diabetes ketoacidosis and hyperglycemia hyperosmolar state. Prognosis is generally good with compliance with medications. The diagnosis of type 1 DM is based on the ADA criteria, which include FPG ≥126 mg/dL (7.0 mmol/L), or 2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT, or A1C ≥6.5% (48 mmol/mol), or classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). Type 1 DM has 2 forms of presentations 1) Classic new onset, which commonly present with persistent thirst, frequent urination, and dehydration 2) Diabetic ketoacidosis, which commonly presents with abdominal pain, vomiting and flu-like symptoms. Patients with classic onset presentation of type 1 DM are usually well appearing. Whereas type 1 DM patients presenting with diabetic ketoacidosis is usually remarkable for tachycardia, tachypnea (kussumal breathing) and dehydration. The international guidelines recommend for patient's based approach (individualization) of insulin therapy and dietary regimen in type 1 diabetes. Type 1 diabetes is characterized by an absolute insulin deficiency. For these patients, a basal-bolus regimen with a long-acting analog and a short- or rapid-acting insulin analog is the most physiologic insulin regimen and the best option for optimal glycemic control. Surgery is not the first-line treatment option for patients with type 1 DM. β-Cell Replacement Therapy is usually reserved for patients with either who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions or in patients who already receieved a kidney transplant. There is currently no preventive measure that can be taken against type 1 diabetes.


==Historical Perspective==
==Historical Perspective==

Revision as of 21:51, 27 December 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]

Overview

Term Diabetes was first decribed in the literature by a Egyptian scientist Eberes papyrus in 1500BC. Friedrick Banting discovery of insulin in 1921-22, was considered as an important landmark in understanding the nature of disease.Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels.Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors that ultimately lead to the destruction of the pancreatic beta cells and insulin deficiency. American Diabetic Association(ADA), classifies type 1 DM based on etiology into 1) Immune mediated and 2) Idiopathic. The exact cause of type 1 DM remains unknown. Studies have found that cause of Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors.The exact cause of type 1 DM remains unknown. Studies have found that cause of Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors. Epidemiology and demographics of type 1 DM varies with geography, age, race and genetic susceptibility. Risk factors for type 1 DM include family history, genetics, geography, congential rubella infection, maternal entero-viral infection, cesarean infection, higher birth weight, older maternal age, low maternal intake of vegetables, enteroviral infection, frequent respiratory or enteric infections, early exposure to cereals, root vegetables, eggs and cow's milk, infant weight gain, persistent or recurrent entero-viral infections, overweight or increased height velocity, high glycemic load, fructose intake, dietary nitrates or nitrosamines, puberty, psychological stress and low vitamin D levels. According to the American Diabetic Association, screening for type 1 DM is not recommended. If left untreated, patients with [type 1 DM] may progress to develop complications of the hyperglycemia state, which commonly include diabetes ketoacidosis and hyperglycemia hyperosmolar state. Prognosis is generally good with compliance with medications. The diagnosis of type 1 DM is based on the ADA criteria, which include FPG ≥126 mg/dL (7.0 mmol/L), or 2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT, or A1C ≥6.5% (48 mmol/mol), or classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). Type 1 DM has 2 forms of presentations 1) Classic new onset, which commonly present with persistent thirst, frequent urination, and dehydration 2) Diabetic ketoacidosis, which commonly presents with abdominal pain, vomiting and flu-like symptoms. Patients with classic onset presentation of type 1 DM are usually well appearing. Whereas type 1 DM patients presenting with diabetic ketoacidosis is usually remarkable for tachycardia, tachypnea (kussumal breathing) and dehydration. The international guidelines recommend for patient's based approach (individualization) of insulin therapy and dietary regimen in type 1 diabetes. Type 1 diabetes is characterized by an absolute insulin deficiency. For these patients, a basal-bolus regimen with a long-acting analog and a short- or rapid-acting insulin analog is the most physiologic insulin regimen and the best option for optimal glycemic control. Surgery is not the first-line treatment option for patients with type 1 DM. β-Cell Replacement Therapy is usually reserved for patients with either who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions or in patients who already receieved a kidney transplant. There is currently no preventive measure that can be taken against type 1 diabetes.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Diabetes Mellitus Type 1 from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

References

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