Villanueva, Rachaela Therese

N313;Group3

CASE REPORT:JUVENILE DIABETES

Diabetes mellitus type 1 (Type 1 diabetes, IDDM, or juvenile diabetes) is a

form of diabetes mellitus that results from autoimmune destruction of insulin-
producing beta cells of the pancreas. The subsequent lack of insulin leads to
increased blood and urine glucose. The classical symptoms of polyuria (frequent
urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight
loss result.

Type 1 diabetes is fatal unless treated with insulin. Injection is the most common
method of administering insulin; insulin pumps and inhaled insulin have been
available at various times. Pancreas and islet transplants have been used to treat
type 1 diabetes; however, islet transplants are currently still at the experimental trial
stage.

Most people who develop type 1 are otherwise healthy. Although the cause of type 1
diabetes is still not fully understood it is believed to be of immunological origin. There
is a growing body of evidence that diet may play a role in the development of type 1
diabetes, through influencing gut flora, intestinal permeability, and immune function
in the gut; wheat in particular has been shown to have a connection to the
development of type 1 diabetes, although the relationship is poorly understood.Type
1 can be distinguished from type 2 diabetes via a C-peptide assay, which measures
endogenous insulin production.

Type 1 treatment must be continued indefinitely in all cases. Treatment need 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 many people. Complications may be associated with
both low blood sugar and high blood sugar. Low blood sugar may lead to seizures or
episodes of unconsciousness and requires emergency treatment. High blood sugar
may lead to increased tiredness and can also result in long term damage to organs.

Signs and symptoms

The classical symptoms of type 1 diabetes include: polyuria (frequent urination),

polydipsia (increased thirst), polyphagia (increased hunger), tiredness, and weight
loss

Genetics

Type 1 diabetes is a polygenic disease, meaning many different genes contribute to

its expression. Depending on locus or combination of loci, it can be dominant,
recessive, or somewhere in between. The strongest gene, IDDM1, is located in the
MHC Class II region on chromosome 6, at staining region 6p21. This is believed to be
responsible for the histocompatibility disorder characteristic of type 1: Insulin-
producing pancreas cells (beta cells) display improper antigens to T cells.

Diagnosis

2006 WHO Diabetes criteria edit Condition 2 hour glucose Fasting

glucose
mmol/l(mg/dl) mmol/l(mg/dl)
Normal <7.8 (<140) <6.1 (<110)
Impaired fasting glycaemia <7.8 (<140) ≥ 6.1(≥110) & <7.0(<126)
Impaired glucose tolerance ≥7.8 (≥140) <7.0 (<126)
Diabetes mellitus ≥11.1 (≥200) ≥7.0 (≥126)

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is

diagnosed by demonstrating any one of the following:[14]

* Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).

* Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral
glucose load as in a glucose tolerance test.
* Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L
(200 mg/dL).
* Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was
recommended by the American Diabetes Association in 2010; it has yet to be
adopted by the WHO.)

About a quarter of people with new type 1 diabetes have developed some degree of
diabetic ketoacidosis (a type of metabolic acidosis which is caused by high
concentrations of ketone bodies, formed by the breakdown of fatty acids and the
deamination of amino acids) by the time the diabetes is recognized. The diagnosis of
other types of diabetes is usually made in other ways. These include ordinary health
screening, detection of hyperglycemia during other medical investigations, and
secondary symptoms such as vision changes or unexplainable fatigue. Diabetes is
often detected when a person suffers a problem that is frequently caused by
diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot
ulcer, certain eye problems, certain fungal infections, or delivering a baby with
macrosomia or hypoglycemia.

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed

by a repeat of any of the above-listed methods on a different day. Most physicians
prefer to measure a fasting glucose level because of the ease of measurement and
the considerable time commitment of formal glucose tolerance testing, which takes
two hours to complete and offers no prognostic advantage over the fasting
test.According to the current definition, two fasting glucose measurements above
126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.

Patients with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are
considered to have impaired fasting glucose. Patients with plasma glucose at or
above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours
after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of
these two pre-diabetic states, the latter in particular is a major risk factor for
progression to full-blown diabetes mellitus as well as cardiovascular disease.

Prevention

Type 1 diabetes risk is known to depend upon a genetic predisposition based on HLA
types (particularly types DR3 and DR4), an unknown environmental trigger
(suspected to be an infection, although none has proven definitive in all cases), and
an uncontrolled autoimmune response that attacks the insulin producing beta
cells.Some research has suggested that breastfeeding decreased the risk in later life;
various other nutritional risk factors are being studied, but no firm evidence has been
found. Giving children 2000 IU of Vitamin D during their first year of life is associated
with reduced risk of type 1 diabetes, though the causal relationship is obscure.

Children with antibodies to beta cell proteins (i.e. at early stages of an immune
reaction to them) but no overt diabetes, and treated with vitamin B3 (niacin), had
less than half the diabetes onset incidence in a 7-year time span as did the general
population, and an even lower incidence relative to those with antibodies as above,
but who received no vitamin B3.

Management

Type 1 is treated with insulin replacement therapy—either via subcutaneous injection

or insulin pump, along with attention to dietary management, typically including
carbohydrate tracking, and careful monitoring of blood glucose levels using glucose
meters. Today the most common insulins are biosynthetic products produced using
genetic recombination techniques; formerly, cattle or pig insulins were used, and
even sometimes insulin from fish.Major global suppliers include Eli Lilly and
Company, Novo Nordisk, and Sanofi-Aventis. A more recent trend, from several
suppliers, is insulin analogs which are slightly modified insulins which have different
onset of action times or duration of action times.

Untreated type 1 diabetes commonly leads to coma, often from diabetic ketoacidosis,
which is fatal if untreated. Continuous glucose monitors have been developed and
marketed which can alert patients to the presence of dangerously high or low blood
sugar levels, but technical limitations have limited the impact these devices have had
on clinical practice so far.

In more extreme cases, a pancreas transplant can restore proper glucose regulation.
However, the surgery and accompanying immunosuppression required is considered
by many physicians to be more dangerous than continued insulin replacement
therapy, and is therefore often used only as a last resort (such as when a kidney
must also be transplanted, or in cases where the patient's blood glucose levels are
extremely volatile). Experimental replacement of beta cells (by transplant or from
stem cells) is being investigated in several research programs. Thus far, beta cell
replacement has only been performed on patients over age 18, and with tantalizing
successes amidst nearly universal failure.

Risk factors

There aren't many known risk factors for type 1 diabetes, though researchers
continue to find new possibilities. Some known risk factors include:

* A family history. Anyone with a parent or sibling with type 1 diabetes has a
slightly increased risk of developing the condition.
* Genetics. The presence of certain genes indicates an increased risk of developing
type 1 diabetes. In some cases — usually through a clinical trial — genetic testing
can be done to determine if someone who has a family history of type 1 diabetes is
at increased risk of developing the condition.
* Geography. The incidence of type 1 diabetes tends to increase as you travel
away from the equator. People living in Finland and Sardinia have the highest
incidence of type 1 diabetes — about two to three times higher than rates in the
United States and 400 times that of people living in Venezuela.

Possible risk factors for type 1 diabetes include:

* Viral exposure. Exposure to Epstein-Barr virus, coxsackievirus, mumps virus or

cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the
virus may directly infect the islet cells.
* Low vitamin D levels. Research suggests that vitamin D may be protective
against type 1 diabetes. However, early intake of cow's milk — a common source of
vitamin D — has been linked to an increased risk of type 1 diabetes.
* Other dietary factors. Omega-3 fatty acids may offer some protection against
type 1 diabetes. Drinking water that contains nitrates may increase the risk.
Additionally, the timing of the introduction of cereal into a baby's diet may affect his
or her risk of type 1 diabetes. One clinical trial found that between ages 3 and 7
months appears to be the optimal time for introducing cereal.

Complications

Type 1 diabetes can affect many major organs in your body, including your heart,
blood vessels, nerves, eyes and kidneys. Keeping your blood sugar level close to
normal most of the time can dramatically reduce the risk of many complications.

Long-term complications of type 1 diabetes develop gradually, over years. The earlier
you develop diabetes — and the less controlled your blood sugar — the higher the
risk of complications. Eventually, diabetes complications may be disabling or even
life-threatening.

* Heart and blood vessel disease. Diabetes dramatically increases your risk of
various cardiovascular problems, including coronary artery disease with chest pain
(angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high
blood pressure. In fact, about 65 percent of people who have diabetes die of some
type of heart or blood vessel disease, according to the American Heart Association.
* Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood
vessels (capillaries) that nourish your nerves, especially in the legs. This can cause
tingling, numbness, burning or pain that usually begins at the tips of the toes or
fingers and gradually spreads upward. Poorly controlled blood sugar could cause you
to eventually lose all sense of feeling in the affected limbs. Damage to the nerves
that control digestion can cause problems with nausea, vomiting, diarrhea or
constipation. For men, erectile dysfunction may be an issue.
* Kidney damage (nephropathy). The kidneys contain millions of tiny blood
vessel clusters that filter waste from your blood. Diabetes can damage this delicate
filtering system. Severe damage can lead to kidney failure or irreversible end-stage
kidney disease, requiring dialysis or a kidney transplant.
* Eye damage. Diabetes can damage the blood vessels of the retina (diabetic
retinopathy), potentially leading to blindness. Diabetes also increases the risk of
other serious vision conditions, such as cataracts and glaucoma.
* Foot damage. Nerve damage in the feet or poor blood flow to the feet increases
the risk of various foot complications. Left untreated, cuts and blisters can become
serious infections. Severe damage might require toe, foot or even leg amputation.
* Skin and mouth conditions. Diabetes may leave you more susceptible to skin
problems, including bacterial and fungal infections. Gum infections also may be a
concern, especially if you have a history of poor dental hygiene.
* Osteoporosis. Diabetes may lead to lower than normal bone mineral density,
increasing your risk of osteoporosis.
* Pregnancy complications. High blood sugar levels can be dangerous for both
the mother and the baby. The risk of miscarriage, stillbirth and birth defects are
increased when diabetes isn't well controlled. For the mother, diabetes increases the
risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced
high blood pressure and preeclampsia.
* Hearing problems. Hearing impairments occur more often in people with
diabetes.