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Type 1 Diabetes MellitusAka: Type I Diabetes Mellitus, Insulin Dependent Diabetes Mellitus, IDDM, Type I Diabetes

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  1. See Also
    1. Diabetes Mellitus
  2. Epidemiology
    1. Age under 30 years
    2. Non-obese patients
  3. Etiology
    1. Type 1A
      1. Environmental and genetic factors
      2. HLA-DR4 association
      3. Cell mediated pancreatic beta cell destruction
    2. Type 1B (uncommon)
      1. Primary autoimmune condition
      2. Associated with other Autoimmune Conditions
        1. Hashimoto's Thyroiditis
        2. Grave's Disease
        3. Myasthenia Gravis
      3. HLA-DR3 association
      4. Incidence highest in 30-50 year olds
    3. Secondary Diabetes Mellitus
      1. Cystic Fibrosis
    4. Environmental Factors
      1. Medications
        1. Streptozocin
        2. Pentamidine
      2. Viruses
        1. Mumps
        2. Coxsackie
          1. Enterovirus IgM linked to IDDM in adolescents
            1. Studied 128 children with new onset IDDM
            2. Non-specific to subtype (coxsackie, echovirus)
            3. Helfand (1995) J Infect Dis 172:1206
        3. Congenital Rubella
          1. Late Type I Diabetes Mellitus develops in 40%
        4. Cytomegalovirus (CMV)
  4. Symptoms and Signs
    1. See Diabetes Mellitus
  5. Common Presentations
    1. Diabetic Ketoacidosis
      1. Major presenting syndrome in 25% of cases
      2. More common in under 3 years and adolescence
    2. Incidental glucosuria or hyperglycemia
    3. Acute Abdominal Pain
    4. Influenza-like illness
  6. Diagnostic criteria
    1. See Diabetes Mellitus
  7. Labs
    1. Initial studies
      1. Urinalysis
      2. Blood Glucose
      3. Electrolytes
      4. Glycosylated Hemoglobin (Hemoglobin A1C)
      5. Thyroid Function Tests
        1. Free T4
        2. Thyroid Stimulating Hormone (TSH)
      6. Oral Glucose Tolerance Test
        1. Rarely indicated
    2. Diagnostics in Atypical Presentation
      1. Fasting Blood Glucose
      2. Two hour post-prandial glucose
      3. Intravenous Glucose Tolerance Test
      4. Anti-GAD65 Antibody present Type I DM (most useful)
      5. Anti-islet cell surface Antibody
      6. Anti-Insulin Antibody
      7. C-peptide low or absent in Type I Diabetes Mellitus
        1. Not as specific for Type I Diabetes as once thought
        2. Consider after Sustacal challenge
        3. May be low in Type II Diabetes Mellitus as well
  8. Management: Initial
    1. Treat acute problems (includes non-diabetic issues)
    2. Set initial goals and targets
      1. See Diabetes Mellitus Glucose Management
    3. Initiate Insulin therapy
      1. See Insulin Dosing
      2. If atypical presentation, then base on ketones
        1. Ketones positive: Start Insulin
        2. Ketones negative: Consider treating as Type II
    4. Education
      1. See Diabetes Mellitus Education
      2. Teach survival skills
      3. Establish plan for ongoing care and education
  9. Management: Follow-up
    1. Initial
      1. Daily phone contact for first 3 days
      2. Office visit within 2 weeks
      3. Emergency 24 hour phone number given
    2. Adjustment phase
      1. Consider weekly phone call
      2. Monthly office visit
    3. Maintenance Phase
      1. Office visit every 3-4 months
      2. Review Blood Sugar Log
        1. Hypoglycemic Episodes
        2. Hyperglycemia
        3. Ketones
      3. Review food plan
      4. Review Exercise program
      5. Review Medications
      6. Exam
        1. Height and Weight
        2. Growth rate (pediatric Diabetes Mellitus)
        3. Blood Pressure
      7. Labs
        1. Check Glucose Meter against Serum Glucose
        2. Hemoglobin A1C
      8. Education
        1. Nutrition in Diabetes Mellitus
        2. Exercise in Diabetes Mellitus
    4. Yearly Exam
      1. Health Maintenance Exam
      2. Fasting lipid profile within 6 months of diagnosis
        1. Triglycerides commonly elevated
      3. Neurologic Exam
      4. Dental exam
      5. Optometry or Ophthalmology Exam
        1. Age over 12 years or Diabetes Mellitus for 5 years
      6. Urine microalbumin yearly
        1. Age over 12 years or Diabetes Mellitus for 5 years
  10. Management: New Tools
    1. Monitoring
      1. Continuous Blood Sugar Monitoring (24 hour)
      2. Transcutaneous Serum Glucose monitoring (watch)
    2. Treatment options
      1. Islet Cell Transplants (high efficacy in trials)
      2. Insulin Pump

Diabetes Mellitus, Insulin-Dependent (C0011854)

Definition (CSP)subtype of diabetes mellitus that is characterized by insulin deficiency; it is manifested by the sudden onset of severe hyperglycemia, rapid progression to diabetic ketoacidosis, and death unless treated with insulin; the disease may occur at any age, but is most common in childhood or adolescence.
Definition (MSH)A subtype of DIABETES MELLITUS that is characterized by INSULIN deficiency. It is manifested by the sudden onset of severe HYPERGLYCEMIA, rapid progression to DIABETIC KETOACIDOSIS, and DEATH unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence.
Definition (NCI)Diabetes mellitus characterized by insulin deficiency, sudden onset, severe hyperglycemia, rapid progression to ketoacidosis, and death unless treated with insulin. The disease may occur at any age, but is most common in childhood or adolescence.
ConceptsDisease or Syndrome (T047)
MSHD003922
EnglishBrittle Diabetes Mellitus, Diabetes mellitus - juvenile, DIABETES MELLITUS INSULIN DEPENDENT, DIABETES MELLITUS TYPE 01, Diabetes mellitus type 1, Diabetes mellitus type I, Diabetes Type I, IDD, IDDM, IDDM - Insulin-dependent diabetes mellitus, IDDM1, insulin dependent diabetes, Insulin dependent diabetes mel, Insulin dependent diabetes mellitus, Insulin-Dependent Diabetes Mellitus, INSULIN-DEPENDENT DIABETES MELLITUS 1, Juvenile Diabetes, juvenile diabetes mellitus, JUVENILE ONSET DIABETES MELLITUS, Juvenile-Onset Diabetes Mellitus, ketosis prone diabetes, Ketosis-Prone Diabetes Mellitus, Sudden-Onset Diabetes Mellitus, type 1 diabetes, Type 1 Diabetes Mellitus, Type I Diabetes, type I diabetes mellitus
Spanishdiabetes mellitus dependiente de insulina, diabetes mellitus insulino - dependiente, diabetes mellitus tipo I
Parent ConceptsAutoimmune Diseases (C0004364), Diabetes Mellitus (C0011849), Duplicate concept (C1274013), Allergic disorder of digestive system (C1720579), Cell-mediated cytotoxic disorder (C1960691)
SourcesCOSTAR, CSP, DXP, LNC, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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