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Type 1 Diabetes; how does it happen, how do we manage it?
Saleh Adi, MDClinical ProfessorPediatric Endocrinology
September, 2013
School of Medicine
School of Medicine
Outline
• Normal physiology
• Types of diabetes
• Type 1 diabetes
• Autoimmunity
• Management: insulin and devices
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Normal physiology
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Normal physiology: Nutrition
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Sugar
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Glucose Metabolism
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Insulin
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(energy)
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Insulin
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(energy)
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Insulin
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An islet
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Diabetes
• Glucose cannot enter the cells
- No insulin = Type 1 Diabetes
- Insulin not working = Type 2 Diabetes
• Other types, less common
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Diabetes
• Glucose accumulates in the blood
• Spills over in the urine (when level is >180)(Normal is 70-110, up to 140)
- Takes water with it
- Increased urine and thirst
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Type 2 Diabetes
Insulin not working
• Overweight and lack of physical activity lead to insulin resistance
• We make more insulin to compensate
• Eventually, islet cells burn out, cannot make enough
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Type 2 Diabetes
Treatment
• Eliminate the cause:
Decrease weight, increase activity
• Drugs
Help make more insulinHelp insulin work betterLower blood sugar (in other ways)
• Insulin
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Type 1 Diabetes
No Insulin
• Trauma – Infection - Surgery
• Cystic Fibrosis
• Autoimmune (true T1D)
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Autoimmunity
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Gland
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The immune system (very simplified)
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Autoimmunity against Beta cells
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Autoimmunity
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Type 1 Diabetes
No Insulin
• Treatment: Take insulin!
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Type 1 Diabetes; Management
In normal physiology, glucose metabolism is exquisitely controlled;
– Blood Glucose (BG) has a tight range– BG levels are sensed continuously– Instantaneous response in the β-cells– Almost immediate and quick effect of insulin– Short lived effect
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Type 1 Diabetes; Management
We’re not even close
•We check BG every few hours•We deliver insulin every few hours•Insulin action is still too slow•Deliver insulin in subcutaneous space (it takes a while to reach the blood)
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Insulin1922
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Insulin
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Frederick Banting & Charles Best
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Insulin1990
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Type 1 Diabetes; Management
We need insulin all the time
• Long acting insulin, 1 or 2 doses/day• Short acting insulin, for every meal
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Type 1 Diabetes; Management
Insulin pump, continuous infusion of short acting insulin
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Type 1 Diabetes; Management
Daily tasks, before each meal
• Check BG• Count the carbohydrates in the meal• Calculate dose of insulin• Deliver insulin, by injection or insulin pump
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Insulin pumps
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Insulin pumps
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Insulin pumps
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Glucose sensors(Continuous Glucose Monitors)
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Glucose sensors(Continuous Glucose Monitors)
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A: pumpB: infusion setC: sensorD: transmitter
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Type 1 Diabetes; Management
Lots of cool tools, but they don’t think for us
•What kind of food (fat, fiber, protein)•Activity (before and after)•Time of day•Time of month•Constantly making adjustments
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Diabetes logs
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Diabetes logs
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Closing the loop
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Closing the loopThe Artificial Pancreas
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