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Medical Management Of Type 1 Diabetes

Diabetes: Type 1 Diabetes

Diabetes: Type 1 Diabetes

Introduction Type 1 diabetes occurs when the body's own immune system destroys the insulin-producing cells of the pancreas (called beta cells). Normally, the body's immune system fights off foreign invaders like viruses or bacteria. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body. This results in a complete deficiency of the insulin hormone. Some people develop a type of diabetes - called secondary diabetes -- which is similar to type 1 diabetes, but the beta cells are not destroyed by the immune system but by some other factor, such as cystic fibrosis or pancreatic surgery. Understanding Insulin Normally, the hormone insulin is always secreted by the pancreas in low amounts. When you eat a meal, food stimulates an increase in the amounts of insulin released from the pancreas. The amount that is released is proportional to the amount that is required by the size of that particular meal. So what does insulin do? Insulin's main role in the body is to help move certain nutrients -- especially a sugar called glucose -- into the cells of the body's tissues. Cells use sugars and other nutrients from meals as a source of energy to run a variety of important processes for the body. When glucose is moved into cells, the amount of sugar in the blood decreases. Normally that signals the beta cells in the pancreas to stop secreting insulin so that you don't develop low blood sugar levels (hypoglycemia). But the destruction of the beta cells that occurs with type 1 diabetes throws the entire process into disarray. In people with type 1 diabetes, glucose isn't moved into the cells because insulin is not available. When glucose builds up in the blood instead of going into cells, the body's cells starve for nutrients and othe Continue reading >>

Pharmacologic Management In Pediatric Type 1 Diabetes Mellitus

Pharmacologic Management In Pediatric Type 1 Diabetes Mellitus

Pharmacologic Management in Pediatric Type 1 Diabetes Mellitus Ernest Mario School of Pharmacy at Rutgers, the State University of New Jersey, Piscataway, New Jersey Clinical Neonatal/Pediatric Pharmacotherapy Specialist K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, Vice Chair, Didactic Education, Department of Pharmacy University of the Sciences in Philadelphia The American Diabetes Association (ADA) defines diabetes mellitus as a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term damage, dysfunction, and failure of various organs, especially the eyes, kidneys, nerves, heart, and blood vessels.1 The ADA estimates that 20.8 million children and adults are diagnosed with diabetes mellitus, 176,500 of whom are younger than age 20.2 Previously known as juvenile diabetes and insulin-dependent diabetes, type 1 diabetes mellitus (T1DM) is the most common chronic disease of childhood and is often diagnosed in children presenting with symptomatic hyperglycemia.3 Although most attention is focused on type 2 diabetes mellitus (T2DM), the incidence of T1DM is rising worldwide.4 Type 2 diabetes mellitus results from insulin resistance combined with relative insulin deficiency, while T1DM is primarily the result of insulin deficiency. Therefore, the focus of pharmacologic treatment in T1DM is exogenous insulin replacement. Pathophysiology and Clinical Manifestations Pancreatic beta cells are responsible for the production of insulin, which regulates the amount of glucose in the body. Insulin regulates glucose metabolism by peripherally stimulating its uptake and inhibiting its production in the liver. During t Continue reading >>

Managing Type 1

Managing Type 1

In type 1 diabetes, the pancreas produces little or no insulin which is vital for converting glucose into energy. People with type 1 diabetes need to do the job of the pancreas and replace the insulin via insulin injections or an insulin pump. The insulin acts to reduce the level of glucose in the blood. Type 1 diabetes is a life threatening condition which needs to be closely managed with daily care. Type 1 diabetes is managed with: Insulin replacement through lifelong insulin injections (up to 6 every day) or use of an insulin pump Monitoring of blood glucose levels regularly (up to 6 times every day or as directed by a doctor or Credentialled Diabetes Educator) Following a healthy diet and eating plan Taking regular exercise The aim diabetes management is to keep blood glucose levels as close to the target range as possible, between 4 to 6 mmol/L (fasting). However, the ranges will vary depending on the individual and an individual’s circumstances. Talk to your doctor or Credentialled Diabetes Educator for the range of blood glucose levels that are right and safe for you. Keeping your blood glucose level at the optimum range is a careful balance between what food is eaten, physical activity and medication. Blood glucose levels which are too high, could result in hyperglycaemia or ketoacidosis. Blood glucose levels which are too low, could result in hypoglycaemia. It is important to learn about each reaction and respond appropriately. Ketoacidosis is an emergency and you must call emergency services immediately. Monitor blood glucose levels throughout the day and even at night. Keeping your blood glucose levels on target will help prevent both short-term and long-term complications. Your Credentialled Diabetes Educator will help you learn how to check your blood glu Continue reading >>

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Treatment Of Type 1 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards of Care, the ADA Professional Practice Committee did MEDLINE searches from 1 January 2016 to November 2016 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards of Care were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendation: This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes. The American Diabetes Association (ADA) first released its practice guidelines for health professionals in 1989. The Standards of Medical Care in Diabetes have since provided an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards of Care cover all aspects of patient care (1); this guideline synopsis focuses on monitoring and pharmacologic approaches for patients with type 1 diabetes. Guideline Development and Evidence Grading Monitoring Glycemia in Type 1 Diabetes Glycemic Goals: Recommendations Pharmacologic Therapy for Type 1 Diabetes: Recommendations Continue reading >>

Medical Management Of Type 1 Diabetes, Seventh Edition Cpe Course

Medical Management Of Type 1 Diabetes, Seventh Edition Cpe Course

Book by Cecilia C. Low Wang, MD, FACP and Avni C. Shah, MD Study Guide by Susan Burke March, MEd, RDN, LDN, CDE Book, 328 pgs and Study Guide with 1 Reporting Form, 30 pgs. This CPE program will enable you to create individualized, flexible treatment plans to optimize blood glucose control while accounting for diabetes complications, psychosocial factors, and the developmental state of each patient. Presents the latest guidelines for the comprehensive management of this disease and practical strategies to improve patient outcomes, including: The latest developments in insulin administration, pump therapy, and CGM Details about adjunctive therapies in type 1 diabetes Updated information on the management and prevention of complications Information on diabetes self-management education and support and psychosocial care Psychosocial factors affecting adherence, quality of life, and well-being. For more information and customer comments, click here. For RDs/RDNs & DTRs/NDTRs for the Professional Development Portfolio 3000, 3010, 3060, 3090, 4000, 4130, 5000, 5190, 5310, 5340, 5010, 5460, 6000, 6030, 6060 6.1.4, 6.3.6, 8.1.4, 8.1.5, 8.3.1, 8.3.1, 8.3.2, 8.3.3, 8.3.4, 8.3.6, 9.1.1, 9.1.2, 9.1.4, 9.1.5, 9.2.1, 9.2.2, 9.2.3, 9.2.4, 9.3.2, 9.3.4, 9.3.5, 9.4.2, 9.4.4, 9.4.5, 9.4.8, 10.1.2, 10.1.3, 10.2.2, 10.2.3, 10.2.4, 10.2.7, 10.2.9, 10.3.2, 12.4.6 DON'T SEE your Performance Indicators or Code Listed here? There are many Performance Indicators (PIs) that are applicable we can't list them all & Per CDR you may use ANY PI or CODE as long as it relates to your Learning Plan. Share with a friend and Save! Click here for important information about sharing. To order an ADDITIONAL Reporting Form click below: Book by Cecilia C. Low Wang, MD, FACP and Avni C. Shah, MD Study Guide by Continue reading >>

Type 1 Diabetes: Management Strategies

Type 1 Diabetes: Management Strategies

ANDREW SMITH, MD, and CHELSEA HARRIS, MD, Lawrence Family Medicine Residency Program, Lawrence, Massachusetts Am Fam Physician.2018Aug1;98(3):154-162. Patient information: See related handout on type 1 diabetes , written by the authors of this article. There is considerable benefit of tight glucose control in patients with type 1 diabetes mellitus. Tight blood glucose control dramatically decreases the incidence of microvascular and macrovascular complications. Although glycemic goals should be individualized, most nonpregnant adults should strive for an A1C level less than 7%. Greater frequency of glucose monitoring and continuous glucose monitoring are both associated with lower A1C levels. The choice to monitor glucose levels via multiple daily capillary blood samples or continuous glucose monitoring is based on cost and patient preference. Intensive insulin treatment is recommended with a combination of multiple mealtime bolus and basal injections or with continuous insulin infusion through an insulin pump. The option to administer insulin with multiple daily injections vs. a pump should be individualized. Adjunctive medical therapy is under investigation but is not currently recommended. All patients with type 1 diabetes should participate in diabetes self-management education and develop individualized premeal insulin bolus plans under the guidance of a dietitian, if possible. Blood pressure and lipid control are important to prevent cardiovascular disease events. Patients with type 1 diabetes should have sick-day plans and be able to identify warning signs of hypoglycemia and diabetic ketoacidosis. Advances in diabetes care, including the bionic pancreas and the closed-loop system of glucose monitoring with an automated insulin pump, may have a significant effec Continue reading >>

Management Of Type 1 Diabetes

Management Of Type 1 Diabetes

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. Type 1 diabetes describes a condition in which the pancreas is no longer able to produce sufficient insulin due to the destruction of the pancreatic beta cells by an autoimmune process. It is a condition which occurs predominantly in younger people, from childhood to young adults, and is increasing in the population, particularly in the under-5 age group. See the separate Diabetes Mellitus article. Type 1 diabetes accounts for over 90% of diabetes in young people aged under 25 years. 12-15% of young people aged under 15 years with diabetes have an affected first-degree relative. Children are three times more likely to develop diabetes if their father has diabetes than if their mother has diabetes.[1] Initial assessment The successful management of the person with diabetes depends on working in partnership with the person affected and all members of the team responsible for the various elements of their care. Before a management plan can be agreed, an initial assessment of the health and lifestyle of the patient must be undertaken with particular reference to:[1] History Diabetic history, both recent and historical. Symptoms of potential complications - eg, deterioration in eyesight. Other medical conditions. Drug history, current medications. Family history. Occupation and social history - eg, level of exercise, type of diet, smoking history, use of alcohol and recreational drugs. Prior knowledge of, attitudes to and concerns about the condition. Examination General examination. H Continue reading >>

Diagnosis And Management Of Type 1 Diabetes In Adults: Summary Of Updated Nice Guidance

Diagnosis And Management Of Type 1 Diabetes In Adults: Summary Of Updated Nice Guidance

Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance BMJ 2015; 351 doi: (Published 26 August 2015) Cite this as: BMJ 2015;351:h4188 Stephanie A Amiel, guideline development group chair, RD Lawrence professor of diabetic medicine1, Bernard Higgins, clinical director, consultant respiratory physician3, Dalia Dawoud, health economist, lecturer4 on behalf of the Guideline Development Group 1Division of Diabetes and Nutritional Sciences, Kings College London, London, UK 2National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK 3National Clinical Guideline Centre, Royal College of Physicians, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK 4National Clinical Guideline Centre, Royal College of Physicians, Faculty of Pharmacy, Cairo University, Cairo, Egypt Correspondence to: N Pursey nancy.pursey{at}rcplondon.ac.uk Offer all adults with type 1 diabetes a structured education programme in self management of diabetes six to 12 months after diagnosis or, if this was not achieved, at any time that is clinically appropriate and suitable for the person Support adults to aim for a target glycated haemoglobin 48 mmol/mol (6.5%) or lower, to minimise risk of vascular complications; ensure that aiming for the target is not accompanied by problematic hypoglycaemia, and support four to 10 daily self monitoring blood tests as routine Offer all adults daily basal-bolus insulin injection regimens, with twice daily insulin detemir as basal insulin therapy and rapid acting insulin analogues injected before meals for mealtime insulin boluses Assess awareness of hypoglycaemia at least annually using a scoring system How Continue reading >>

Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus

Treatment Approach In the short term, insulin is life-saving because it prevents diabetic ketoacidosis, a potentially life-threatening condition. The long-term goal of insulin treatment is the prevention of chronic complications by maintaining blood glucose levels as close to normal as possible. Generally, A1C (glycosylated hemoglobin) goals determine the aggressiveness of therapy, which is in turn individualized. The American Diabetes Association (ADA) recommends a target A1C goal of <7.5% for patients <18 years with type 1 diabetes and <7% for adult patients. [1] [31] Less stringent goals may be appropriate for very young children, older adults, people with a history of severe hypoglycemia, and those with limited life expectancies, advanced microvascular or macrovascular complications, or comorbid conditions. [1] Good glycemic control in type 1 diabetes requires attention to diet, exercise, and insulin therapy. All 3 components should be coordinated for ideal control. Self-monitoring of blood glucose (SMBG) is a core component of good glycemic control. Patients on multiple injections daily should consider SMBG before meals, occasionally after meals and at bedtime, and before exercising, to assess presence and adequate treatment of hypoglycemia, and before any task during which hypoglycemia could have particularly dangerous consequences. Some patients will need to check their blood glucose 6 to 10 times daily. [1] The most cost-effective or appropriate use of continuous glucose monitoring is likely to be when targeted at people with type 1 diabetes who have hypoglycemic unawareness, frequent hypoglycemia, or continued poor control during intensified insulin therapy, and those who frequently use continuous glucose monitoring. [1] [32] The limiting factor for tight glyce Continue reading >>

Type 1 Diabetes Treatments

Type 1 Diabetes Treatments

People with type 1 diabetes (T1D) can live long, happy lives with proper care and disease management. Advancements in medication types and delivery methods give people the freedom to choose which treatment options work best with their particular circumstance. T1D prognoses can be greatly improved with a combination of treatments and lifestyle choices. Type 1 diabetes is managed through use of a variety of insulins. People with T1D must work closely with their medical team to find the right insulin treatment for their condition. Further information about the types of insulin and their effects are available on our insulin page. Insulin can be delivered via syringes or pens, pumps or new artificial pancreas systems. Though the administration method, frequency and type of insulin dosage vary on a case-by-case basis, injections may be needed multiple times per day. Combined with insulin, diet and exercise, type 2 diabetes (T2D) drug metformin is sometimes prescribed to people with T1D to help treat their diabetes. Metformin helps control the bodys blood-sugar levels and how the liver processes sugar. Used in conjunction withinsulin, pramlintide is often prescribed after other medications prove not as effective as needed. It acts as a hormone to help the body better control blood sugar. Blood pressure drugs, cholesterol medications and aspirin: Medications for high blood pressure and high cholesterol as well as aspirin can be prescribed with insulin to help the overall health and treatment of diabetes. Since people with diabetes have an increased chance of cardiovascular disease, these drugs are used in combination with other diabetes medications. The benefits of T1D medications far outweigh their associated side effects. The most common side effects of insulin are injection Continue reading >>

Treating & Managing Type 1 Diabetes

Treating & Managing Type 1 Diabetes

Understanding type 1 diabetes is the first step to managing it. Get information on type 1 diabetes causes, risk factors, warning signs, and prevention tips. Type 1 diabetes requires lifelong treatment to keep blood sugar levels within a target range. For those with diabetes, an insulin shot delivers medicine into the tissue between your skin and muscle. Follow these steps when injecting insulin. If you have diabetes, a fear of needles or an impression that injections equate to failure can keep you from gaining the benefits of injectable medicines. Learn how overcoming the fear of injections can lower your risk for diabetes complications. It's important to eat a healthy diet when you have type 1 diabetes. Learn what to eat and why it matters. Diabetes doesn't have to limit your child. Learn how to help manage your child's disease, at and away from home. Well-controlled blood sugars help children with diabetes grow and develop normally. See guidelines for your child's blood sugar level. Continue reading >>

The Management Of Type 1 Diabetes

The Management Of Type 1 Diabetes

Go to: ABSTRACT Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive pancreatic beta-cell loss resulting in insulin deficiency and hyperglycemia. Exogenous insulin therapy is essential to prevent fatal complications from hyperglycemia. The Diabetes Control and Complications Trial and its long-term follow up, the Epidemiology of Diabetes and its Complications study, demonstrated that stringent glycemic control with intensive insulin therapy can prevent or postpone progression of microvascular disease and reduce risk for macrovascular disease and all-cause mortality. In addition, data obtained from the T1D Exchange, a registry of T1D patients founded in 2010, has become an invaluable resource for scientists worldwide, facilitating collaboration and accelerating understanding of prevailing diabetes practices. Insulin therapy using rapid- and long-acting insulin analogues is the mainstay of management of T1D. Insulin delivery is achieved subcutaneously using multiple daily injections or subcutaneous insulin infusion using insulin pumps. Effective management also involves use of self-monitoring of blood glucose using improved blood glucose meters, continuous glucose monitoring (CGM) devices, and newer insulin pumps with integrated sensor-augmented systems. Addressing psychosocial aspects of T1D plays a crucial role in effective disease management. Strategies to manage T1D are rapidly evolving. In addition to newer insulins, adjunctive non-insulin therapies such as use of incretin agents and SGLT-2 and combination SGLT-1/2 inhibitors are being actively pursued. CGM technology combined with glucose prediction algorithms has allowed for the development of artificial pancreas delivery systems which are actively being tested in clinical trials. Cellular rep Continue reading >>

A Complete List Of Diabetes Medications

A Complete List Of Diabetes Medications

Diabetes is a condition that leads to high levels of blood glucose (or sugar) in the body. This happens when your body can’t make or use insulin like it’s supposed to. Insulin is a substance that helps your body use the sugar from the food you eat. There are two different types of diabetes: type 1 diabetes and type 2 diabetes. People with both types of diabetes need medications to help keep their blood sugar levels normal. The types of drugs that can treat you depend on the type of diabetes you have. This article gives you information about drugs that treat both types of diabetes to help give you an idea of the treatment options available to you. Insulin Insulin is the most common type of medication used in type 1 diabetes treatment. It’s also used in type 2 diabetes treatment. It’s given by injection and comes in different types. The type of insulin you need depends on how severe your insulin depletion is. Options include: Short-acting insulin regular insulin (Humulin and Novolin) Rapid-acting insulins Intermediate-acting insulin Long-acting insulins Combination insulins NovoLog Mix 70/30 (insulin aspart protamine-insulin aspart) Humalog Mix 75/25 (insulin lispro protamine-insulin lispro) Humalog Mix 50/50 (insulin lispro protamine-insulin lispro) Humulin 70/30 (human insulin NPH-human insulin regular) Novolin 70/30 (human insulin NPH-human insulin regular) Ryzodeg (insulin degludec-insulin aspart) Amylinomimetic drug Pramlintide (SymlinPen 120, SymlinPen 60) is an amylinomimetic drug. It’s an injectable drug used before meals. It works by delaying the time your stomach takes to empty itself. It reduces glucagon secretion after meals. This lowers your blood sugar. It also reduces appetite through a central mechanism. Most medications for type 2 diabetes are o Continue reading >>

Type 1 Diabetes Mellitustreatment & Management

Type 1 Diabetes Mellitustreatment & Management

Type 1 Diabetes MellitusTreatment & Management Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Long-term management requires a multidisciplinary approach that includes physicians, nurses, dietitians, and selected specialists. In some patients, the onset of type 1 DM is marked by an episode of diabetic ketoacidosis (DKA) but is followed by a symptom-free honeymoon period in which the symptoms remit and the patient requires little or no insulin. This remission is caused by a partial return of endogenous insulin secretion, and it may last for several weeks or months (sometimes for as long as 1-2 years). Ultimately, however, the disease recurs, and patients require insulin therapy. Often, the patient with new-onset type 1 DM who presents with mild manifestations and who is judged to be compliant can begin insulin therapy as an outpatient. However, this approach requires close follow-up and the ability to provide immediate and thorough education about the use of insulin; the signs, symptoms, and treatment of hypoglycemia; and the need to self-monitor blood glucose levels. The American Diabetes Association (ADA) recommends using patient age as one consideration in the establishment of glycemic goals , with targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels. [ 5 ] In 2014, the ADA released a position statement on the diagnosis and management of type 1 diabetes in all age groups. The statement includes a new pediatric glycemic control target of HbA1c of less than 7.5% across all pediatric age groups, replacing e Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Print Diagnosis Diagnostic tests include: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as pregnancy or an uncommon form of hemoglobin (hemoglobin variant) — your doctor may use these tests: Random blood sugar test. A blood sample will be taken at a random time and may be confirmed by repeat testing. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. If you're diagnosed with diabetes, your doctor may also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help your doctor distinguish between type 1 and type 2 diabetes when the diagnosis is uncertain. The presence of ketones — byproducts from the breakdown of fat — in your urine also suggests type 1 diab Continue reading >>

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