Diabetes mellitus type 1

"It is necessary to get a good control of the glycaemia to prevent the medium-long term complications of the diabetic: neurological, renal damage, etc."

DR. JAVIER ESCALADA
DIRECTOR. ENDOCRINOLOGY AND NUTRITION DEPARTMENT

Diabetes is a chronic condition that occurs when the pancreas is unable to produce enough insulin or when the body fails to use the insulin it produces.

It is mainly characterized by the presence of high concentrations of glucose in the blood (hyperglycemia). This occurs due to the alteration in the action of insulin or in the absence of this hormone, which is produced in the pancreas to allow the capture of glucose by the tissues, which use it as fuel.

Within type 1 diabetes mellitus (DM) two fundamental types can be distinguished: DM type 1a, of autoimmune origin, and DM type 1b, of an idiopathic nature.

In autoimmune diabetes, the cells that produce insulin are attacked and destroyed: the pancreas' beta cells. Without insulin, the metabolism of carbohydrates, fats and proteins cannot be carried out correctly.

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What are the symptoms of type 1 diabetes?

The main symptoms before the diagnosis of type 1 diabetes mellitus are:

  • Fatigue.
  • Weight loss.
  • Intense thirst.
  • Continuous production of urine, even at night.

The uncontrolled elevation in blood of glucose and the so-called ketone bodies (which are produced in the liver by an excess of fats released into the bloodstream in situations of high insulin deficiency) is particularly serious, since, without treatment, it is potentially fatal when it reaches the extreme of so-called ketoacidotic coma.

Do you have any of these symptoms?

You may have type 1 diabetes mellitus

What are the causes of type 1 diabetes?

Type 1 diabetes mellitus is an autoimmune disease due to genetic and environmental factors.

Type 1 diabetes mellitus is an autoimmune disease, in which the cells that produce insulin are attacked and destroyed: the pancreatic beta cells. Without insulin, the metabolism of carbohydrates, fats and proteins cannot be carried out correctly.

This autoimmune attack is triggered by a combination of genetic and environmental factors. Among the environmental factors, viruses seem to be the most likely candidates.

So far, no specific causes (including vaccines and dietary elements) have been identified that could trigger this disease in people who must previously have a genetically conditioned susceptibility.

Hereditary factors appear to play a role, but the disease is almost never directly acquired through heredity.

Research and Diabetes

Cell therapy and immunotherapy, the main hope for treating diabetes.

In addition to pancreatic islet transplantation, which continues to show limitations and poor performance, the main hopes are placed on cell therapy and immunotherapy. To date, these techniques have been applied experimentally in animals.

Cell therapy aims at achieving an inexhaustible source of insulin-producing cells from stem cells (embryonic or adult) with the capacity of self-regeneration and differentiation into mature cells, in our case, into insulin-producing beta cells.

Immunotherapy seeks to stop the alteration of the immune system that destroys the insulin-producing cells themselves.

Treatment with adult mesenchymal stem cells are stem cells but with mainly immunomodulatory properties. They are relatively easy to obtain, usually from the patient's own bone marrow, without the need for immunosuppression. 

How is type 1 diabetes diagnosed?

<p>&nbsp;Imagen Laboratorio de Bioquimica</p>

The diagnosis is usually simple as it is determined by a clearly elevated blood glucose value (usually above 200 mg/dl).

The new methods of continuous glucose monitoring in the interstitial space are a major advance in the management of these patients. By means of a minimally invasive technique, such as inserting a sensor into the anterior wall of the abdomen, glucose values are obtained for approximately 72 h without interruption. This system makes it possible to evaluate glycemic fluctuations in order to improve metabolic control.

In the Diabetes Unit, we carry out pancreatic autoimmunity studies in order to confirm the differential diagnosis of type 1 diabetes mellitus with the remaining diabetic syndromes, with determination of ICA, IAA, GAD and IA2 antibodies.

The glucagon test is performed in order to study the residual function of the pancreatic cell (pancreatic reserve) in patients with diabetes mellitus.

How is type 1 diabetes treated?

From the moment of diagnosis, insulin treatment should be initiated.

Intensive treatment guidelines:

  • Multidose (basal-bolo regimens). By multiple injections (three or more injections a day). In general, an intermediate- or ultra-low acting insulin (which makes at the same time basal doses) is used in combination with rapid-acting insulin before meals.
  • Continuous Insulin Infusion Pump (CIIP) - Allows basal and bolus insulin to be administered before meals.

Self-control and continuous infusion pumps are the main advances over the type 1 fiabetes.

There have been great advances such as:

  • Production of human insulin through recombination techniques.
  • Premixed insulins (fast and slow insulin in various proportions).
  • New administration systems, such as insulin pens.
  • Continuous insulin infusion pumps by subcutaneous or intraperitoneal route. They schedule the administration of insulin administered 24 hours a day and in bolus form before each meal, simulating more precisely the physiological production of insulin by the pancreas.
  • Minimally invasive continuous glucose monitoring methods are available to establish the 24-hour blood glucose profile of a diabetic in studies longer than 24 hours.

But the great advance is self-monitoring, a comprehensive model of treatment that consists of the modification by the diabetic of his insulin treatment in an autonomous way, determining the value of his blood glucose at any time, in a quick and simple way, with glucometers. Diabetes education is received through the Diabetes Unit.

Where do we treat it?

IN NAVARRE AND MADRID

The Department of Endocrinology and Nutrition of the
of the Clínica Universidad de Navarra

The Department is organized into care units with specialists totally dedicated to the study, diagnosis and treatment of this type of disease.

We work with established protocols, which ensure that all diagnostic tests to be performed are done in the shortest time possible and that the most appropriate treatment is started as soon as possible in each case.

Organized in care units

  • Obesity Area.
  • Diabetes Unit.
  • Thyroid and Parathyroid Disease Unit.
  • Osteoporosis Unit
  • Other diseases: e.g. Cushing's syndrome.
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Why at the Clinica?

  • European Center of Excellence in the diagnosis and treatment of Obesity.
  • Team of specialized nurses at the Day Hospital of Endocrinology and Nutrition.
  • We have a Metabolic Research Laboratory of international prestige.

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