Type 1 Diabetes Mellitus
Practice Essentials
Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults
See Clinical Findings in Diabetes Mellitus, a Critical Images slideshow, to help identify various cutaneous, ophthalmologic, vascular, and neurologic manifestations of DM.
Signs and symptoms
The classic symptoms of type 1 diabetes are as follows:
Polyuria
Polydipsia
Polyphagia
Unexplained weight loss
Other symptoms may include fatigue, nausea, and blurred vision.
The onset of symptomatic disease may be sudden. It is not unusual for patients with type 1 diabetes to present with diabetic ketoacidosis (DKA).
See Clinical Presentation for more detail.
Diagnosis
Diagnostic criteria by the American Diabetes Association (ADA) include the following
:
A fasting plasma glucose (FPG) level ≥126 mg/dL (7.0 mmol/L), or
A 2-hour plasma glucose level ≥200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test (OGTT), or
A random plasma glucose ≥200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
Lab studies
A fingerstick glucose test is appropriate for virtually all patients with diabetes. All fingerstick capillary glucose levels must be confirmed in serum or plasma to make the diagnosis. All other laboratory studies should be selected or omitted on the basis of the individual clinical situation.
An international expert committee appointed by the ADA, the European Association for the Study of Diabetes, and the International Diabetes Association recommended the HbA1c assay for diagnosing type 1 diabetes only when the condition is suspected but the classic symptoms are absent. [3]
Screening
Screening for type 1 diabetes in asymptomatic low-risk individuals is not recommended. [2] However, in patients at high risk (eg, those who have first-degree relatives with type 1 diabetes), it may be appropriate to perform annual screening for anti-islet antibodies before the age of 10 years, along with 1 additional screening during adolescence. [4]
See Workup for more detail.
Management
Glycemic control
The ADA recommends using patient age as one consideration in the establishment of glycemic goals, with different targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels in patients aged 0-6, 6-12, and 13-19 years. [5] Benefits of tight glycemic control include not only continued reductions in the rates of microvascular complications but also significant differences in cardiovascular events and overall mortality.
Self-monitoring
Optimal diabetic control requires frequent self-monitoring of blood glucose levels, which allows rational adjustments in insulin doses. All patients with type 1 diabetes should learn how to self-monitor and record their blood glucose levels with home analyzers and adjust their insulin doses accordingly.
Real-time continuous monitoring of glucose—using continuous glucose monitors (CGMs)—can help patients improve glycemic control. [6, 7] CGMs contain subcutaneous sensors that measure interstitial glucose levels every 1-5 minutes, providing alarms when glucose levels are too high or too low or are rapidly rising or falling.
https://emedicine.medscape.com/article/117739-overviewnext
مرسل: الأحد ديسمبر 30, 2018 10:40 pm