Type 1 Diabetes Mellitus

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease characterized by the destruction of pancreatic beta cells, resulting in absolute insulin deficiency.

Pathophysiology

The pathophysiology of T1DM involves an abnormal immune response, where the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This leads to a lack of insulin production, making it difficult for glucose to enter cells, resulting in hyperglycemia.

Clinical Presentation

The clinical presentation of T1DM typically includes:

• Polyuria (frequent urination)
• Polydipsia (excessive thirst)
• Polyphagia (increased hunger)
• Weight loss
• Blurred vision
• Fatigue
• Slow healing of cuts and wounds

Diagnosis

The diagnosis of T1DM is based on:

• Elevated blood glucose levels (hyperglycemia)
• Presence of ketones in the urine or blood (ketonuria or ketosis)
• Autoantibodies against pancreatic islet cells, insulin, or glutamic acid decarboxylase (GAD)
• Low or undetectable levels of C-peptide, a marker of insulin production

Treatment and Management

The treatment and management of T1DM involve:

• Insulin replacement therapy, which can be administered through injections or an insulin pump
• Carbohydrate counting and meal planning to manage blood glucose levels
• Regular monitoring of blood glucose levels using a glucometer
• Adjustment of insulin doses based on blood glucose levels, food intake, and physical activity
• Annual comprehensive eye exams to screen for diabetic retinopathy
• Regular foot care to prevent complications such as ulcers and amputations

Complications

If left unmanaged or poorly managed, T1DM can lead to several complications, including:

• Diabetic ketoacidosis (DKA), a life-threatening condition characterized by high blood glucose levels and ketone production
• Hypoglycemia (low blood sugar), which can be severe and even life-threatening if not promptly treated
• Microvascular complications, such as diabetic retinopathy, nephropathy, and neuropathy
• Macrovascular complications, such as cardiovascular disease, stroke, and peripheral artery disease

Epidemiology

T1DM is a relatively rare condition, affecting approximately 9 million people worldwide. It can occur at any age, but it is most commonly diagnosed in children and adolescents.