Diabetes Type 1
Type 1 diabetes occurs when body immune system reacts against own body cells. Therefore there is destruction of insulin producing beta cells in the pancreas resulting in absolute insulin deficiency. There are two types of type 1 diabetes, immune-mediated type 1(individuals in this category have antibodies that identify the autoimmune process) and idiopathic type 1 diabetes (Swati & Agarwal, 2015). It accounts for about 10 % of all diabetes cases in the world. It is the most common endocrine disorder in childhood, annually more than 200 000 children are diagnosed worldwide. Its incidence is rising globally at a rate of 3-5 %.
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Aetiology and Risk Factors
The exact aetiology of type 1 diabetes mellitus remains unknown, though an interplay between genetics and environmental factors are shown to be initiators of the disease process. The environmental factors cause direct toxicity to the pancreatic beta cells or stimulate autoimmune directed destruction against the beta cells…
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The disease is more common in the young population. With more males than females. Increased urbanisation has also led to increased incidence of the disease.
Pathophysiology
Most type 1 diabetes are due to cellular mediated type autoimmune destruction of the insulin secreting cells of the pancreatic beta cells, the other islet cell lines are preserved. In most patients the process is T-cell mediated. The autoimmune process begins months or years before the clinical presentation, 80-90% of the cells are destroyed before the onset of symptoms (Wile & Wilding, 2014)…
Clinical Manifestation and Complications.
Type 1 diabetes mellitus presents with a number of signs and symptoms due to hyperglycaemia that makes it easy to have a high index of suspicion. The complications arising from the disease are many as well.
The most common symptoms that patients presents with are: polyuria due to osmotic diuresis, polydipsia due to excessive thirst from increased plasma osmolality and hypovolemia, polyphagia due to lack of glucose in the cells…
Diagnosis.
Blood glucose levels are maintained in a very narrow range. A number of tests can be done to determine if one is euglycemic, has impaired glucose tolerance or whether one is overly diabetic. One can test urine or blood samples for abnormalities in glucose, ketones or proteins (in the urine sample). The following are diagnostic of diabetes.
- A random blood sugar of 200 mg/dl or higher with clinical signs and symptoms
- A fasting blood sugar of 126 mg/dl or higher in more than one occasion.
- An abnormal oral glucose tolerance test in which glucose concentration is 200 mg/dl or higher 2 hours after a standard carbohydrate load of 75 grams of glucose.(from Robbins)
Euglycemic levels for the fasting blood sugars are below 110 mg/dl and below 140 for the oral glucose tolerance test.
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References
El-Hattab, A. W., Adesina, A. M., Jones, J., & Scaglia, F. (2015). MELAS syndrome: clinical
manifestations, pathogenesis, and treatment options. Molecular genetics and
metabolism, 116(1), 4-12.
Wile, D. B., & Wilding, J. P. (2014). Glucose metabolism and the pathophysiology of
diabetes mellitus. In Clinical Biochemistry: Metabolic and Clinical Aspects (Third
Edition) (pp. 273-304).
Rewers, M., & Ludvigsson, J. (2016). Environmental risk factors for type 1 diabetes. The
Lancet, 387(10035), 2340-2348.
Swati, S., & Agarwal, P. (2015). Diabetes mellitus: an Ayurvedic view. Journal of Scientific
and Innovative Research, 4(4), 193-196.
