Type 1 Diabetes Flashcards
Type 1 diabetes mellitus (T1DM)
Type 1 diabetes mellitus (T1DM) = 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.
- Significant differences in incidence globally e.g., lowest in Thailand and Venezuela and highest in Finland and Sardinia.
- TD1M reduces life expectancy in the UK by 11–15 years.
Signs and symptoms:
- Similar to T2DM but are more severe and faster in onset.
- Profound symptoms can develop in days or weeks.
- DKA presentation at diagnosis is common: Nausea, vomiting, abdominal pain, dehydration and shortness of breath.
- ED, anxiety and depression.
- Hypoglycaemia (< 3.5 mmol / L):
Often due to missing meals, over exercising and excess antidiabetic medication e.g., insulin.
DKA can be fatal.
- 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%).
Signs and symptoms:
- Similar to T2DM but are more severe and faster in onset.
- Profound symptoms can develop in days or weeks.
- DKA presentation at diagnosis is common: Nausea, vomiting, abdominal pain, dehydration and shortness of breath.
- ED, anxiety and depression.
- Hypoglycaemia (< 3.5 mmol / L):
Often due to missing meals, over exercising and excess antidiabetic medication e.g., insulin.
DKA can be fatal.
- 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%).
Autoimmunity of T1DM:
- 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.
Causes and risk factors:
- Genetics: 30–70% in identical twins. Polymorphisms:
(HLA)-DR / DQ gene increase susceptibility.
- Stress — e.g., serious life events.
- Viral infections — Coxsackievirus B, rotavirus, mumps virus, and cytomegalovirus. EBV may be implicated. ‒ Viruses can cause direct cytolytic destruction of beta-cells or by promoting autoimmunity.
- Obesity — the prevalence of obesity in T1DM is increasing!
A 10% increment in weight was associated with a 50–60% increase in risk of T1D before the age of 3 years.
- Early nutrition — introducing gluten < 4
months old and cow’s milk < 12 months encourages gut dysbiosis in infants.
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Caesarean delivery. Breastfeeding confers protection. Nitrates — N-nitroso compounds (damaging to β-cells). Found in smoked and cured meats.
- in pre-diabetic children with autoantibodies.
Vitamin D deficiency — low levels are often seen
- Omega-3 deficiency — promoting inflammation.
Supplementation suppresses inflammatory cytokines.
Glucose monitoring:
In clinical practice, clients / families can experience increased stress in relation to managing the disease and glycaemic control.
- T1DM requires regular accurate glucose monitoring to avoid hypo- and hyperglycaemic episodes. Education is paramount.
- Continuous glucose monitoring devices have made it easier to understand and manage glucose levels. For example:
– Dexcom®: A slim sensor continuously monitors glucose, alarm alerts and app to view readings, graphs and trends.
– Freestylelibre ®: Small sensor on skin, scanning device to get current glucose reading, tracking reports and app.
Glucose monitoring:
In clinical practice, clients / families can experience increased stress in relation to managing the disease and glycaemic control.
- T1DM requires regular accurate glucose monitoring to avoid hypo- and hyperglycaemic episodes. Education is paramount.
- Continuous glucose monitoring devices have made it easier to understand and manage glucose levels. For example:
– Dexcom®: A slim sensor continuously monitors glucose, alarm alerts and app to view readings, graphs and trends.
– Freestylelibre ®: Small sensor on skin, scanning device to get current glucose reading, tracking reports and app.
Naturopathic approach:
- 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.
Naturopathic approach:
- 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.
Early intervention (‘honeymoon period’)
- 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.
Alphalipoic acid
- 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.
EPA and DHA
- 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.
Vitamin D
- Improves survival of islet cells and insulin production.
- Immunoregulatory (Th1 / Th2 balance).
- Dosage: 800 IU (children), 2000 IU (adults), ↑ if deficient.
Vitamin C
- 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).
