Type I Diabetes Mellitus

10.2310/fm.4017 ◽

2019 ◽

Author(s):

Joseph I. Wolfsdorf ◽

Katharine Garvey

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Autoimmune Diabetes ◽

Type I ◽

Insulin Deficiency ◽

Glucose Levels

Type 1 diabetes mellitus is characterized by severe insulin deficiency, making patients dependent on exogenous insulin replacement for survival. These patients can experience life-threatening events when their glucose levels are significantly abnormal. Type 1 diabetes accounts for 5 to 10% of all diabetes cases, with type 2 accounting for most of the remainder. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment, disposition and outcomes of patients with Type 1 diabetes mellitus. Figures show the opposing actions of insulin and glucagon on substrate flow and plasma levels; plasma glucose, insulin and C-peptide levels throughout the day; the structure of human proinsulin; current view of the pathogenesis of Type 1 autoimmune diabetes mellitus; pathways that lead from insulin deficiency to the major clinical manifestations of Type 1 diabetes mellitus; relationship between hemoglobin A1c values at the end of a 3-month period and calculated average glucose levels during the 3-month period; different combinations of various insulin preparations used to establish glycemic control; and basal-bolus and insulin pump regimens. Tables list the etiologic classification of Type 1 diabetes mellitus, typical laboratory findings and monitoring in diabetic ketoacidosis, criteria for the diagnosis of Type 1 diabetes, clinical goals of Type 1 diabetes treatment, and insulin preparations. This review contains 10 figures, 9 tables, and 40 references. Keywords: Type 1 diabetes mellitus, optimal glycemic control, hypoglycemia, hyperglycemia, polyuria, polydipsia, polyphagia, HbA1c, medical nutrition therapy, Diabetic Ketoacidosis

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Type I Diabetes Mellitus

10.2310/em.4017 ◽

2019 ◽

Author(s):

Joseph I. Wolfsdorf ◽

Katharine Garvey

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Autoimmune Diabetes ◽

Type I ◽

Insulin Deficiency ◽

Glucose Levels

Type 1 diabetes mellitus is characterized by severe insulin deficiency, making patients dependent on exogenous insulin replacement for survival. These patients can experience life-threatening events when their glucose levels are significantly abnormal. Type 1 diabetes accounts for 5 to 10% of all diabetes cases, with type 2 accounting for most of the remainder. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment, disposition and outcomes of patients with Type 1 diabetes mellitus. Figures show the opposing actions of insulin and glucagon on substrate flow and plasma levels; plasma glucose, insulin and C-peptide levels throughout the day; the structure of human proinsulin; current view of the pathogenesis of Type 1 autoimmune diabetes mellitus; pathways that lead from insulin deficiency to the major clinical manifestations of Type 1 diabetes mellitus; relationship between hemoglobin A1c values at the end of a 3-month period and calculated average glucose levels during the 3-month period; different combinations of various insulin preparations used to establish glycemic control; and basal-bolus and insulin pump regimens. Tables list the etiologic classification of Type 1 diabetes mellitus, typical laboratory findings and monitoring in diabetic ketoacidosis, criteria for the diagnosis of Type 1 diabetes, clinical goals of Type 1 diabetes treatment, and insulin preparations. This review contains 10 figures, 9 tables, and 40 references. Keywords: Type 1 diabetes mellitus, optimal glycemic control, hypoglycemia, hyperglycemia, polyuria, polydipsia, polyphagia, HbA1c, medical nutrition therapy, Diabetic Ketoacidosis

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KETOASIDOSIS DIABETIK DI DIABETES MELITUS TIPE 1

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v22i2.1127 ◽

2018 ◽

Vol 22 (2) ◽

pp. 200

Author(s):

Zuhrinah Ridwan ◽

Uleng Bahrun ◽

Ruland DN Pakasi R

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Glucose Level ◽

Insulin Deficiency ◽

C Peptide ◽

Arterial Blood ◽

Laboratory Test Results

Type 1 Diabetes Mellitus (DMT1) is an autoimmune disease characterized by impaired carbohydrate, protein and lipid metabolismresulting in insulin deficiency either absolute or relative. The absolute insulin deficiency found in DMT1, is caused by a defect in thepancreatic ß cells leading to a defect in insulin synthesis by the pancreas gland. In this article, a case of type 1 DM in a child withketoacidosis diabetes has been reported. The diagnosis was based on classical symptoms, blood glucose level, C-peptide, metabolic acidosisand keton uria. The case reported is a 12 year old girl, with main complaints of 9 kg body weight loss since three (3) years ago. Thepatient always felt hungry, thirsty and was frequently urinating. In her family history no such case was denied. The patient had beentreated in the district general hospitals for five (5) days and was diagnosed as type 1 diabetes mellitus and was then referred to the Dr.Wahidin Sudirohusodo Hospital. The laboratory test results revealed as follows, random glucose level was 729 mg/dL, arterial blood gasanalysis showed metabolic acidosis, C-peptide was 0.1 ng/mL and urinalysis showed 150 mg/dL protein, 1000 mg/dL glucose, 150 mg/dL ketone and 250 RBC/uL. The patient was diagnosed as type 1 diabetes mellitus with diabetic ketoacidosis and received 0.5 U/kg/dayinsulin therapy. This case report aimed to determine the type 1 diabetes mellitus in a child is accompanied by diabetic ketoacidosis.

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Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case–control study

SLEEP ◽

10.1093/sleep/zsz226 ◽

2019 ◽

Author(s):

Grace C Macaulay ◽

Barbara C Galland ◽

Sara E Boucher ◽

Esko J Wiltshire ◽

Jillian J Haszard ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Sleep Onset ◽

Sleep Time ◽

Glucose Levels ◽

Control Subjects

Abstract Study Objectives To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. Methods Participants included 82 children (5–18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. Results There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = −40 minutes; 95% confidence interval = −77, −3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). Conclusions Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.

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A case of nivolumab-induced acute-onset type 1 diabetes mellitus in melanoma

Current Oncology ◽

10.3747/co.26.4130 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 8

Author(s):

C. Sakaguchi ◽

K. Ashida ◽

S. Yano ◽

K. Ohe ◽

N. Wada ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Insulin Secretion ◽

Adverse Events ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Autoimmune Diabetes ◽

Acute Onset ◽

Thyroid Disorder

Nivolumab, an anti–PD-1 antibody, is now considered an important therapeutic agent in several advanced malignancies. However, immune-related adverse events such as endocrinopathies have been reported with its use. Thyroid disorder and isolated adrenocorticotropic hormone deficiency have frequently been reported as nivolumab-induced immune-related adverse events. Another endocrinopathy is nivolumab-induced type 1 diabetes mellitus (t1dm), described as diabetes mellitus with rapid onset and complete insulin insufficiency, at times leading to fulminant t1dm. We report the case of a 68-year-old woman who developed pancreatic islet–related autoantibody-negative t1dm, possibly induced by nivolumab, under continuous glucocorticoid administration. She was treated with nivolumab for advanced malignant melanoma, concomitant with 10 mg prednisolone daily for thrombophlebitis tapered to 5 mg after 13 courses of nivolumab therapy. At approximately the 27th course of nivolumab therapy, she showed elevated plasma glucose levels despite preserved insulin secretion. A month later, she developed diabetic ketoacidosis. Her insulin secretion decreased and finally was exhausted. She was diagnosed with acute-onset rather than fulminant t1dm because of a rapidly progressive course to diabetic ketoacidosis during just more than 1 week. She is currently receiving insulin replacement. There has been no recurrence of the melanoma. Thus, nivolumab might induce autoimmune diabetes mellitus, with patients having t1dm-sensitive human leucocyte antigen being more susceptible even when receiving glucocorticoids. Physicians should be aware that nivolumab could potentially induce t1dm as a critical immune-related adverse event..

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Type 1 Diabetes Mellitus

10.2310/tywc.1017 ◽

2018 ◽

Author(s):

Joseph I. Wolfsdorf ◽

Katharine Garvey

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Pancreatic Beta Cells ◽

Insulin Pump ◽

Autoimmune Diabetes ◽

Clinical Manifestations ◽

Laboratory Findings

Type 1 diabetes mellitus is a heterogeneous metabolic disease characterized by destruction of the pancreatic beta cells resulting in an absolute deficiency of insulin secretion with subsequent hyperglycemia. This review details the definition and classification, epidemiology, pathophysiology, pathogenesis, prevention, diagnosis, and management of type 1 diabetes mellitus. Figures show the opposing actions of insulin and glucagon, particularly within the liver, on substrate flow and plasma levels; plasma glucose, insulin and C-peptide levels; the structure of human proinsulin; the cellular actions of insulin; measurement of insulin levels after the administration of glucose; the pathways that lead from insulin deficiency to the major clinical manifestations of type 1 diabetes mellitus; the pathogenesis of type 1 autoimmune diabetes mellitus; the relationship between hemoglobin A1C and calculated average glucose level; basal-bolus and insulin pump regimens; and management of diabetic ketoacidosis. Tables list the etiologic classification of diabetes mellitus, criteria for the diagnosis of diabetes, American Diabetes Association standards for glycemic control in diabetes mellitus, insulin preparations, potential advantages of continuous subcutaneous insulin infusion compared with multiple daily injections, cardiovascular risk factor screening and treatment, and typical admission laboratory findings and monitoring in diabetic ketoacidosis. This review contains 10 highly rendered figures, 7 tables, and 66 references.

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