Diabetes mellitus type 1
From Open Encyclopedia
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| ICD-10 | E10 |
| ICD-O: | {{{ICDO}}} |
| ICD-9 | 250.x1, 250.x3 |
| OMIM | }}} |
| MedlinePlus | }}} |
| eMedicine | }}} |
| DiseasesDB | }}} |
See diabetes mellitus for further general information on diabetes.
Contents |
Pathophysiology
Type 1 diabetes (formerly known as "childhood" or "juvenile" diabetes or "insulin dependent" diabetes) is most commonly diagnosed in children and adolescents, but can occur in adults as well. It is an autoimmune disorder, in which the body's own immune system attacks the beta cells in the Islets of Langerhans of the pancreas, destroying them or damaging them sufficiently to reduce insulin production. The autoimmune attack may be triggered by reaction to an infection, for example by one of the viruses of the Coxsackie virus family. Some researchers believe that the autoimmune response is caused by antibodies for cow's milk proteins, that make their way intact into the bloodstream. A subtype of type 1 (identifiable by the presence of antibodies against beta cells) develops slowly and so is often confused with Type 2. In addition, a small proportion of type 1 cases has the hereditary condition maturity onset diabetes of the young (MODY).
Vitamin D in doses of 2000 IU per day given during the first year of child's life have been shown to reduce risk of getting type I diabetes later in life by 80% [1].
Vitamin D3 may be an important pathogenic factor in type 1 diabetes independent of geographical latitude [2].
Some poisons (e.g. certain rat poisons) work by selectively destroying certain types of cells, including pancreatic beta cells, thus producing "artificial" type 1 diabetes. Other pancreatic problems including trauma, pancreatitis or tumors (either malignant or benign) can also lead to loss of insulin production.
Treatment
Currently, type 1 is treated with insulin injections, lifestyle adjustments, and careful monitoring of blood glucose levels using blood test kits. Insulin delivery is also available by an insulin pump, which allows the infusion of insulin 24 hours a day at preset levels, and the ability to program push doses (bolus) of insulin as needed at meal times. The treatment must be continued indefinitely. Experimental replacement of beta cells (by transplant) is being investigated in several research programs and may become clinically available in the future. For more on managing the disease, see Diabetes Management.
About 5-10% of all North American cases of diabetes are Type 1 diabetics. The fraction of type 1 diabetics in other parts of the world differs; this is likely due to both differences in the rate of type 1 and differences in the rate of other types, most prominently type 2. Most of this difference is not currently understood.
Curing Type 1 Diabetes
Although type 1 diabetes is not currently curable, there are several approaches being researched:
- Pancreas transplantation
- Pancreas transplants are not generally recommended because introducing a new, functioning pancreas to a diabetic patient can have negative effects on the patient's normally functioning kidney. For patients with kidney failure, however, a pancreas transplant is a viable option.
- Islet cell transplantation
- Less invasive than a pancreas transplant, Islet cell transplantation is considered a very promising approach to curing type 1 diabetes. In this procedure, Islet cells are injected into the patient's liver, where the cells take residence and begin to produce insulin. The liver is chosen because it is more accessible than the pancreas and the Islet cells seem to produce insulin well in that environment. The patient's body, however, will treat the new cells just as it would any other introduction of foreign tissue: the immune system will attack the cells as it would a viral infection. Thus, the patient also needs to undergo treatment involving immunosupressants, which limit the activity of one's immune system. Recent studies have shown that Islet cell transplants have progressed to the point that 58% of the patients in one study were insulin independent one year after the operation.[{{fullurl:}}#endnote_mayo]
- Artificial pancreas development
- Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with type 1 diabetes)
Notes
- ^ Mayo Clinic: "Islet cell transplant: Emerging treatment for type 1 diabetes," 2005.
