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Towards A Better Understanding Of Type 1 Diabetes

Towards A Better Understanding Of Type 1 Diabetes

According to the NCD Risk Factor Collaboration, an estimated 422 million people worldwide were living with diabetes in 2014—four fold more than 35 years ago. Type 2 diabetes represents the majority of the epidemic (85–95%), and as a consequence type 1 diabetes has too often been overlooked. Today's Lancet features a clinical Series on type 1 diabetes—an autoimmune disease in which insulin-producing β cells of the pancreas are destroyed. The precise aetiology and pathogenesis of type 1 diabetes remain a subject for research. The two Series papers discuss in depth recent developments in genetic risk factors and environmental risk factors, respectively. In the first paper, Flemming Pociot and Åke Lernmark review the advances from research in children followed up from birth, and genetic studies, which have reframed understanding from a classic association with genetic factors to genetic determinants that can trigger β-cell autoimmunity and contribute to subsequent progression to clinical onset. Beyond the HLA region, which can contribute up to 50% of the risk, more than 50 susceptibility loci that might affect the likelihood of developing type 1 diabetes have now been identified. The disease is complex. It is also heterogeneous. Such heterogeneity might be explained by a combination of an individual's genetics and exposure to various environmental factors at different life stages. A wide range of environmental risk factors that have been suggested to trigger islet autoimmunity in genetically predisposed people and promote progression to type 1 diabetes is reviewed in the second paper by Marian Rewers and Johnny Ludvigsson. Although there is no dearth of factors that could be involved, good evidence is scarce. The factors with the strongest evidence include enterovi Continue reading >>

What Is Type 1 Diabetes?

What Is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar that most foods are broken down into by our digestive system. Without insulin, the body starves to death. It's important to note that everyone is insulin-dependent. People without diabetes make insulin in their pancreas. People with Type 1 diabetes must inject insulin. According to the National Institutes of Health, an estimated 850,000 to 1.7 million Americans have Type 1 diabetes. Of those, about 125,000 are kids 19 and under. An additional 30,000 Americans develop Type 1 diabetes every year, 13,000 of whom are children. Type 2 diabetes is much more prevalent, with an estimated 16 million Americans having Type 2. Millions of people with type 2 diabetes have not yet been diagnosed. Diabetes Develops Gradually The process of developing diabetes is gradual. Studies performed by the Joslin Clinic1 have shown changes as much as nine years before the actual presentation of diabetes symptoms. The development of Type 1 diabetes can be broken down into five stages: Genetic predisposition Environmental trigger Active autoimmunity Progressive beta-cell destruction Presentation of the symptoms of Type 1 diabetes People with Type 1 diabetes have a genetic pre-disposition to the disease, but one or more environmental insults is required to trigger disease. This fact can be derived from studies of identical twins with Type 1 diabetes. When one twin has Type 1 diabetes, the other twin gets diabetes only half the time. If the cause of Type 1 diabetes were purely genetic, both identical twins would always have Type 1 diabetes. One environmental trigger is thought to be the Coxsackie B virus. Researchers at UCL Continue reading >>

Type 1 Diabetes: What Are The Symptoms?

Type 1 Diabetes: What Are The Symptoms?

What Is Type 1 Diabetes (Juvenile)? Type 1 diabetes is a chronic condition that usually starts in childhood, but can occur in adults (30 to 40-year-olds). In type 1 diabetes, the pancreas produces very little insulin. Insulin helps cells in the body convert sugar into energy. When the pancreas cannot make enough insulin, sugar starts to build up in the blood, causing life-threatening complications. Individuals with type 1 diabetes must take some form of insulin for the rest of their lives. Unusual Thirst Symptoms Unusual thirst is a very common symptom of type 1 diabetes. This condition causes the kidneys to remove excess sugar in the blood by getting rid of more water. The water is removed through urinating, causing dehydration and dehydration causes you to drink more water. Weight Loss Symptoms Patient with type 1 diabetes develop unintentional weight loss and an increase in appetite because blood sugar levels remain high and the body metabolizes fat for energy. Disrupted glucose metabolism also causes patient to feel a lack of energy and drowsy for extended periods Excess urination also cause weight loss because many calories are leaving the body in urine. Skin Problems Symptoms The disruption in glucose metabolism in patient with type 1 diabetes causes skin changes. Type 1 diabetics are at a higher risk for bacterial infections and fungal infections. Poor blood circulation in the skin may also occur. Patient with type 1 diabetes are often infected with fungal infections caused by the yeast Candida albicans. Common fungal infections include athlete's foot, vaginal yeast infection in women, jock itch, ringworm, and diaper rashes in babies. Diaper rash caused by the yeast Candida albicans can spread to other areas of the body such as the stomach and legs. Other Dangero Continue reading >>

Magnetic Resonance Imaging: A Reliable Method For Measuring Pancreatic Volume In Type 1 Diabetes.

Magnetic Resonance Imaging: A Reliable Method For Measuring Pancreatic Volume In Type 1 Diabetes.

Abstract AIM: To validate magnetic resonance imaging (MRI) for monitoring pancreatic atrophy in Type 1 diabetes. METHODS: Twelve male patients with Type 1 diabetes of duration >or= 10 years (median age 28, range 19-32 years) and 12 healthy controls (median age 30, range 22-36 years) were invited for two abdominal MRI scans, 14 days apart. Four sequences were used: standard T1-weighted; standard T2-weighted; volumetric interpolated breath-hold examination (VIBE); and T1-weighted breath hold with fat suppression (T1BHFS). The pancreas was identified on coded images by one observer and volumes estimated by interpolation. RESULTS: Eleven patients and all controls were scanned twice. Visualization of the pancreas was best with VIBE and T1BHFS, allowing volume estimation from 47 and 46 scans, respectively. The pancreatic volume of patients estimated from these sequences were half those of controls (52.4 ml, +/- 17.1 ml, mean +/- sd) vs. (101 ml, +/- 19.5 ml, P < 0.001) and estimates showed little bias between visits; mean difference 1.1 ml (95% CI; -3.1 to 5.3 ml, P = 0.61) using VIBE and -2.6 ml (-5.8 to 0.6 ml, P = 0.03) using T1BHFS. Both sequences gave similar precision; the standard deviation of the differences in volume estimates between visits was 9.7 ml for VIBE and 7.3 ml for T1BHFS, although mean volumes estimated from T1BHFS were 4.9 ml lower (-8.2 to -1.7 ml, P = 0.005). CONCLUSIONS: Pancreatic volume can be measured reliably using MRI and shows a 48% reduction in long-standing Type 1 diabetes as compared with age-matched normal subjects. MRI should prove useful in determining the natural history of pancreatic atrophy in diabetes. Continue reading >>

Diabetes

Diabetes

Click on the English or Spanish version of the topics listed below to view or download the diabetes-care programs you want in either color or black & white. Note: The programs on this page are not for use by organizations or health care professionals. Click here for more information. About Diabetes Click on program title to see cover image. Type 1 Diabetes Click on program title to see cover image. Healthy Eating Click on program title to see cover image. Saving Money Click on program title to see cover image. Blood Sugar Click on program title to see cover image. Be Active! Click on program title to see cover image. Caring for Diabetes Click on program title to see cover image. Medicine Click on program title to see cover image. Preventing Problems Click on program title to see cover image. Stressbusters This program by cartoonist Steve Yurko is designed to help you relax. Steve’s cartoons offer a funny and sometimes off-beat look at some of the many things you can do to cope with the stress of living with diabetes. REMINDER: The diabetes-care programs on this page are not for use by health care professionals or organizations. Continue reading >>

Imaging Inflammation Of The Pancreatic Islets In Type 1 Diabetes

Imaging Inflammation Of The Pancreatic Islets In Type 1 Diabetes

Abstract Type 1 diabetes is the clinical manifestation of aberrant leukocytic infiltration of the pancreatic islets; it is usually diagnosed only very late in disease progression, after the critical autoimmune phenomena have mostly played out. A noninvasive means of directly monitoring the evolution of islet infiltrates would have important research and clinical applications. We have exploited fluorescence and MRI of long-circulating magnetofluorescent nanoparticles to visualize micro-vascular leakage, as an indicator of inflammation, in pancreata of mouse models of type 1 diabetes ex vivo or in vivo. We could detect the onset and evolution of insulitis in vivo and in real time, permitting us to study the natural history of diabetes in individual animals. Type 1 diabetes (T1D) results from T lymphocyte attack on the insulin-producing β cells of the islets of Langerhans of the pancreas. Disease unfolds through the following two main stages: the occult phase, termed insulitis, when a mixed population of leukocytes invades the islets, promoting β cell death; and the overt phase, diabetes, when the bulk of β cells have been destroyed and the pancreas can no longer produce sufficient insulin to control blood glucose levels. A major hindrance to the study of T1D is that its overt manifestation signifies that most of the islet β cells have already been destroyed and that the preceding (autoimmune) processes have already played out. Experimentally, in animal models, this late diagnosis engenders difficulties in charting the early events and unraveling their underlying mechanisms, especially given that individual animals exhibit significant scatter in disease parameters and variability in disease course. Clinically, diagnosis at such a late stage creates problems for providi Continue reading >>

A Visual Guide To Type 1 Diabetes

A Visual Guide To Type 1 Diabetes

What Is It? When you have type 1 diabetes, your pancreas can’t make insulin. This vital hormone helps your body's cells convert sugar into energy. Without it, sugar builds up in your blood and can reach dangerous levels. To avoid life-threatening complications, people with type 1 diabetes must take insulin for their entire lives. The symptoms of type 1 diabetes tend to come on suddenly and may include: Feeling more thirsty than usual Dry mouth Fruity breath Peeing a lot As blood sugar levels remain high, type 1 diabetes often leads to: Weight loss Bigger appetite Lack of energy, drowsiness Many people with type 1 diabetes get uncomfortable skin conditions, including: Bacterial infections Fungal infections Itching, dry skin, poor circulation Girls with type 1 diabetes are more likely to have genital yeast infections. Babies can get candidiasis, a severe form of diaper rash caused by yeast. It can easily spread from the diaper area to the thighs and stomach. When blood sugar isn't controlled, type 1 diabetes can cause more serious symptoms, like: Numbness or tingling in the feet Blurred vision Low blood sugar (called hypoglycemia) Passing out If your blood sugar gets too high or too low, you could go into a diabetic coma. You may not have any warning signs before this happens. You will need to get emergency treatment. Without treatment, type 1 diabetes deprives your cells of the sugar they need for energy. Your body starts burning fat instead, which causes ketones to build up in the blood. These are acids that can poison your body. This plus other changes in your blood can trigger a life-threatening condition called diabetic ketoacidosis. This is an emergency that must be treated quickly. You may need to go to the ER. In type 1 diabetes, your immune system destroys cell Continue reading >>

Your Type 1 Diabetes Care Plan

Your Type 1 Diabetes Care Plan

Be Proactive Juggling food, exercise, insulin, and testing can seem like a circus act. But it doesn't have to be that way. A written care plan can help you keep all the balls in the air. With your diabetes care team, craft one that accounts for your changing needs. Together, you can keep blood sugar in its "sweet" spot. You have to take insulin to get glucose out of your blood and into your cells for energy. Some types work slowly and last most of the day. Others work fast but don't last long. You may need several types of insulin to control your blood sugar around the clock -- and avoid problems like kidney, nerve, and eye damage. You can inject yourself with insulin in a syringe or an injection pen. You'll probably need shots several times a day. Or you can use a pump. It sits in your pocket or on a belt. The pump is connected to your body with a tube and a needle under the skin. It releases insulin slowly and continuously. You can also program the pump to deliver more insulin when you need it. Glucose testing tells you if your blood sugar is on target. You'll probably need to check it four to eight times a day. Usually, you do it before meals, at bedtime, and before and after exercise. Your plan should tell you what to do if your sugar isn't where it needs to be: A little high, drink water or take a brisk walk; too low, drink a half-cup of fruit juice. Visit your medical team at least four times a year. You might go more often when you have trouble controlling your blood sugar or if you have other problems. Sometimes, you'll get blood tests. For example, the A1c tracks your "average" blood sugar over the past few months. Your doctor may change your treatment (and your plan), based on the results. You may also need to see specialists. Generally, your diet should favor Continue reading >>

Pancreatic Inflammation Captured By Imaging Technology At The Onset Of Fulminant Type 1 Diabetes

Pancreatic Inflammation Captured By Imaging Technology At The Onset Of Fulminant Type 1 Diabetes

Type 1 diabetes mellitus is classified as autoimmune (type 1A) or idiopathic (type 1B) (1). Fulminant type 1 diabetes is classified as type 1B, characterized by acute onset of diabetic ketoacidosis soon after the development of typical diabetes symptoms, near-normal HbA1c level at onset, negative serum GAD antibody, and markedly acute progression of insulin deficiency (2). Infiltration of macrophage and T cells into the islets of Langerhans and complete destruction of pancreatic β-cells are characteristic. In this report, we detected pancreatic inflammation in a patient with fulminant type 1 diabetes by both dynamic computed tomography (CT) and MRI, which have been focused on as noninvasive imaging technologies for the pancreas (3). A 36-year-old Japanese male was referred to our hospital because of diabetic ketoacidosis. He suffered from left abdominal pain, sore throat, and high fever (over 38°C) for 10 days. Polydipsia, polyuria, and nausea developed 2 days before admission. On admission, he was markedly dehydrated and hyperglycemic (49.7 mmol/L) with severe ketosis (urinary ketone 3+). Arterial pH was 7.127 and bicarbonate was 6.1 mmol/L, suggesting marked metabolic acidosis. He was diagnosed as having diabetic ketoacidosis and was treated by intravenous infusion of saline and insulin. On admission, HbA1c was 5.7%. Serum immunoreactive insulin (<0.5 μU/mL) and serum (0.05 ng/mL) and urinary C-peptide response (<0.8 μg/day) were markedly decreased, indicating severe impairment of insulin secretory capacity. GAD antibody was negative. Serum lipase, elastase 1, and amylase levels were increased: 177 IU/L (normal range 11–53 IU/L), 1,900 ng/dL (normal range 100–400 ng/dL), and 167 IU/L (normal range 33–120 IU/L), respectively. The patient’s HLA genotype was Continue reading >>

A Deeper Look Into Type 1 Diabetes – Imaging Immune Responses During Onset Of Disease

A Deeper Look Into Type 1 Diabetes – Imaging Immune Responses During Onset Of Disease

1Type 1 Diabetes Center, La Jolla Institute for Allergy and Immunology, La Jolla, CA, USA 2Novo Nordisk Diabetes Research and Development Center, Seattle, WA, USA Cytotoxic T lymphocytes execute the killing of insulin-producing beta cells during onset of type 1 diabetes mellitus (T1D). The research community has come far in dissecting the major events in the development of this disease, but still the trigger and high-resolved information of the immunological events leading up to beta cell loss are missing. During the past decades, intravital imaging of immune responses has led to significant scientific breakthroughs in diverse models of disease, including T1D. Dynamic imaging of immune cells at the pancreatic islets during T1D onset has been made possible through the development of both advanced microscopes, and animal models that allow long-term immobilization of the pancreas. The use of these modalities has revealed a milling microenvironment at the pancreatic islets during disease onset with a plethora of active players. Clues to answering the remaining questions in this disease may lie in intravital imaging, including how key immune cells traffic to and from the pancreas, and how cells interact at this target tissue. This review highlights and discusses recent studies, models, and techniques focused to understand the immune responses during T1D onset through intravital imaging. Continue reading >>

Diabetes Related Images

Diabetes Related Images

All images may be downloaded and used, provided credit is given to WHO and photographers as mentioned in individual photos. WHO/Atul Loke jpg, 9.08Mb Global burden Over the past four decades, diabetes prevalence has risen faster in low- and middle-income countries. In this image, a nurse from Thane Civil Hospital in India checks the level of sugar in the blood of diabetic patients. WHO/Eduardo Martino jpg, 9.27Mb Complications of diabetes Diabetes complications include vision loss as well as stroke, heart attack, kidney failure and limb amputation. Roseane from Brazil has type 1 diabetes. In this image, she has her regular eye examination to prevent complications from her disease. WHO/Quinn Mattingly jpg, 16.75Mb Preventing diabetes To prevent type 2 diabetes, it is recommended that people eat healthily, be physically active and avoid excessive weight gain. WHO/Quinn Mattingly jpg, 3.29Mb Access to essential medicines for diabetes Insulin and oral hypoglycaemic agents are reported as generally available in only a minority of low- and middle-income countries. This image shows medicines in a cabinet at the National Hospital of Endocrinology in Hanoi, Viet Nam. WHO/Fredrik Naumann jpg, 3.38Mb National capacity for prevention and control of diabetes Most countries report having national policies on both diabetes and on related factors such as diet and physical activity. They also have national guidelines or protocols to improve the management of diabetes. In this image from Norway, Mikael, a teenager with type 1 diabetes, meets his doctor to discuss adjustments to his insulin intake. Together they talk about his blood sugar levels and other factors that influence type 1 diabetes. Continue reading >>

Noninvasive Imaging Of Pancreatic Islet Inflammation In Type 1a Diabetes Patients

Noninvasive Imaging Of Pancreatic Islet Inflammation In Type 1a Diabetes Patients

The MNP ferumoxtran-10 has a dextran coating and size characteristics similar to those of the MNPs used in the earlier animal experiments. It is readily taken up by macrophages, while not provoking activation or inducing proinflammatory cytokines or superoxide anions, is not chemotactic, and does not interfere with Fc-receptor–mediated phagocytosis (8). It has been used in the noninvasive detection of clinically occult cancer metastatic to lymph nodes (9). Two “training sets” were used to develop a protocol capable of differentiating individuals recently diagnosed with diabetes from controls, varying parameters such as MRI sequence and timing of MNP infusion; these are detailed in Supplemental Table 1 (supplemental material available online with this article; doi: 10.1172/JCI44339DS1). This protocol was then applied to a “validation set,” consisting of an additional 10 T1D patients within 6 months of diagnosis and 12 nondiabetic controls. The T1D and control groups were similar in age, sex, weight, BMI, and body-surface area (Table 1). As expected, there were significant differences in metabolic and immunologic parameters (notably HbA1c, P < 0.0005, and autoAb titers, P < 0.00005); in addition, diabetes-promoting HLA alleles were more highly represented in the patients, while diabetes-protective alleles were enriched in the controls (Supplemental Table 2). All participants underwent, at a minimum, 3 MRI scans: a pre-MNP series, which yields baseline signal values; an immediate post-MNP series, an indicator of vascular volume and useful for pancreas volume estimates; and a delayed post-MNP series, which likely reflects leakage of MNPs and retention by phagocytic cells. Table 1 Characteristics of study participants in the validation group While our primary focus Continue reading >>

How To Manage Type 1 Diabetes

How To Manage Type 1 Diabetes

Expert Reviewed Juvenile diabetes, now known as Type 1 diabetes or insulin dependent diabetes mellitus (IDDM), is a disease in which the pancreas, which normally produces insulin, stops producing insulin. Insulin is important because it's a hormone that regulates the amount of sugar (glucose) in the blood and helps to transfer the glucose to your cells for energy. If your body isn't producing insulin, this means that the glucose stays in your blood and your blood sugar level can become too high. Though there is no cure for Type 1 diabetes, you can learn to effectively manage your diabetes through a combination of insulin therapy, lifestyle changes and basic education about diabetes. Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Type 1 diabetes (insulin dependent diabetes, juvenile) is a condition in which the body stops making insulin. This causes the person's blood sugar to increase. There are two types of diabetes, type 1 and type 2. In type 1 diabetes, the pancreas is attacked by the immune system and then it cannot produce insulin. In type 2 diabetes the pancreas can produce insulin, but the body can't use it. Causes of type 1 diabetes are auto-immune destruction of the pancreatic beta cells. This can be caused by viruses and infections as well as other risk factors. In many cases, the cause is not known. Scientists are looking for cures for type 1 diabetes such as replacing the pancreas or some of its cells. Risk factors for type 1 diabetes are family history, introducing certain foods too soon (fruit) or too late (oats/rice) to babies, and exposure to toxins. Symptoms of type 1 diabetes are skin infections, bladder or vaginal infections, and Sometimes, there are no significant symptoms. Type 1 diabetes is diagnosed by blood tests. The level of blood sugar is measured, and then levels of insulin and antibodies can be measured to confirm type 1 vs. type 2 diabetes. Type 1 diabetes is treated with insulin and lifestyle changes. Specifically, meal planning to ensure carbohydrate intake matches insulin dosing. Complications of type 1 diabetes are kidney disease, eye problems, heart disease, and nerve problems (diabetic neuropathy) such as loss of feeling in the feet. Poor wound healing can also be a complication of type 1 diabetes. Type 1 diabetes cannot be prevented, however, keeping blood sugar at healthy levels may delay or prevent symptoms or complications. There is currently no cure, and most cases of type 1 diabetes have no known cause. The prognosis or life-expectancy for a person with Continue reading >>

Imaging Of Β-cell Mass And Insulitis In Insulin-dependent (type 1) Diabetes Mellitus

Imaging Of Β-cell Mass And Insulitis In Insulin-dependent (type 1) Diabetes Mellitus

Insulin-dependent (type 1) diabetes mellitus is a metabolic disease with a complex multifactorial etiology and a poorly understood pathogenesis. Genetic and environmental factors cause an autoimmune reaction against pancreatic β-cells, called insulitis, confirmed in pancreatic samples obtained at autopsy. The possibility to noninvasively quantify β-cell mass in vivo would provide important biological insights and facilitate aspects of diagnosis and therapy, including follow-up of islet cell transplantation. Moreover, the availability of a noninvasive tool to quantify the extent and severity of pancreatic insulitis could be useful for understanding the natural history of human insulin-dependent (type 1) diabetes mellitus, to early diagnose children at risk to develop overt diabetes, and to select patients to be treated with immunotherapies aimed at blocking the insulitis and monitoring the efficacy of these therapies. In this review, we outline the imaging techniques currently available for in vivo, noninvasive detection of β-cell mass and insulitis. These imaging techniques include magnetic resonance imaging, ultrasound, computed tomography, bioluminescence and fluorescence imaging, and the nuclear medicine techniques positron emission tomography and single-photon emission computed tomography. Several approaches and radiopharmaceuticals for imaging β-cells and lymphocytic insulitis are reviewed in detail. Radioiodine (131I) therapy of benign thyroid diseases was introduced 70 yr ago, and the patients treated since then are probably numbered in the millions. Fifty to 90% of hyperthyroid patients are cured within 1 yr after 131I therapy. With longer follow-up, permanent hypothyroidism seems inevitable in Graves' disease, whereas this risk is much lower when treating t Continue reading >>

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