Type 1 Diabetes Flashcards
1
Q
Type 1 Diabetes
A
A generally autoimmune condition characterised by pancreatic beta cell destruction and absolute insulin deficiency.
- T1DM constitutes 5-10% of all diabetes mellitus.
- TD1M peaks in early childhood (6 months to 5 years) and again during puberty. Increasing annual prevalence of 3% globally.
- More common in males than in females.
- TD1M reduces life expectancy in the UK by 11-15 years.
2
Q
T1DM: Signs and symptoms
A
- Similar to T2DM but are more severe and faster in onset.
- Profound symptoms can develop in days or weeks.
- DKA (diabetic ketoacidosis) presentation at diagnosis is common: Nausea, vomiting, abdominal pain, dehydration and shortness of breath. DKA can be fatal.
- ED, anxiety and depression.
- Hypoglycaemia (< 3.5 mmol / L): Often due to missing meals, over exercising and excess anti-diabetic medication e.g., insulin.
- T1DM increases risk of other AI diseases (20%-25% have thyroid antibodies) e.g., Grave’s, Hashimoto’s, AI gastritis (5-10%), coeliac disease (4%).
3
Q
Autoimmunity of T1DM:
A
- Approximately 90% of individuals develop T1DM due to autoimmune destruction of beta cells.
- Occurs in genetically susceptible individuals and is marked by the presence of circulating autoantibodies to islet cells.
- Activation of auto aggressive T-helper (Th) cells and macrophages are proposed. Growing evidence to suggest altered Th1 / Th2 balance is key.
- Autoantibody negative T1DM: Lack measurable autoantibody responses, autoantibody false negatives or have rare monogenic diabetes.
4
Q
T1DM: Causes and risk factors
A
- Genetics Polymorphisms: ( HLA)-DR/ DQ
- Stress
- Viral infections- Coxsackievirus B, rotavirus, mumps virus, and cytomegalovirus. EBV may be implicated.
- Obesity
- Introducing gluten < 4 months old and cow’s milk < 12 months
- Caesarean delivery/bottle feeding.
- Nitrates
- Vitamin D deficiency
- Omega 3 deficiency
5
Q
Naturopathic approach
A
- Many of the T2DM naturopathic goals apply in T1DM, but note that insulin will always be needed in T1DM.
- Support blood glucose balance low GI meals , avoid high refined carbohydrate snacking, alcohol, concentrated sugars (fructose) and nitrates. Increase high fibre foods.
- Restore nutrient deficiencies (e.g., vitamin D, omega 3 ).
- Optimise GI health (e.g., digestion, microbiome).
- Reduce stress, support exercise and sleep.
- Reduce inflammation associated with AI disease.
Remove allergenic triggers e.g., gluten, cow’s milk.
6
Q
Early intervention (‘honeymoon period’)
A
- Early intervention may help to delay or reverse beta cell damage.
- Combine strict glycaemic control and immune modulation to protect β cell function during this period.
- Exercise: a case control study revealed that the honeymoon period is 5 times longer in men who exercise.
- Niacinamide and epicatechin may help with immune modulation and reduce immune mediated damage to B cells.
‒ Epicatechin: the polyphenols exhibit antiviral activity against rotavirus and enterovirus.
7
Q
T1DM: Supplements
A
Alpha Lipoic Acid
EPA and DHA
Vitamin D
Vitamin C
8
Q
Alpha Lipoic Acid
A
- An antioxidant reduces oxidative stress and inflammation (can also improve insulin sensitivity).
- Dosage: 400-800 mg / day.
Children >10 years, 300 mg BID for 4 months studied.
9
Q
EPA and DHA
A
- Reduces inflammation, protects cell membranes and cardiovascular health.
- Deficiencies during pregnancy linked to T1DM development.
- Dosage: 1000 mg for children, up to 4000 mg for adults.
10
Q
Vitamin D
A
- Improves survival of islet cells and insulin production.
- Immunoregulatory Th1 / Th2 balance).
- Dosage: 800 IU (children), 2000 IU (adults), if deficient.
11
Q
Vitamin C
A
- Usually low in T1DM. Reduces oxidative stress and inflammation, improves endothelial dysfunction.
- Higher levels can reduce sorbitol (increases risk of diabetic complications)
- Increase food sources (e.g., berries, bell pepper, kiwi).
- Dosage: From 200 mg (children), to 2-3 g (adults).
