essay on diabetes type 1

Essay on Diabetes for Students and Children

500+ words essay on diabetes.

Diabetes is a very common disease in the world. But people may never realize, how did they get diabetes and what will happen to them and what will they go through. It may not be your problem but you have to show respect and care for the one who has diabetes. It can help them and also benefited you to know more about it and have a better understanding of it. Diabetes is a metabolic disorder which is identified by the high blood sugar level. Increased blood glucose level damages the vital organs as well as other organs of the human’s body causing other potential health ailments.

Types of Diabetes

Diabetes Mellitus can be described in two types:

Description of two types of Diabetes Mellitus are as follows

1) Type 1 Diabetes Mellitus is classified by a deficiency of insulin in the blood. The deficiency is caused by the loss of insulin-producing beta cells in the pancreas. This type of diabetes is found more commonly in children. An abnormally high or low blood sugar level is a characteristic of this type of Diabetes.

Most patients of type 1 diabetes require regular administration of insulin. Type 1 diabetes is also hereditary from your parents. You are most likely to have type 1 diabetes if any of your parents had it. Frequent urination, thirst, weight loss, and constant hunger are common symptoms of this.

2) Type 2 Diabetes Mellitus is characterized by the inefficiency of body tissues to effectively respond to insulin because of this it may be combined by insulin deficiency. Type 2 diabetes mellitus is the most common type of diabetes in people.

People with type 2 diabetes mellitus take medicines to improve the body’s responsiveness to insulin or to reduce the glucose produced by the liver. This type of diabetes mellitus is generally attributed to lifestyle factors like – obesity, low physical activity, irregular and unhealthy diet, excess consumption of sugar in the form of sweets, drinks, etc.

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Causes of Diabetes

By the process of digestion, food that we eat is broken down into useful compounds. One of these compounds is glucose, usually referred to as blood sugar. The blood performs the job of carrying glucose to the cells of the body. But mere carrying the glucose to the cells by blood isn’t enough for the cells to absorb glucose.

This is the job of the Insulin hormone. Pancreas supply insulin in the human body. Insulin acts as a bridge for glucose to transit from blood to the body cells. The problem arises when the pancreas fails to produce enough insulin or the body cells for some reason do not receive the glucose. Both the cases result in the excess of glucose in the blood, which is referred to as Diabetes or Diabetes Mellitus.

Symptoms of Diabetes

Most common symptoms of diabetes are fatigue, irritation, stress, tiredness, frequent urination and headache including loss of strength and stamina, weight loss, increase in appetite, etc.

Levels of Diabetes

There are two types of blood sugar levels – fasting blood sugar level and postprandial blood sugar level. The fasting sugar level is the sugar level that we measure after fasting for at least eight hours generally after an overnight fast. Blood sugar level below 100 mg/dL before eating food is considered normal. Postprandial glucose level or PP level is the sugar level which we measure after two hours of eating.

The PP blood sugar level should be below 140 mg/dL, two hours after the meals. Though the maximum limit in both the cases is defined, the permissible levels may vary among individuals. The range of the sugar level varies with people. Different people have different sugar level such as some people may have normal fasting sugar level of 60 mg/dL while some may have a normal value of 90 mg/dL.

Effects of Diabetes

Diabetes causes severe health consequences and it also affects vital body organs. Excessive glucose in blood damages kidneys, blood vessels, skin resulting in various cardiovascular and skin diseases and other ailments. Diabetes damages the kidneys, resulting in the accumulation of impurities in the body.

It also damages the heart’s blood vessels increasing the possibility of a heart attack. Apart from damaging vital organs, diabetes may also cause various skin infections and the infection in other parts of the body. The prime cause of all type of infections is the decreased immunity of body cells due to their inability to absorb glucose.

Diabetes is a serious life-threatening disease and must be constantly monitored and effectively subdued with proper medication and by adapting to a healthy lifestyle. By following a healthy lifestyle, regular checkups, and proper medication we can observe a healthy and long life.

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My Type 1 Diabetes Diagnosis Story (in Hailey's own words)

"on my sixth birthday, i came inside from recess and left early with my mom, my head warmer than the sun and everything aching. when i got home, i slept for 16 consecutive hours".

It was late in the evening, and I was with my father in the kitchen. I scratched my wrists, and my dad looked appalled. I looked down. They were red and raw, like my mom’s, not at all how the wrists of a six year old were supposed to look. I hadn’t noticed. I just thought they were itchy, maybe I had gotten some bug bites or poison ivy. How was I supposed to know that my wrists could be a sign of something so much bigger?

My wrists weren’t the only issue. I had always loved drinking soda and chocolate milk and water, but now I was taking in so much more. Every soccer game I would take over the oranges, the strawberries, the watermelon, whatever was there, desperate for every scrap of liquid I could find. I was SO thirsty. My breath made my family cringe, although I loved the sweet tanginess, except of course when that tanginess prohibited me from getting any satisfaction from all of the liquids I was taking in. In school, my kindergarten teacher thought I was just trying to get out of “Circle Time” when I went to the bathroom ten times in one day; she hadn’t noticed the gallons of water I was chugging throughout the day, the fact that I was practically hopping in place waiting for her to let me go, my face twisted in agony. Twice I had fallen into a deep sleep during rest time, and twice it had been nearly impossible to wake up. Connie, an aid in my classroom, frantically called my mother in from across the hall, where she worked as a kindergarten aid, while at the same time Lorrie, the school nurse, ran into our blue-outlined room, ready to do whatever was necessary to wake me up.

On my sixth birthday, I came inside from recess and left early with my mom, my head warmer than the sun and everything aching. When I got home, I slept for sixteen consecutive hours.

My sister, Emily, who had always played on the A team for our town soccer league, had a tournament on Columbus Day weekend. I made it through the games and out to lunch at the mall. I went to the bathroom before, during, and after lunch. My mother and I got into our van, ready to go home and leave Emily to hang out with her friends. Not more than ten minutes after my last trip to the bathroom, I already had to pee again. My mom raced through route 9, trying to make it home. I was whining about how bad I had to go when suddenly, my whines turned into sobs. I was six years old and I had wet my pants. While I was freaking out with shame and disgust, my mom calmly pulled into Papa Gino’s. We ran into the bathroom, ignoring the “No Public Restrooms” posters, me with urine trickling down my legs and soaking my pants.

When we got home, I showered and did my best to clean myself up, leaving my mom to deal with the disaster in the van and my yellow stained clothes. When my dad got home that night, my mom turned to me:

“Do you want to tell Dad what happened today?” she asked. I could feel myself going red with shame.

“What happened?” he echoed.

I twisted around on the couch to avoid meeting his gaze. “I wet my pants in the car.” My dad was not pleased.

On October 10th, 2006, my entire kindergarten class went on a trip to Bolton Orchards to go apple picking. As I watched my friends running, laughing, playing, and piling apple after apple into their bags, I sat myself down in the shade and sucked the life out of every apple within my reach. I didn’t get up to run. I didn’t want to play or laugh. I didn’t keep any apples in my bag for longer than five minutes. Soon, my pile of lifeless apples that lay on the ground beside me was comprised of more apples than all the bags of my friends combined.

My mom was disgusted at my gluttony. After talking to Lorrie about my strange behavior, she decided to take me to see my pediatrician, Dr. Michael.

Luckily for us, Joanne, a friend of my mom’s, answered the phone and listened as my mother rattled off my long list of ailments and symptoms. Recognizing these signs, Joanne put us in the system and told us to come in right away. When I arrived at my pediatrician’s office, Dr. Michael smiled and joked and tried to make me laugh, but concern was etched across his face. I felt like crap, and he knew it. He was afraid of telling us the life changing news. He sent me down to the lab for urine and blood tests. I peed in a cup and saw my life flash before my eyes as the phlebotomists drew nearer to me with a long, sharp needle. They put it in, and I let out a sigh of relief. That wasn’t that bad . It was better than a vaccine. The phlebotomists were shocked. The tiny, 49 pound, three foot eight little girl hadn’t even flinched when they stuck her with the needle that had caused countless adults to fall unconscious.

Dr. Michael came down moments later to review the results of my blood work. He said something about “diabetes”. What’s diabetes? Am I going to die? When can I go home? Can you please get me more water? I’m really thirsty. Do you need another urine sample? Because I can get that for you. I’ve been holding it for ten whole minutes. Honestly. Are you sure you don’t need me to pee again? Oblivious to the chaos inside my mind, Dr. Michael told my mother and I to go to the UMass Emergency Room in Worcester.

As Dr. Michael walked away, a tragic expression on his face, I turned to my mom and uttered the only question I could get out of my mouth: “Mommy, are there going to be more shots like that?”

She looked back at my weary face and my angry red hands. She didn’t have the energy to sugar coat it. Why bother? It’s not like I wouldn’t find out anyway. “Yes.” That was when I started to cry. After Dinina, my mom’s best friend, dropped off my dad at Fallon Clinic, I fell into his arms and allowed all of my fear to fall out into him.

I sobbed my way out of the lab, through the automatic door, past the pharmacy, through the parking lot and into the minivan I had claimed my territory in just days before. I wailed as the three of us walked into CVS, picking out an Etch-a-Sketch, a notepad and pencils to play with in the hospital. I bawled the quick drive up Route 9, over the bridge and into Worcester, out of the van and into the parking garage, through the glass doors and across the street to the ER. I sat with my parents in the neutrally decorated room, my head in my mother’s lap, weeping silently while we waited. It wasn’t a very long wait. I guess the imminent threat of my body poisoning itself made me a top priority.

They squished my finger with a small black device that looked like a finger-cast, checking the oxygen level in my blood, and I was all over how soft it was. Then the nurses brought me into an exam room to take the rest of my vitals and get me changed into a patient gown. With a patient ID bracelet strapped to my wrist, I settled into the bed to watch Scooby Doo on the small TV in the corner, trying to ignore the talking, the beeping, and the sharp pain that came with every shot.

By the time I was finally wheeled into a patient room on the pediatric floor, despite the fact that I could walk without a problem, I was beat. I got into bed, my IV dangling next to me, afraid I would have to pee in the middle of the night and not know how to wheel with me. As soon as I was introduced to the night doctors and nurses, I put my head on my pillow and closed my eyes, hoping that by the time the morning came, maybe my dad would be back with my siblings, and that Zoe would come and visit me soon.

The next day, with my blood sugars on their way down into a normal range, my parents were ushered from meeting to meeting, learning what “diabetes” was, how to manage it, how to help me to manage it, and what our new lives were going to be like. As a six-year-old, I wasn’t quite old or mature enough to be included in these meetings. Feeling a little left out, I went to the playroom and played Keep-It-Up with the sweet, teenage volunteer for what felt like hours. Finally having an open ear to talk to, I had the time of my life hitting the ball in the air and saying everything that came to mind. Predictably, not long after we started playing, I needed to go to the bathroom. When the volunteer asked me if I knew how to get back to my room, I lied and told her “no,” torn between fear that she wouldn’t be there when I got back and the feeling of loneliness that had been creeping up inside me. When I got out of the bathroom, I found myself in the midst of a large crowd of white-coated adults. Being the ever-social kid I was, I immediately started to talk their ears off. By the time my parents returned from one of their meetings, I was in bed, blocked from their view by the group of medical professionals. Of course, having a child newly diagnosed with a disease they knew nothing about, they assumed something was very wrong. They eventually made their way through the crowd and discovered that I was, in fact, fine.

After lunch, Emily came by with a suitcase, including my least favorite pair of pastel pink sweatpants. Gail, the aid in my kindergarten classroom, stopped in with a pile comprised of more than 20 Get-Well-Soon cards from my class. She decided to stay and keep me company while my parents were sent to yet another meeting. We went to the playroom and were joined by Kelly, my best friend’s mother, who also happened to be my hairdresser and favorite babysitter. The three of us sat on the child size stools and played my own hospitalized version of Sorry! With blood red, pee yellow, puke green, and water blue. My mom was ready to kill me when she found out I had been speaking like that to a teacher.

As my health began to improve, I was joined in my hospital room by a roommate. A few years older than me, she too had been diagnosed with diabetes, though not as early as I had been. She was spilling ketones (compounds released when a person has a high blood sugar for a prolonged period of time), and in a far worse condition than I had ever been in. Every time I tried to chat with her, I was shushed by my parents, doctors, and nurses. She had much more important things to worry about than the annoying six year old in the bed next door. With her IV in her hand, I stared at her as we played in the playroom, both of our parents in meetings and her not lasting nearly as long as I could without taking a break. I’d smile and laugh, trying to share some of the fun and happiness I was feeling at the endless attention and fun, but she stayed quiet.

After three of the best days of my life and three of the worst days of my parents’ lives, I was finally discharged. My parents couldn’t wait to get me home, but I had quickly grown to love all of the attention I was getting in the hospital and all of the friends I had made. Despite the fact that I thought it had been one of the most enjoyable weekends I had ever experienced, the doctors who yelled at me for jumping on my bed would definitely have to disagree. In contrast with the common views of modern society, I had the time of my life whilst fighting for my life.

Type 1 diabetes articles from across Nature Portfolio

Type 1 diabetes (also known as diabetes mellitus) is an autoimmune disease in which immune cells attack and destroy the insulin-producing cells of the pancreas. The loss of insulin leads to the inability to regulate blood sugar levels. Patients are usually treated by insulin-replacement therapy.

Latest Research and Reviews

Beta-adrenergic agonism protects mitochondrial metabolism in the pancreatectomised rat heart

Ross T. Lindsay
Louise Thisted
Andrew J. Murray

Unmet needs in the treatment of type 1 diabetes: why is it so difficult to achieve an improvement in metabolic control?

Francesco Antonio Mazzotta
Lorenzo Lucaccini Paoli
Dario Pitocco

Flavor and taste recognition impairments in people with type 1 diabetes

Immacolata Cristina Nettore
Giuseppe Palatucci
Paolo Emidio Macchia

Impact of a community pharmacy-based medication therapy management program on clinical and humanistic outcomes in patients with uncontrolled diabetes: a randomised controlled trial

Basmah Albabtain
Ghada Bawazeer
Muhammad Abdul Hadi

The spleen assumes a major role in blood glucose regulation in type 1 diabetes patients treated with BCG

Hans F. Dias
Jessie Fanglu Fu
Denise L. Faustman

Finishing the odyssey to a stem cell cure for type 1 diabetes

Lise Hunault
Daniel Hesselson

News and Comment

Combination therapy increases human β-cell mass in vivo

Olivia Tysoe

How medical schools can prepare students for new technologies

Patient educators and nurses can demonstrate the real-life use of health technologies.

Chantal Mathieu

Reply to ‘Slowly progressive insulin dependent diabetes mellitus in type 1 diabetes endotype 2’

Maria J. Redondo
Noel G. Morgan

Slowly progressive insulin-dependent diabetes mellitus in type 1 diabetes endotype 2

Tetsuro Kobayashi
Takashi Kadowaki

METTL3 restrains autoimmunity in β-cells

Activation of innate immunity has been linked to the progression of type 1 diabetes. A study now shows that overexpression of METTL3, a writer protein of the m 6 A machinery that modifies mRNA, restrains interferon-stimulated genes when expressed in pancreatic β-cells, identifying it as a promising therapeutic target.

Balasubramanian Krishnamurthy
Helen E. Thomas

Type 1 diabetes mellitus: a brave new world

One hundred years after the Nobel prize was bestowed on Banting and McLeod for the ‘discovery’ of insulin, we are again seeing major evolutions in the management of type 1 diabetes mellitus, with the prospect of achieving disease control beyond mere management now becoming real. Here, we discuss the latest, most notable developments.

Pieter-Jan Martens

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Essay on Diabetes

Students are often asked to write an essay on Diabetes in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Diabetes

What is diabetes.

Diabetes is a chronic disease where the body can’t control blood sugar levels. This happens because the body either doesn’t make enough insulin or can’t use it properly.

Types of Diabetes

There are two main types: Type 1 and Type 2. Type 1 is when the body doesn’t produce insulin. Type 2 is when the body doesn’t use insulin well.

Managing Diabetes

Diabetes can be managed through a healthy diet, regular exercise, and medication. Regular check-ups are also important to monitor blood sugar levels.

The Impact of Diabetes

If not managed, diabetes can lead to serious health problems like heart disease, kidney disease, and vision loss.

250 Words Essay on Diabetes

Introduction.

Diabetes, a chronic metabolic disorder, is characterized by an increased level of glucose in the blood. It arises due to the body’s inability to produce or effectively utilize insulin, a hormone responsible for glucose regulation.

Etiology of Diabetes

Diabetes is classified into two major types: Type 1 and Type 2. Type 1 diabetes, an autoimmune disorder, is a result of the body’s immune system attacking insulin-producing cells in the pancreas. On the other hand, Type 2 diabetes, the more prevalent form, is primarily associated with insulin resistance and often linked to obesity and sedentary lifestyle.

Impact and Management

Diabetes can lead to severe complications like heart disease, kidney failure, and blindness if left unmanaged. Management involves lifestyle modifications, including a healthy diet, regular physical activity, and medication or insulin therapy as needed.

Prevention and Future Research

Prevention strategies for Type 2 diabetes involve promoting healthier lifestyles and early detection. For Type 1 diabetes, research is still ongoing to understand its triggers. Advances in technology and medicine, such as artificial pancreas systems and islet cell transplantation, show promise for future diabetes management.

Diabetes, a global health crisis, requires comprehensive understanding and management strategies. With ongoing research and advancements, the future holds potential for improved diabetes care and prevention.

500 Words Essay on Diabetes

Introduction to diabetes.

There are primarily two types of diabetes: Type 1 and Type 2. Type 1 diabetes is an autoimmune condition where the body’s immune system attacks the insulin-producing cells in the pancreas. This type is less common and usually develops early in life. Type 2 diabetes, on the other hand, is more prevalent and typically develops in adulthood. It occurs when the body becomes resistant to insulin or doesn’t produce enough to maintain a normal glucose level.

Risk Factors and Symptoms

Several factors increase the risk of developing diabetes, including genetics, obesity, lack of physical activity, and poor diet. Additionally, certain ethnic groups are at a higher risk.

Management and Treatment

While there is currently no cure for diabetes, it can be effectively managed with a combination of lifestyle changes and medication. Regular exercise, a balanced diet, and maintaining a healthy weight are crucial for managing both types of diabetes.

For Type 1 diabetes, insulin injections or use of an insulin pump are necessary. Type 2 diabetes can often be managed with lifestyle changes and oral medication, but insulin may be required as the disease progresses.

Complications and Prevention

Prevention strategies for Type 2 diabetes include regular physical activity, a healthy diet, maintaining a normal body weight, and avoiding tobacco use. Early detection through regular health screenings is also critical, as early treatment can prevent or delay the onset of complications.

Diabetes is a significant global health concern that requires concerted efforts for effective management and prevention. Understanding the disease, its risk factors, and the importance of early detection can go a long way in reducing the impact of this chronic condition. Through lifestyle changes and medical intervention, individuals with diabetes can lead healthy and fulfilling lives.

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357 Diabetes Essay Topics & Examples

When you write about the science behind nutrition, heart diseases, and alternative medicine, checking titles for diabetes research papers can be quite beneficial. Below, our experts have gathered original ideas and examples for the task.

🏆 Best Diabetes Essay Examples & Topics

⭐ most interesting diabetes research paper topics, ✅ simple & easy diabetes essay topics, 🎓 good research topics about diabetes, 💡 interesting topics to write about diabetes, 👍 good essay topics on diabetes, ❓ diabetes research question examples.

Living with a Chronic Disease: Diabetes and Asthma This paper will look at the main effects of chronic diseases in the lifestyle of the individuals and analyze the causes and the preventive measures of diabetes as a chronic disease.
Diabetes Mellitus: Symptoms, Types, Effects Insulin is the hormone that controls the levels of glucose in the blood, and when the pancreas releases it, immediately the high levels are controlled, like after a meal.
Leadership in Diabetes Management Nurses can collaborate and apply evidence-based strategies to empower their diabetic patients. The involvement of all key stakeholders is also necessary.
Adult-Onset Type 2 Diabetes: Patient’s Profile Any immediate care as well as post-discharge treatment should be explained in the best manner possible that is accessible and understandable to the patient.
Type 2 Diabetes as a Public Health Issue In recent years, a steady increase in the incidence and prevalence of diabetes is observed in almost all countries of the world.
Gestational Diabetes: Child Bearing Experience Insulin resistance in GDM is likely to be the result of a combination of lifestyle factors and the insulin-desensitizing effect of chorionic gonadotrophins.
Nursing Care Development Plan for Diabetes and Hypertension In addressing the first nursing diagnosis, the main aim of the nursing interventions will be to prevent the development of secondary hypoglycemia by increasing blood glucose levels.
Diabetes Management and Evidence-Based Practice Diabetes is a state of glucose intolerance that requires the management of blood glucose. Good glycemic control ensures that the level of glucose in a diabetic patient is maintained at levels similar to that of […]
Nursing Diagnosis: Type 1 Diabetes & Hypertension The nursing diagnosis based on the identified and primary problems are, “Risk for injury related to hypoglycemia, ‘Risk for Unstable blood glucose level related to lack of adequate management of hypoglycemia evidenced by decreased blood […]
Disease Management for Diabetes Mellitus The selection of the appropriate philosophical and theoretical basis for the lesson is essential as it allows for the use of an evidence-based method for learning about a particular disease.
Case Study of Patient with DKA and Diabetes Mellitus It is manifested by a sharp increase in glucose levels and the concentration of ketone bodies in the blood, their appearance in the urine, regardless of the degree of violation of the patient’s consciousness.
Health Nursing and Managing Diabetes The practice will equip more patients with the best ideas and initiatives to deal with diabetes. The completed study will provide the best practices and evidence-based ideas to help patients with diabetes type II.
Diabetes: Symptoms, Treatment, and Prevention As a consequence, the amount of sugar in the blood is made to rise and this cause discomfort for the affected individuals.
Diabetes Mellitus: Types, Causes, Presentation, Treatment, and Examination Diabetes mellitus is a chronic endocrinologic disease, which is characterized by increased blood glucose concentration.
The Nature of Type 1 Diabetes Mellitus Type 1 diabetes mellitus is a chronic autoimmune disease that has an active genetic component, which is identified by increased blood glucose levels, also known as hyperglycemia.
Counseling and Education Session in Type II Diabetes Patients will be educated about the glycemic index and its effect on their blood sugar Patients will learn to count their carbohydrates. Patients will set up their goal and the timeframe to achieve it.
Gestational Diabetes in a 38-Year-Old Woman The concept map, created to meet B.’s needs, considers her educational requirements and cultural and racial hurdles to recognize her risk factors and interventions to increase her adherence to the recommended course of treatment.B.said in […]
Type 2 Diabetes Mellitus and Its Implications You call an ambulance and she is taken in to the ED. Background: Jean is still very active and works on the farm 3 days a week.
Development of Comprehensive Inpatient and Outpatient Programs for Diabetes Overcoming the fiscal and resource utilization issues in the development of a comprehensive diabetes program is essential for the improvement of health and the reduction of treatment costs.
Healthcare Cost Depending on Chronic Disease Management of Diabetes and Hypertension A sufficient level of process optimization and the presence of a professional treating staff in the necessary number will be able to help improve the indicators.
Improving Glycemic Control in Black Patients with Type 2 Diabetes Information in them is critical for answering the question and supporting them with the data that might help to acquire an enhanced understanding of the issue under research. Finally, answering the PICOT question, it is […]
Shared Decision-Making That Affects the Management of Diabetes The article by Peek et al.is a qualitative study investigating the phenomenon of shared decision-making that affects the management of diabetes. The researchers demonstrate the racial disparity that can arise in the choice of approaches […]
Managing Obesity as a Strategy for Addressing Type 2 Diabetes When a patient, as in the case of Amanda, requires a quick solution to the existing problem, it is necessary to effectively evaluate all options in the shortest possible time.
Tests and Screenings: Diabetes and Chronic Kidney Disease The test is offered to patients regardless of gender, while the age category is usually above 45 years. CDC1 recommends doing the test regardless of gender and is conducted once or twice to check the […]
Obesity Management for the Treatment of Type 2 Diabetes American Diabetes Association states that for overweight and obese individuals with type 2 diabetes who are ready to lose weight, a 5% weight reduction diet, physical exercise, and behavioral counseling should be provided.
COVID-19 and Diabetes Mellitus Lim et al, in their article, “COVID-19 and diabetes mellitus: from pathophysiology to clinical management”, explored how COVID-19 can worsen the symptoms of diabetes mellitus.
The Importance of Physical Exercise in Diabetes II Patients The various activities help to improve blood sugar levels, reduce cardiovascular cases and promote the overall immunity of the patient. Subsequently, the aerobic part will help to promote muscle development and strengthen the bones.
Diabetes Education Workflow Process Mapping DSN also introduces the patient to the roles of specialists involved in managing the condition, describes the patient’s actions, and offers the necessary educational materials.
Diabetes: Treatment Complications and Adjustments One of the doctor’s main priorities is to check the compatibility of a patient’s medications. The prescriptions of other doctors need to be thoroughly checked and, if necessary, replaced with more appropriate medication.
The Type 2 Diabetes Mellitus PICOT (Evidence-Based) Project Blood glucose levels, A1C, weight, and stress management are the parameters to indicate the adequacy of physical exercise in managing T2DM.
Chronic Disease Cost Calculator (Diabetes) This paper aims at a thorough, detailed, and exhaustive explanation of such a chronic disease as diabetes in terms of the prevalence and cost of treatment in the United States and Maryland.
Diabetes Mellitus Epidemiology Statistics This study entails a standard established observation order from the established starting time to an endpoint, in this case, the onset of disease, death, or the study’s end. It is crucial to state this value […]
Epidemiology: Type II Diabetes in Hispanic Americans The prevalence of type II diabetes in Hispanic Americans is well-established, and the search for inexpensive prevention methods is in the limelight.
Diabetes: Risk Factors and Effects Trends in improved medical care and the development of technology and medicine are certainly contributing to the reduction of the problem. All of the above indicates the seriousness of the problem of diabetes and insufficient […]
Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes The primary role of physicians, nurses, and other healthcare team members is to provide patients with medical treatment and coordinate that care while also working to keep costs down and expand access.
Hereditary Diabetes Prevention With Lifestyle Modification Yeast infections between the fingers and toes, beneath the breast, and in or around the genital organs are the common symptoms of type 2 diabetes.
Health Equity Regarding Type 2 Diabetes According to Tajkarimi, the number of research reports focusing on T2D’s prevalence and characteristics in underserved minorities in the U. Adapting the program’s toolkits to rural Americans’ eating and self-management habits could also be instrumental […]
Diabetes Mellitus: Treatment Methods Moreover, according to the multiple findings conducted by Park et al, Billeter et al, and Tsilingiris et al, bariatric surgeries have a positive rate of sending diabetes into remission.
Diagnosing Patient with Insulin-Dependent Diabetes The possible outcomes of the issues that can be achieved are discussing the violations with the patient’s family and convincing them to follow the medical regulations; convincing the girl’s family to leave her at the […]
Human Service for Diabetes in Late Adulthood The mission of the Georgia Diabetic Foot Care Program is to make a positive difference in the health of persons living with diabetes.
Diabetes: Symptoms and Risk Factors In terms of the problem, according to estimates, 415 million individuals worldwide had diabetes mellitus in 2015, and it is expected to rise to 642 million by the year 2040.
Diabetes: Types and Management Diabetes is one of the most prevalent diseases in the United States caused when the body fails to optimally metabolize food into energy.
Epidemiology of Diabetes and Forecasted Trends The authors note that urbanization and the rapid development of economies of different countries are the main causes of diabetes. The authors warn that current diabetes strategies are not effective since the rate of the […]
The Aboriginal Diabetes Initiative in Canada The ADI’s goal in the CDS was to raise type 2 diabetes awareness and lower the incidence of associated consequences among Aboriginal people.
Communicating the Issue of Diabetes The example with a CGM sensor is meant to show that doctors should focus on educating people with diabetes on how to manage their condition and what to do in extreme situations.
Obesity and Diabetes Mellitus Type 2 The goal is to define the features of patient information to provide data on the general course of the illness and its manifestations following the criteria of age, sex, BMI, and experimental data.
The Prevention of Diabetes and Its Consequences on the Population At the same time, these findings can also be included in educational programs for people living with diabetes to warn them of the risks of fractures and prevent them.
Uncontrolled Type 2 Diabetes and Depression Treatment The data synthesis demonstrates that carefully chosen depression and anxiety treatment is likely to result in better A1C outcomes for the patient on the condition that the treatment is regular and convenient for the patients.
Type 2 Diabetes: Prevention and Education Schillinger et al.came to the same conclusion; thus, their findings on the study of the Bigger Picture campaign effectiveness among youth of color are necessary to explore diabetes prevention.
A Diabetes Quantitative Article Analysis The article “Correlates of accelerometer-assessed physical activity and sedentary time among adults with type 2 diabetes” by Mathe et al.refers to the global issue of the prevention of diabetes and its complications.
A Type 2 Diabetes Quantitative Article Critique Therefore, the main issue is the prevention of type 2 diabetes and its consequences, and this paper will examine one of the scientific studies that will be used for its exploration.
The Diabetes Prevention Articles by Ford and Mathe The main goal of the researchers was to measure the baseline MVPA of participants and increase their activity to the recommended 150 minutes per week through their participation in the Diabetes Community Lifestyle Improvement Program.
Type 2 Diabetes in Hispanic Americans The HP2020 objectives and the “who, where, and when” of the problem highlight the significance of developing new, focused, culturally sensitive T2D prevention programs for Hispanic Americans.
Diabetes Mellitus as Problem in US Healthcare Simultaneously, insurance companies are interested in decreasing the incidence of diabetes to reduce the costs of testing, treatment, and provision of medicines.
Diabetes Prevention as a Change Project All of these queries are relevant and demonstrate the importance of including people at high risk of acquiring diabetes in the intervention.
Evidence Synthesis Assignment: Prevention of Diabetes and Its Complications The purpose of this research is to analyze and synthesize evidence of good quality from three quantitative research and three non-research sources to present the problem of diabetes and justify the intervention to address it.
Diabetes Mellitus: Causes and Health Challenges Second, the nature of this problem is a clear indication of other medical concerns in this country, such as poor health objectives and strategies and absence of resources.
Diabetes in Adults in Oxfordshire On a national level, Diabetes Research and Wellness Foundation aims to prevent the spread of the decease through research of the causes and effective treatment of diabetes 2 type.
Diabetes Mellitus (DM) Disorder Case Study Analysis Thus, informing the patient about the importance of regular medication intake, physical activity, and adherence to diet in maintaining diabetes can solve the problem.
Diabetes Mellitus in Young Adults Thus, programs for young adults should predominantly focus on the features of the transition from adolescence to adulthood. As a consequence, educational programs on diabetes improve the physical and psychological health of young adults.
A Healthcare Issue of Diabetes Mellitus Diabetes mellitus is seen as a primary healthcare issue that affects populations across the globe and necessitates the combination of a healthy lifestyle and medication to improve the quality of life of people who suffer […]
Control of LDL Cholesterol Levels in Patients, Gestational Diabetes Mellitus In addition, some patients with hypercholesterolemia may have statin intolerance, which reduces adherence to therapy, limits treatment efficacy, and increases the risk of CVD.
Exploring Glucose Tolerance and Gestational Diabetes Mellitus In the case of a glucose tolerance test for the purpose of diagnosing GDM type, the interpretation of the test results is carried out according to the norms for the overall population.
Type 2 Diabetes Health Issue and Exercise This approach will motivate the patient to engage in exercise and achieve better results while reducing the risk of diabetes-related complications.
Diabetes Interventions in Children The study aims to answer the PICOT Question: In children with obesity, how does the use of m-Health applications for controlling their dieting choices compare to the supervision of their parents affect children’s understanding of […]
Diabetes Tracker Device and Its Advantages The proposed diabetes tracker is a device that combines the functionality of an electronic BGL tester and a personal assistant to help patients stick to their diet plan.
Latino People and Type 2 Diabetes The primary aim of the study is to determine the facilitators and barriers to investigating the decision-making process in the Latin population and their values associated with type 2 diabetes.
Diabetes Self-Management Education and Support Program The choice of this topic and question is based on the fact that despite the high prevalence of diabetes among adolescents in the United States, the use of DSMES among DM patients is relatively low, […]
Diabetes Mellitus Care Coordination The aim is to establish what medical technologies, care coordination and community resources, and standards of nursing practice contribute to the quality of care and safety of patients with diabetes.
Healthy Lifestyle Interventions in Comorbid Asthma and Diabetes In most research, the weight loss in cases of comorbid asthma and obesity is reached through a combination of dietary interventions and physical exercise programs.
PDSA in Diabetes Prevention The second step in the “Do” phase would be to isolate a few members of the community who are affected by diabetes voluntarily.
Diabetes: Statistics, Disparities, Therapies The inability to produce adequate insulin or the body’s resistance to the hormone is the primary cause of diabetes. Diabetes is a serious health condition in the U.S.and the world.
Type 2 Diabetes Prescriptions and Interventions The disadvantage is the difficulty of obtaining a universal model due to the complexity of many factors that can affect the implementation of recommendations: from the variety of demographic data to the patient’s medical history.
Health Education for Female African Americans With Diabetes In order to address and inform the public about the challenges, nurses are required to intervene by educating the population on the issues to enhance their understanding of the risks associated with the conditions they […]
Diabetes Risk Assessment and Prevention It is one of the factors predisposing patients suffering from diabetes to various cardiovascular diseases. With diabetes, it is important to learn how to determine the presence of carbohydrates in foods.
Diabetes Mellitus: Preventive Measures In addition to addressing the medical specialists who will be of service in disease prevention, it will emphasize the intervention programs required to help control the spread of the illness.
“The Diabetes Online Community” by Litchman et al. The researchers applied the method of telephone interviews to determine the results and effectiveness of the program. The study described the value of DOC in providing support and knowledge to older diabetes patients.
Mobile App for Improved Self-Management of Type 2 Diabetes The central focus of the study was to assess the effectiveness of the BlueStar app in controlling glucose levels among the participants.
Type 2 Diabetes in Minorities from Cultural Perspective The purpose of this paper is to examine the ethical and cultural perspectives on the issue of T2DM in minorities. Level 2: What are the ethical obstacles to treating T2DM in ethnic and cultural minorities?
Ethics of Type 2 Diabetes Prevalence in Minorities The purpose of this article analysis is to dwell on scholarly evidence that raises the question of ethical and cultural aspects of T2DM prevalence in minorities.
Type 2 Diabetes in Minorities: Research Questions The Level 2 research questions are: What are the pathophysiological implications of T2DM in minorities? What are the statistical implications of T2DM in minorities?
Improving Adherence to Diabetes Treatment in Primary Care Settings Additionally, the patients from the intervention group will receive a detailed explanation of the negative consequences of low adherence to diabetes treatment.
An Advocacy Tool for Diabetes Care in the US To ensure the implementation and consideration of my plea, I sent a copy of the letter to the government officials so it could reach the president.
Diabetes and Allergies: A Statistical Check The current dataset allowed us to test the OR for the relationship between family history of diabetes and the presence of diabetes in a particular patient: all variables were dichotomous and discrete and could take […]
Type 2 Diabetes in Adolescents According to a National Diabetes Statistics Report released by the Centers for Disease Control and Prevention, the estimated prevalence of the disease was 25 cases per 10,000 adolescents in 2017. A proper understanding of T2D […]
Analysis of Diabetes and Its Huge Effects In the US, diabetes is costly to treat and has caused much physical, emotional and mental harm to the people and the families of those who have been affected by the disease.
Nursing: Self-Management of Type II Diabetes Sandra Fernandes and Shobha Naidu’s journal illustrates the authors’ understanding of a significant topic in the nursing profession.”Promoting Participation in self-care management among patients with diabetes mellitus” article exposes readers to Peplau’s theory to understand […]
The Impact of Vegan and Vegetarian Diets on Diabetes Vegetarian diets are popular for a variety of reasons; according to the National Health Interview Survey in the United States, about 2% of the population reported following a vegetarian dietary pattern for health reasons in […]
“Diabetes Prevention in U.S. Hispanic Adults” by McCurley et al. This information allows for supposing that face-to-face interventions can be suitable to my practicum project that considers measures to improve access to care among African Americans with heart failure diseases. Finally, it is possible to […]
Diabetes Disease of the First and Second Types It is a decrease in the biological response of cells to one or more effects of insulin at its average concentration in the blood. During the first type of diabetes, insulin Degludec is required together […]
Person-Centered Strategy of Diabetes and Dementia Care The population of focus for this study will be Afro-American women aged between sixty and ninety who have diabetes of the second type and dementia or are likely to develop dementia in the future.
Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services For example, during one of my interactions with the patient, I was asked whether the hospital had the policy to avoid face-to-face interaction during the pandemic with the help of video examinations.
Diets to Prevent Heart Disease, Cancer, and Diabetes In order to prevent heart disease, cancer, and diabetes, people are required to adhere to strict routines, including in terms of diet. Additionally, people wanting to prevent heart disease, cancer, and diabetes also need to […]
The Centers for Diabetes’ Risks Assessment In general, the business case for the Centers for Diabetes appears to be positive since the project is closely aligned with the needs of the community and the targets set by the Affordable Care Act.
Diabetes Management Type 1 and Type 2 diabetes contrast based on their definitions, the causes, and the management of the conditions. Since the CDC promotes the avoidance of saturated fat and the increase of fiber intake for […]
Intervention Methods for Type 2 Diabetes Mellitus An individual should maintain a regulated glycemic control using the tenets of self-management to reduce the possibility of complications related to diabetes.
Diabetes Mellitus as Leading Cause of Disability The researchers used data from the Centers for Disease Control and Prevention, where more than 12% of older people in the US live with the condition.
Depression in Diabetes Patients The presence of depression concomitant to diabetes mellitus prevents the adaptation of the patient and negatively affects the course of the underlying disease.
The Relationship Between Diabetes and COVID-19 After completing the research and analyzing the articles, it is possible to suggest a best practice that may be helpful and effective in defining the relationship between diabetes and COVID-19 and providing a way to […]
Pre-diabetes and Urinary Incontinence Most recent reports indicate that a physiotherapy procedure gives a positive result in up to 80% of patients with stage I or SUI and mixed form and 50% of patients with stage II SUI.
Type 1 Diabetes: Recommendations for Alternative Drug Treatments Then, they have to assess the existing levels of literacy and numeracy a patient has. Tailoring educational initiatives to a person’s unique ethnic and cultural background is the basis of cultural competence in patient education.
Type 2 Diabetes: A Pharmacologic Update Diabetes presents one of the most common diagnoses in causes of ED visits among adults and one of the leading causes of death in the United States.
Diabetes: Vulnerability, Resilience, and Care In nursing care, resilience is a critical concept that shows the possibility of a person to continue functioning and meeting objectives despite the existing challenges.
Diabetes Prevention in the United States The analysis of these policies and the other strategies provides the opportunity to understand what role they might play in the improvement of human health. NDPP policy, on the other hand, emphasizes the role of […]
Teaching Experience: Diabetes Prevention The primary objective of the seminar is to reduce the annual number of diabetes cases and familiarize the audience with the very first signs of this disease.
Summary of Type 2 Diabetes: A Pharmacologic Update The authors first emphasize that T2D is one of the most widespread diseases in the United States and the seventh leading cause of death.
Insulin Effects in a Diabetes Person I will use this source to support my research because the perception of diabetes patients on insulin therapy is essential for understanding the impact they cause on the person.
Diabetes and Medical Intervention In the research conducted by Moin et al, the authors attempted to define the scope of efficiency of such a tool as an online diabetes prevention program in the prevention of diabetes among obese/overweight population […]
Relation Between Diabetes And Nutrition Any efforts to lessen and eliminate the risk of developing diabetes must involve the dietary habit of limiting the consumption of carbohydrates, sugar, and fats. According to Belfort-DeAguiar and Dongju, the three factors of obesity, […]
Diabetes Mellitus Type 2 and a Healthy Lifestyle Relationship The advantage of this study over the first is that the method uses a medical approach to determining the level of fasting glucose, while the dependences in the study of Ugandans were found using a […]
Diabetes and Its Economic Effect on Healthcare For many years, there has been an active increase in the number of cases of diabetes of all types among the global population, which further aggravates the situation.
Pathogenesis and Prevention of Diabetes Mellitus and Hypertension The hormone is produced by the cells of the islets of Langerhans found in the pancreas. It is attributed to the variation in the lifestyle of these individuals in these two geographical zones.
Parental Intervention on Self-Management of an Adolescent With Diabetes Diabetes development and exposure are strongly tied to lifestyle, and the increasing incidents rate emphasizes the severity of the population’s health problem.
Addressing the Needs of Hispanic Patients With Diabetes Similarly, in the program at hand, the needs of Hispanic patients with diabetes will be considered through the prism of the key specifics of the community, as well as the cultural background of the patients.
Diabetes Issues: Insulin Price and Unaffordability According to the forecast of researchers from Stanford University, the number of people with type 2 diabetes who need insulin-containing drugs in the world will increase by about 79 million people by 2030, which will […]
Diabetes: Epidemiologic Study Design For instance, the range of their parents’ involvement in the self-management practices can be a crucial factor in treatment and control.
What to Know About Diabetes? Type 1 diabetes is caused by autoimmune reaction that prevent realization of insulin in a body. Estimated 5-10% of people who have diabetes have type 1.
Diabetes in Saudi Arabia It is expected that should this underlying factor be discovered, whether it is cultural, societal, or genetic in nature, this should help policymakers within Saudi Arabia create new governmental initiatives to address the problem of […]
“Medical Nutrition Therapy: A Key to Diabetes Management and Prevention” Article Analysis In the process of MNT application, the dietitian keeps a record of the changes in the main components of food and other components of the blood such as blood sugars to determine the trend to […]
Global and Societal Implications of the Diabetes Epidemic The main aim of the authors of this article seems to be alerting the reader on the consequences of diabetes to the society and to the whole world.
Diabetes and Hypertension Avoiding Recommendations Thus, the promotion of a healthy lifestyle should entail the encouragement of the population to cease smoking and monitor for cholesterol levels.
Pregnant Women With Type I Diabetes: COVID-19 Disease Management The grounded theory was selected for the given topic, and there are benefits and drawbacks of utilizing it to study the experiences of pregnant women with type I diabetes and COVID-19.
Current Recommendations for the Glycemic Control in Diabetes Management of blood glucose is one of the critical issues in the care of people with diabetes. Therefore, the interval of the A1C testing should also depend on the condition of the patient, the physician’s […]
Diabetes Problem at Country Walk Community: Intervention and Evaluation This presentation develops a community health nursing intervention and evaluation tool for the diabetes problem affecting Country Walk community.
The Minority Diabetes Initiative Act’s Analysis The bill provides the right to the Department of Health and Human Services to generate grants to public and nonprofit private health care institutions with the aim of providing treatment for diabetes in minority communities.
Communication Challenges Between Nurses and Patients With Type 2 Diabetes According to Pung and Goh, one of the limitations of communication in a multicultural environment is the language barrier that manifests itself in the direct interaction of nurses with patients and in the engagement work […]
Diabetes Type 2 from Management Viewpoint Demonstrate the effects of type 2 diabetes and provide background information on the disease; Discuss the management plans of diabetes centers and critically analyze the frameworks implemented in the hospitals; Examine the existing methodology models […]
Nursing Plan for the Patient with Diabetes Type 2, HTN, and CAD The health of the population is the most valuable achievement of society, so the preservation and strengthening of it is an essential task in which everyone should participate without exception.
Diagnosis and Classification of Diabetes Mellitus Diabetes is a serious public health concern that introduces a group of metabolic disorders caused by changes in the sugar blood level.
Diabetes Mellitus Type II: A Case of a Female Adult Patient In this presentation, we are going to develop a care plan for a 47-year-old woman with a 3-year-old history of Diabetes Mellitus Type 2 (also known as Type II DM).
Diabetes Insipidus: Disease Process With Implications for Healthcare Professionals This presentation will consider the topic of Diabetes Insipidus (DI) with a focus on its etiology and progress.
A Study of Juvenile Type 1 Diabetes in the Northwest of England The total number of children under seventeen years living with type 1 diabetes in North West England by 2009 was 2,630.
Imperial Diabetes Center Field Study The purpose is to examine the leadership’s practices used to maintain and improve the quality and safety standards of the facility and, using the observations and scholarly research, offer recommendations for improvement.
Diabetes Risk Assessment After completing the questionnaire, I learned that my risk for the development of diabetes is above average. Modern risk assessment tools allow identifying the current state of health and possibilities of developing the disease.
The Role of Telenursing in the Management of Diabetes Type 1 Telemedicine is the solution that could potentially increase the coverage and improve the situation for many t1DM patients in the world.
Health Issues of Heart Failure and Pediatric Diabetes As for the population, which is intended to participate in the research, I am convinced that there is the need to specify the patients who should be examined and monitored.
Juvenile Diabetes: Demographics, Statistics and Risk Factors Juvenile diabetes, also referred to as Type 2 diabetes or insulin-dependent diabetes, describes a health condition associated with the pancreas’s limited insulin production. The condition is characterized by the destruction of the cells that make […]
Diabetes Mellitus: Pathophysiologic Processes The main function of insulin produced by cells within the pancreas in response to food intake is to lower blood sugar levels by the facilitation of glucose uptake in the cells of the liver, fat, […]
Type 2 Diabetes Management in Gulf Countries One such study is the systematic review on the quality of type 2 diabetes management in the countries of the cooperation council for the Arab states of the Gulf, prepared by Alhyas, McKay, Balasanthiran, and […]
Patient with Ataxia and Diabetes Mellitus Therefore, the therapist prioritizes using the cushion to the client and persuades the patient to accept the product by discussing the merits of the infinity cushion with a low profile in enabling the customer to […]
Diabetes Evidence-Based Project: Disseminating Results In this presentation, the involvement of mentors and collaboration with administration and other stakeholders are the preferred steps, and the idea to use social networking and web pages has to be removed.
The Problem of Diabetes Among African Americans Taking into consideration the results of the research and the information found in the articles, the problem of diabetes among African Americans has to be identified and discussed at different levels.
Childhood Obesity, Diabetes and Heart Problems Based on the data given in the introduction it can be seen that childhood obesity is a real problem within the country and as such it is believed that through proper education children will be […]
Hypertension and Antihypertensive Therapy and Type 2 Diabetes Mellitus In particular, Acebutolol impairs the functions of epinephrine and norepinephrine, which are neurotransmitters that mediate the functioning of the heart and the sympathetic nervous system.
Diabetes: Diagnosis and Treatment The disease is characterized by the pancreas almost not producing its own insulin, which leads to an increase in glucose levels in the blood.
How to Manage Type 2 Diabetes The article is significant to the current research problem as the researchers concluded that the assessment of metabolic processes in diabetic patients was imperative for adjusting in the management of the condition.
Clinical Trial of Diabetes Mellitus On the other hand, type II diabetes mellitus is caused by the failure of the liver and muscle cells to recognize the insulin produced by the pancreatic cells.
Diabetes: Diagnosis and Related Prevention & Treatment Measures The information presented on the articles offers an insight in the diagnosis of diabetes among various groups of persons and the related preventive and treatment measures. The study identified 3666 cases of initial stages of […]
Reinforcing Nutrition in Schools to Reduce Diabetes and Childhood Obesity For example, the 2010 report says that the rates of childhood obesity have peaked greatly compared to the previous decades: “Obesity has doubled in Maryland over the past 20 years, and nearly one-third of youth […]
The Connection Between Diabetes and Consuming Red Meat In light of reporting the findings of this research, the Times Healthland gave a detailed report on the various aspects of this research.
Synthesizing the Data From Relative Risk Factors of Type 2 Diabetes Speaking of such demographic factors as race, the white population suffers from it in the majority of cases, unlike the rest of the races, the remaining 0.
Using Exenatide as Treatment of Type 2 Diabetes Mellitus in Adults Kendal et al.analyzed the effects of exenatide as an adjunct to a combination of metformin and sulfonylurea against the combination of the same drugs without the adjunct.
Enhancing Health Literacy for People With Type 2 Diabetes Two professionals, Andrew Long, a professor in the school of heath care in the University of Leeds, and Tina Gambling, senior lecturer in the school of health care studies from the University of Cardiff, conducted […]
The Scientific Method of Understanding if Coffee Can Impact Diabetes The hypothesis of the experiment ought to be straightforward and understandable. The control group and the experiment group for the test are then identified.
Gestational Diabetes Mellitus: Review This is because of the current patterns that show an increase in the prevalence of diabetes in offspring born to mothers with GDM.
Health Service Management of Diabetes During the task, Fay makes a countless number of short calls and often takes water irrespective of the time of the day or the prevailing weather conditions.
Necrotizing Fasciitis: Pathophysiology, Role of Diabetes In the event of such an infection, the body becomes desperate to get rid of the intruders. For WBC, zero is given if the count is below 15cells/mm3, one is given if the count lies […]
The Benefits of Sharing Knowledge About Diabetes With Physicians In this research, 3600 diabetic patients were surveyed from twelve hospitals, but due to exclusion criterion, only 1,200 were considered for this particular research. The system allocated numbers to the participants out of which 100 […]
Gestational Diabetes Mellitus – NSW, Australia We had a deeper evaluation of the implications of GDM and we cited the inadequacy of resources and technology as the contributors of GDM.
Health and Wellness: Stress, Diabetes and Tobacco Related Problems
52-Year-Old Female Patient With Type II Diabetes
Healthy People Project: Personal Review About Diabetes
Nursing Care For the Patient With Diabetes
Coronary Heart Disease Aggravated by Type 2 Diabetes and Age
Diabetes as the Scourge of the 21st Century: Locating the Solution
Psychosocial Implications of Diabetes Management
Gestational Diabetes in a Pregnant Woman
Diabetes Mellitus: Prominent Metabolic Disorder
Holistic Approach to Man’s Health: Diabetes Prevention
Holistic Image in Prevention of Diabetes
Educational Strategies for Diabetes to Patients
Diabetes and Obesity in the United Arab Emirates
Epidemiological Problem: Diabetes in Illinois
Diabetes as a Chronic Condition
Managing Diabetes Through Genetic Engineering
Diabetes, Functions of Insulin, and Preventive Practices
Treating of Diabetes in Adults
Diabetes II: Reduction in the Incidence
Community Health Advocacy Project: Diabetes Among Hispanics
Community Health Advocacy Project: Hispanics With Diabetes
Hispanics Are More Susceptible to Diabetes That Non-Hispanics
Rates Diabetes Between Hispanics Males and Females
Diabetes Mellitus and HFSON Conceptual Framework
Prince Georges County Community Health Concern: Diabetes
Fats and Proteins in Relation to Type 2 Diabetes
Alcohol Interaction With Medication: Type 2 Diabetes
Critical Analysis of Policy for Type 2 Diabetes Mellitus in Australia
The Treatment and Management of Diabetes
Obesity and Diabetes: The Enemies Within
Impact of Diabetes on the United Arab Emirates’ Economy
Childhood Obesity and Type 2 Diabetes
Diabetes Management: How Lifestyle, Daily Routine Affect Blood Sugar
Diabetes Management: Diagnostics and Treatment
Diabetes Mellitus Type 2: The Family Genetic History
Diabetes Type II: Hormonal Mechanism and Intracellular Effects of Insulin
Social, Behavioral, and Psychosocial Causes of Diseases: Type 2 Diabetes
Supportive Intervention in the Control of Diabetes Mellitus
Enhancing Foot Care Practices in Patients With Diabetes
Community Health Promotion: The Fight Against Diabetes in a Community Setting
Diabetes in Australia and Saudi Arabia
Diabetes: The Advantages and Disadvantages of Point of Care Testing
Diabetes Mellitus Type 2 or Non-Insulin-Dependent Diabetes Mellitus
Qualitative Research in Diabetes Management in Elderly Patient
Diabetes Prevention Measures in the Republic of the Marshall Islands
Diabetes Mellitus Management in the Elderly
Impact of Diabetes on Healthcare
Gestational Diabetes: American Diabetes Association Publishers
Health Promotion: Diabetes Mellitus and Comorbidities
Diabetes Mellitus Effects on Periodontal Disease
Diabetes Type II Disease in the Community
The Relationship of Type 2 Diabetes and Depression
Glycemic Control in Individuals With Type 2 Diabetes
The Diagnosis of Diabetes in Older Adults and Adolescents
Physical Activity in Managing Type-2 Diabetes
High Risk of Developing Type 1 and Type 2 Diabetes Mellitus
Children With Type 1 Diabetes in Clinical Practice
Type 2 Diabetes Treatment Analysis
Type 2 Diabetes Mellitus: Revealing the Diagnosis
The Type 2 Diabetes Prevention: Lifestyle Choices
Indigenous and Torres Strait Population and Diabetes
Interpretation of the Diabetes Interview Transcript
Type 1 Diabetes: Using Glucose Monitoring in Treatment
Managing Type 2 Diabetes Patients’ Blood Sugar Prior to and After Surgical Procedures
Diabetes Prevention: The Sanofi-Aventis Leaflet Review
Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes: Medical Terminology Definition
Modern Diabetes Treatment Tools
Current Dietary for the Treatment of Diabetes
Stranahan on Diabetes Impairs Hippocampal Function
Is There Anu Cure For Diabetes?
Diabetes Self-Management: Evidence-Based Nursing
Diabetes Type 2 in Children: Causes and Effects
Diabetes Prevention in Chinese Elderly in Hunan
Type 2 Diabetes: Nursing Change Project
Type 2 Diabetes in Geriatric Patients
Cultural Empowerment. Diabetes in Afro-Americans
Diabetes Self-Management: Relationships & Expectations
Diagnosis and Classification of Diabetes Mellitus
Diabetes Impact on Cardiovascular and Nervous Systems
Side Effects of Metformin in Diabetes Treatment
Type 2 Diabetes and Drug Treatments
Diabetes Mellitus and Health Determinants
Nursing Leadership in Diabetes Management
Latent Autoimmune Adult Diabetes
Obesity: Epidemiology and Health Consequences
Diabetes in Urban Cities of United States
Diabetes in Australia: Analysis
Type 2 Diabetes in the Afro-American Bronx Community
Type 2 Diabetes From Cultural and Genetic Aspects
Type 2 Diabetes in Bronx: Evidence-Based Practice
Type 2 Diabetes in Bronx Project for Social Change
Diabetes as Community Health Issue in the Bronx
Diabetes Management Plan: Diagnosis and Development
Diabetes Treatment and Care
Transition from Pediatric to Adult Diabetes Care
Diabetes Awareness Program and Strategic Planning
Diabetes: Disease Control and Investigation
Perception of Diabetes in the Hispanic Population
Clinical Studies of Diabetes Mellitus
Diabetes Mellitus and Problems at Work
Diabetes in the US: Cost Effectiveness Analysis
Diabetes Investigation in Space Flight Research
Diabetes Care Advice by Food and Drug Administration
Artificial Intelligence for Diabetes: Project Experiences
Diabetes Patients’ Long-Term Care and Life Quality
Chronic Care Model for Diabetes Patients in the UAE
Diabetes Among British Adults and Children
Endocrine Disorders: Diabetes and Fibromyalgia
Epidemiology of Type 1 Diabetes
Diabetes: Treatment Technology and Billing
Pathophysiology of Mellitus and Insipidus Diabetes
Cure for Diabetes: The Impossible Takes a Little Longer
Stem Cell Therapy and Diabetes Medical Research
Type II Diabetes Susceptibility and Socioeconomic Status
Diabetes Mellitus Type 2: Pathophysiology and Treatment
Obesity and Hypertension in Type 2 Diabetes Patients
Strongyloides Stercoralis Infection and Type 2 Diabetes
Socioeconomic Status and Susceptibility to Type II Diabetes
Diabetes Disease in the USA Adults
Education for African Americans With Type 2 Diabetes
Diabetes Care: Leadership and Strategy Plan
Diabetes Mellitus’ New Treatment: Principles and Process
Diet and Nutrition: European Diabetes
Preventing the Proliferation Diabetes
Diabetes and Cardiovascular Diseases in Medicine
Ecological Models to Deal with Diabetes in Medicine
Analysis of Program “Prevent Diabetes Live Life Well”
The Effect of Physical, Social, and Health Variables on Diabetes
Micro and Macro-Cosmos in Medicine and Care Models for Prevention of Diabetes
Why Qualitative Method Was Chosen for Diabetes Program Evaluation
Humanistic Image of Managing Diabetes
Diabetes mellitus Education and hemoglobin A1C level
Obesity, Diabetes and Heart Disease
Illuminate Diabetes Event Design
Cause and Diagnosis of Type 2 diabetes
Patient Voices: Type 2 Diabetes. Podcast Review
Type I Diabetes: Pathogenesis and Treatment
Human Body Organ Systems Disorders: Diabetes
Age Influence on Physical Activity: Exercise and Diabetes
Hemoglobin A1C Test for Diabetes
Why Injury and Diabetes Have Been Identified as National Health Priority?
What Factors Are Involved in the Increasing Prevalence of Type II Diabetes in Adolescents?
Does the Socioeconomic Position Determine the Incidence of Diabetes?
What Are the Four Types of Diabetes?
How Fat and Obesity Cause Diabetes?
How Exercise Affects Type 2 Diabetes?
How Does the Treatment With Insulin Affect Type 2 Diabetes?
How Diabetes Does Cause Depression?
Does Diabetes Prevention Pay For Itself?
How Does Snap Participation Affect Rates of Diabetes?
Does Overeating Sugar Cause Diabetes, Cavities, Acne, Hyperactivity and Make You Fat?
Why Diabetes Mellitus and How It Affects the United States?
Does Alcohol Decrease the Risk of Diabetes?
How Does a Person With Diabetes Feel?
Does Periodontal Inflammation Affect Type 1 Diabetes in Childhood and Adolescence?
How Can the Paleolithic Diet Control Type 2 Diabetes?
How Does Insulin Help Diabetes Be Controlled?
Does Economic Status Matter for the Regional Variation of Malnutrition-Related Diabetes?
How Can Artificial Intelligence Technology Be Used to Treat Diabetes?
What Are the Main Causes and Treatments of Diabetes?
What Evidence Exists for Treatments Depression With Comorbid Diabetes Using Traditional Chinese Medicine and Natural Products?
Why Was Qualitative Method Chosen for Diabetes Program Evaluation?
What Are the Three Types of Diabetes?
How Does Poverty Affect Diabetes?
What Is the Leading Cause of Diabetes?
How Is Diabetes Diagnosed?
What Are the Main Symptoms of Diabetes?
How Diabetes Adversely Affects Your Body?
What Are the Most Common Symptoms of Undiagnosed Diabetes?
Epigenetics Essay Titles
Alcohol Abuse Paper Topics
Pathogenesis Research Ideas
Therapeutics Research Ideas
Hypertension Topics
Osteoarthritis Ideas
Cardiomyopathy Titles
Malnutrition Titles
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Life with Type 1—A Photo Essay

When I began dating my husband Tom I couldn’t have told you the purpose of the pancreas, let alone the difference between type 1 and type 2 diabetes . An ever-growing epidemic in the United States, type 2 is typically the result of diet and lifestyle choices and is largely preventable. It’s a disease that we’ve unfortunately become accustomed to hearing about on a regular basis. But what about the millions in this country living with type 1? They seem to have been lost in the discussion.

Both diseases are a result of problems with insulin, one of the hormones the body uses to regulate blood sugar and derive energy from food. But that’s where similarities end. Very simply put, type 2 diabetes has to do with insulin resistance. The pancreas produces it, but the body doesn’t use the insulin properly. Type 2 can be managed through a combination of diet, exercise and medication before (if ever) resorting to insulin injections. Meanwhile type 1 is an autoimmune disease (often diagnosed early in life—in Tom’s case at 2 years old) in which the pancreas stops producing insulin altogether. People with type 1 diabetes rely on insulin injections to lower blood sugar. Insulin is not a cure; it simply allows a person with type 1 to stay alive.

The complications of type 1 diabetes are grave, both short and long term. Administering too much insulin can cause low blood glucose (hypoglycemia), which can lead to seizures, coma and in extreme circumstances, death. On the opposite end of the spectrum, not enough insulin can cause very high blood glucose which can lead to diabetic ketoacidosis (DKA), a life-threatening condition in which the blood becomes too acidic. The potential long-term complications are equally terrifying: blindness, kidney failure and limb amputation to name a few.

Life with type 1 is a perpetual and exhausting tightrope act. The goal is to achieve optimal blood glucose levels without going too high or too low. But despite constant finger pricks to check/re-check blood sugar, meticulous dosage and timing of insulin boluses, counting carbs and considering a myriad of other factors, it is virtually impossible to mimic the human pancreas. Factors that impact blood sugar include and are not limited to: all food (healthy or unhealthy), stress, imperfect timing and/or dosage of insulin, dehydration, exercise, weather, sleep (too much or lack of), inconsistent schedule, hormones, caffeine, illness … the list goes on.

Tempering my anxiety over Tom’s disease while being a supportive (but not overbearing) partner is something I work at on a daily basis. Lows in particular are a constant struggle for me. After having the disease for over 33 years, Tom has developed a dangerous condition called hypoglycemic unawareness in which he can no longer feel the symptoms (shakiness, lightheadedness) that serve to warn of a dropping blood sugar. I worry he’ll go too low while he’s driving, while he’s sleeping, when I’m not there. I worry about everything.

I often think about how unfair it is that people with type 1 diabetes never get a break from the burden of such complex, unrelenting disease. One can’t take a pill and forget about it for a few hours. Imagine having to manage a disease without a rulebook—it behaves differently for each person and under each circumstance. Type 1 requires attention and action 24/7, so it’s easy to understand how one might feel burned out or isolated. I’ve told my husband that I wish I could take his place, even for a single day, so he could know the freedom of life without having to think about blood sugar.

All this being said, to know Tom is to know the happiest guy on the planet. I marvel at his strength, his commitment to his health (particularly when it’s not easy, which is most of the time), his childlike joy for life. His absolute refusal to give in to bitterness. Every single day with Tom is filled with adventure and belly laughs. Yes, type 1 is always there, looming, but never able to define him. He won’t let it.

Documenting life with type 1 has been cathartic for me, and I hope can bring some awareness (however small) to the plight of all people with type 1 diabetes and their families.

A small tattoo on Tom’s right forearm with big meaning. It’s an homage to his lifeblood: C 2 5 7 H 3 8 3 N 6 5 O 7 7 S 6 is the chemical formula for the synthetic insulin he has taken for the majority of his life.

Tom filling up the reservoir of his insulin pump, which he must wear at all times. Tubing connects the pump to an insertion site on his stomach (the site needs to be moved around every few days to avoid scar tissue buildup). At the insertion site is a tiny cannula that delivers the insulin directly into his bloodstream. A healthy pancreas constantly produces basal insulin (meaning a low dose, baseline) every few minutes, 24 hours a day, and automatically increases/decreases the amount it makes based on the current amount of glucose already in the blood. It also produces bolus insulin (meaning a larger amount) when the body requires more insulin to cover the increased amount of glucose in the bloodstream when a person eats. A healthy pancreas does a remarkable job of monitoring the exact amount of insulin needed to match the glucose that enters the blood. With type 1 diabetes, the pancreas cannot produce basal or bolus insulin, so synthetic insulin must be administered either by injection, or in Tom’s case, with a pump.

The question of course, is how much insulin. The pump has been a life-changing piece of technology for Tom and so many others; until he was 15 years old he had to administer manual injections to himself. It’s important to remember, however, that the insulin pump is not an intelligent device. While it makes administering the insulin much easier, Tom must still make the decisions as far as dosing.

The contents of Tom’s diabetes supply cabinet. It isn’t entirely clear what triggers the onset of type 1 diabetes. Researchers have discovered that genetics play a role; there is an inherited predisposition. They do not, however, know exactly what sets off the immune system causing it to turn against itself and destroy the insulin-producing beta cells in the pancreas. Unlike type 2, type 1 diabetes has nothing to do with diet or lifestyle and is typically diagnosed during childhood.

Keeping my anxiety in check while Tom sleeps can be difficult for me. Is he just sleeping in? Is he conscious? Is he taking a nap because he’s genuinely tired or because he’s lethargic due to a low? I admit my worry has gotten the best of me many times. Early on in our relationship, I found myself waking him up to deliver pressing messages like “look how cute the dog is being right now” just to make sure he wasn’t dangerously low or unconscious. Needless to say, that approach didn’t go over well. Type 1 is a disease that affects the whole family, and I’m still very much a-work-in-progress when it comes to determining when is appropriate for me to act as caretaker and when I’m overstepping boundaries and need to let go.

One of the insulin pumps Tom has used over the 21 years he’s been pumping. Once it was retired, we decided to take it apart for a look at the innards. Just like this old one, his new pump is routinely mistaken for a pager and it cracks us up every time.

Here Tom is inserting the sensor for his continuous glucose monitor, or CGM. A tiny electrode measures the blood glucose levels in tissue fluid every five minutes. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. This recent technology has been a game changer in his management of type 1. Not only does it give Tom a ballpark idea of where his blood sugar is at, but an alarm on the monitor will sound when certain levels (high or low) are reached. The CGM is not 100 percent accurate by any means (there’s a lag when glucose moves from blood to tissue fluid so it’s not quite real time) and it doesn’t replace finger pricks (it constantly needs to be calibrated with them), but is a useful tool and potential safety net. The CGM alarm sounding like a fog horn at 3 a.m. is always a jarring, but a welcome, disruption from sleep … at least to me.

Between constant finger pricks and in the above case, accidentally hitting a blood vessel during CGM sensor insertion, it’s hard for people with type 1 diabetes not to feel like a pin cushion at times.

Type 1 is an invisible, misunderstood disease. Things people often say to Tom: “You don’t look like you have diabetes,” “But you’re thin,” “Can you eat that?”, “That stinks you can’t have sugar.” Many erroneously lump type 1 diabetes together with type 2, which is understandable (and something I did before I met Tom) due to the fact that they share the same name. Many type 1 advocates, myself included, feel that the diseases should be differentiated with unique names. There’s already so much confusion surrounding the facts about diabetes, it would help raise awareness and benefit those living with both type 1 and type 2 if the public were better informed.

Tom filling his pump with insulin and priming the tubing before insertion.

Our days are filled with yo-yoing numbers, and this is one that we don’t like to see. 65 is low enough to require treatment with fast-acting carbohydrates. I sometimes find myself hovering over the meter when Tom does a finger prick, trying to get a glimpse of the number. While my intentions are of course good, it’s important to remind myself to respect Tom’s space and his ability to manage it on his own. It’s his body, after all, and he survived most of his life just fine without me. I once heard type 1 likened to a stepchild for a spouse, a comparison that resonated with me. While it will always be a part of my life and it’s important for me to be involved to a certain extent, type 1 will always be Tom’s baby and his alone.

Juice boxes are the go-to treatment for lows so Tom knows exactly how many carbs he’s taking in with each one.

Tom participating as a subject in an artificial pancreas study at the University of Chicago. Researchers are working to develop an algorithm that links the insulin pump to the CGM, while automatically delivering the appropriate amount of insulin making it a fully automated process. The artificial pancreas could potentially ease the burden of people with type 1 diabetes in a monumental way, allowing them not to have to think about their blood glucose 24/7. It wouldn’t be a cure, but the next best thing.

Apple juice to the rescue.

Tom spent 72 hours in the hospital monitoring his blood sugar every five minutes, with a team of researchers sitting beside the bed (even while he slept) working on the algorithm.

The unicorn: a constant straight line of stable blood sugar readings on Tom’s CGM monitor.

Type 1 is a cruel, demanding disease. You can do everything right and still get an inexplicable blood sugar. It’s easy to blame yourself, get down about it and stress about the potential complications. What’s more important, as Tom has taught me, is to live life on your own terms. The straight line above is yes, something to be celebrated, but not something to be expected on an average day with type 1. That’s the thing, there IS no average day. All you can do is your best, and meanwhile enjoy life.

This article was originally published on Anne Marie Moran’s blog.

Want to spread awareness? Become an ambassador at Beyond Type 1 . Click the button to learn all the ways you can become involved in Beyond Type 1’s global community!

WRITTEN BY Anne Marie Moran, POSTED 09/14/16, UPDATED 04/03/24

Diabetes and the ketogenic diet -, diabetes isn’t even that bad -, how diabetes impacts your mental health -.

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Life with Diabetes: A College Entrance Essay by an Amazing Young Woman

Wednesday, february 22, 2012, 15 comments:.

Stephanie, Good luck...your attitude and spirit will see you far in life. Thank you so much for allowing Hallie to share this with us. My son is 8. "D" isn't on his radar yet...too busy with hockey. I have a feeling we will struggle on and off over the years. I have encouraged him to try a "d" camp and he is not interested yet. I do think it is so very important to realize some "same-same" in all of this. Love to you and your fam, Reyna

Stephanie, Thank you for that and thank you Hallie for sharing it. My 10yo daughter is only four months into this D-life but I hope she grows up to have such a wonderful attitude! She will be going to a D-camp this summer and I hope it helps. Thank you for the encouragement! I might just let her read your essay. Julie

Stephanie I've been contemplating camp for my 9 yr old who's only been dx for 7 mths, thanks for the encouraging word we will look into it now. She has no one at her school and still doesn't like to test and take shots in front of people. Thank you for sharing your essay. Jennifer, mom to Sophia

Stephanie, Thank you for sharing your beautiful words. As a parent of a T1 child, I find your insight into this secluded world both interesting and encouraging. My nine year old daughter was diagnosed last May. I think so far she has struggled most with the feeling of being different than her peers. She has recently begun to feel the sting of exclusion from parties and play dates with the other girls in her class because of ignorance of this disease. Thank you for the reminder that diabetes can have some positive effects in her life to slightly off set the long list of negatives. I pray that some day she will have as positive an attitude as you do. Thank you for the much needed encouragement. May God bless you in all that you do.

Thank you, Stephanie, for your sweet words! You are mature for your age, and I'm so proud of you. My daughter is 9, and going on 8 years with D by her side. She's growing, and I pray she turns out with a great attitude like yours! : ) Hugs, Holly Thanks for sharing, Hallie!!

Stephanie Hi! This is Jen Loving's daughter Nora.I was dxd with T1D when i was 4 in a half years old and now I am 11 years old. I always ask the questions to myself 'Why me?' too. Now that I read this masterpiece of yours I am not. I KNOW YOU WILL GET VERY FAR IN YOUR LIFE!! :) I want to thank you for sharing your story with all of us!:) God Bless, Nora

Hallie, you are the amazing one! You reach so many people and really make a difference. One note: I was scared to death to send Stephanie to overnight Diabetes Camp, since I couldn't talk to her for a week and I wouldn't be in control of her diabetes care. She and I both cried when I dropped her off. I worried all week, but was comforted by the fact that there were doctors and nurses there to care for her. I worried that she was miserable and couldn't call me to talk about it. It was a very stressful week for me. Then...I went to pick her up a week later and she didn't want to leave camp. She cried when we left to go home. Her and her new friends made plans to meet up and plan for camp a year later. I was so relieved! I began to look forward to overnight diabetes camp along with Stephanie. Now for the past 7 years there has been a week where she feels "normal" and where I can relax knowing she is happy and well cared for in a way that surpasses how I could ever care for her. Dianne

Being a D mama of a 5yo I can imagine how proud your parents must be! You'll do great things in life for sure, you have the right attitude. Keep walking your head held high, you are a wonderful young woman! Thanks for sharing Stephanie Camille ;)

Well hi everyone! This is kind of surreal because the only person on here I've ever met is my mom...and you're all saying such nice things to/about me. I almost cried reading all of it. I'm so happy that my essay has had such an effect on everyone. I absolutely LOVE that I might be convincing people to send their kids to camp. (Do it! You will NEVER regret it!) I just wanted to thank you all for the kind words and thank Hallie for posting this. Tell Sweetpea I say hi :) Stay Diabetastic ;) -Stephanie

thank you for sharing :) kelly woods

Wow! Stephanie, you are a real inspiration. I can't wait to share your beautiful words with my 8 year old. Best of luck to you!

Well, thanks for the cry! Just beautiful!

thank you for sharing this! it is beautiful and inspiring and gives me such hope for my Emma's future. My favorite line is "I want to use my story to show people that your differences aren’t a weed you need to kill. They’ll flower into something amazing if you let them." Good luck to Stephanie in all of your future endeavors!

I really enjoyed reading that! No, I did not cry perhaps because I am a PWD. It was so heartfelt and real and lovely. I like this Stephanie person a lot!

Your blog is very useful and provides tremendous facts. Keep up the good work. best admission essay

Thanks for commenting! Comments = Love

Acknowledgments

Connected content.

In a special series of the ADA Journals' podcast Diabetes Core Update , host Dr. Neil Skolnik interviews special guests and authors of this clinical compendium issue. Listen now at Special Podcast Series: Focus on Diabetes or view the interviews on YouTube at A Practice Guide to Diabetes-Related Eye Care .

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Thomas W. Gardner; Summary and Conclusion. ADA Clinical Compendia 1 July 2022; 2022 (3): 20. https://doi.org/10.2337/db20223-20

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Diabetes is a multifactorial disease process, and its long-term management requires the active involvement of people with diabetes and their families, as well as a large multidisciplinary care team to ensure optimal health, quality of life, and productivity. Keeping up with new medications, emerging technology, and evolving treatment recommendations can be challenging, and the language and care processes commonly used by practitioners in one discipline may be less familiar to other diabetes care professionals.

In the realm of diabetes-related eye care, our ability to prevent the progression of diabetes-related retinal disease and thereby preserve vision has never been greater. However, far too many people with diabetes still are not receiving appropriate screening to identify eye disease early and ensure its timely treatment.

It is our hope that this compendium has provided information and guidance to improve communication and encourage collaboration between eye care professionals and other diabetes health care professionals and allow them to more effectively cooperate to reduce barriers to care and improve both the ocular and systemic health of their shared patients.

Editorial and project management services were provided by Debbie Kendall of Kendall Editorial in Richmond, VA.

Dualities of Interest

B.A.C. is a consultant for Genentech and Regeneron. S.A.R. is a speaker for Allergan, Inc., and VSP Vision Care. No other potential conflicts of interest relevant to this compendium were reported.

Author Contributions

All authors researched and wrote their respective sections. Lead author T.W.G. reviewed all content and is the guarantor of this work.

The opinions expressed are those of the authors and do not necessarily reflect those of VSP Vision Care, Regeneron, or the American Diabetes Association. The content was developed by the authors and does not represent the policy or position of the American Diabetes Association, any of its boards or committees, or any of its journals or their editors or editorial boards.

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Home — Essay Samples — Nursing & Health — Diabetes — The Type 1 and Type 2 Diabetes

The Type 1 and Type 2 Diabetes

Categories: Diabetes

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Published: Jan 29, 2019

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Sharing My Story: Our First Month as Parents of a Type 1 Diabetic

Kylie’s son, Rowen, lives with type 1 diabetes—but Kylie refuses to let the fear hold their family back.

I’m the parent of a type 1 diabetic. It’s probably something you never wondered about before—I know I had never thought about it. One day your 14-month-old baby is healthy and happy, the next they are vomiting, weak, unable to move and being rushed to the ER. It’s a terrifying time to a be a parent. In the PICU we were scared and overwhelmed. Hundreds of questions and thoughts raced through our minds. Is my child going to survive? Type 1 diabetes? You can’t be serious?But no one in my family is type 1! I don’t know if I can do this. I have to poke my child several times a day to check his blood sugar and give him insulin now?

Coming home from the hospital, it was like having a newborn. Except my new job is a full-time pancreas for my child, and let me tell you, it is a very labor-intensive one. Until we got Rowen’s CGM (continuous glucose monitor), our schedule was as follows per our endocrinologist:

Breakfast: Check blood sugar
30 minutes after breakfast: Give insulin based on amount of carbs eaten (do not exceed 30 minutes; if he’s not done, unfortunately he is now)
Two hours after breakfast: Check blood sugar (if high, give water; if low, treat accordingly and re-check in 10-15 minute.)
Lunch: Check blood sugar
30 minutes after lunch: Give insulin based on amount of carbs eaten (do not exceed 30 minutes; if he’s not done, unfortunately he is now)
Two hours after lunch: Check blood sugar
Dinner: Check blood sugar
Two hours after dinner: Check blood sugar
Before bed: Check blood sugar
2:00 am: Check blood sugar (this one is very important since some diabetics go low around this time)

It’s extremely overwhelming to overhaul the life you once knew. Going to the grocery store takes twice as long because you have to read the amount of carbs and sugar in everything you are going to give your child. Going out for a meal, you either have to bring your own food for him, go to a chain that has nutrition facts or utilize my favorite diabetic term, SWAG (scientific wild a** guess). Everything in your pantry and fridge has a number. You keep tons of candy and frosting on hand. Your child becomes more emotional when he has high blood sugar, low blood sugar, and drops or rises quickly. How active your child is affects his blood sugar--adrenaline sometimes will make your blood sugar go up, then drop. Taking a warm bath or shower lowers his blood sugar. When Rowen is very angry, he has elevated blood sugar. When he sleeps, is he breathing? When his blood sugar is low, is he going to have a seizure?

Diabetes. Affects. Everything. Not just the individual with diabetes. The whole family dynamic changes. It’s expensive. It’s taxing on the emotions of the caretakers. Diseases can make or break parents. Fortunately it hasn’t broken us, as stressful as it can be.

When you get the confirmation of type 1 diabetes, you have to swallow every emotion you have, put it in the back of your mind and become strong. You want to be a role model for your child. You want to show them that this disease will not define them and hold them back. Instead of worrying about how you’re going to do this, you dive right in and say, “I can do it, I was meant to do this.”

People tell you “I don’t know how you do it, I could never!” When it’s your child, you don’t think. You just do. More than anything, you wish to take their place. You begin to carry the weight of this heavy disease. You no longer sleep because you’re always worried about their blood sugar levels. You check your phone every five minutes to see what his updated blood sugar number is. Five minutes can be the difference between regular blood sugar or the need to treat a dangerously low blood sugar. You cry in the shower because that is the only place you allow yourself to break for just a moment.

Eventually you stop crying (as much), you get a grasp on it and continue life as usual.

It’s hard to be a parent to type 1 diabetic because your life revolves around numbers, insulin and your child’s feelings. If you know anyone who has a child who is type 1 or is type 1 themselves, reach out every now and then. You don’t need to understand what they are going through--just be around for them. It’s a very isolating disease. We go through a lot and it’s not an easy job with terrible pay.

But the reward is seeing your child thrive, and it is so worth it.

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These are the personal experiences of individuals living with diabetes and does not constitute medical advice. Please consult with qualified health care professionals to meet your individual health and medical needs.

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Current and future therapies for type 1 diabetes

Bernt johan von scholten.

1 Global Chief Medical Office, Novo Nordisk A/S, Søborg, Denmark

Frederik F. Kreiner

Stephen c. l. gough, matthias von herrath.

2 Type 1 Diabetes Center, The La Jolla Institute for Immunology, La Jolla, CA USA

Associated Data

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In type 1 diabetes, insulin remains the mature therapeutic cornerstone; yet, the increasing number of individuals developing type 1 diabetes (predominantly children and adolescents) still face severe complications. Fortunately, our understanding of type 1 diabetes is continuously being refined, allowing for refocused development of novel prevention and management strategies. Hitherto, attempts based on immune suppression and modulation have been only partly successful in preventing the key pathophysiological feature in type 1 diabetes: the immune-mediated derangement or destruction of beta cells in the pancreatic islets of Langerhans, leading to low or absent insulin secretion and chronic hyperglycaemia. Evidence now warrants a focus on the beta cell itself and how to avoid its dysfunction, which is putatively caused by cytokine-driven inflammation and other stress factors, leading to low insulin-secretory capacity, autoantigen presentation and immune-mediated destruction. Correspondingly, beta cell rescue strategies are being pursued, which include antigen vaccination using, for example, oral insulin or peptides, as well as agents with suggested benefits on beta cell stress, such as verapamil and glucagon-like peptide-1 receptor agonists. Whilst autoimmune-focused prevention approaches are central in type 1 diabetes and will be a requirement in the advent of stem cell-based replacement therapies, managing the primarily cardiometabolic complications of established type 1 diabetes is equally essential. In this review, we outline selected recent and suggested future attempts to address the evolving profile of the person with type 1 diabetes.

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Supplementary Information

The online version contains a slide of the figure for download available at 10.1007/s00125-021-05398-3.

Introduction

In addition to prolonging the life expectancy of people living with type 1 diabetes, the discovery of insulin a century ago revolutionised the management of this chronic autoimmune disease. Today, type 1 diabetes is the most common type of diabetes in children, and estimates suggest that around 100,000 children develop the disease every year [ 1 ]. Unfortunately, despite the availability of advanced insulins, affected individuals remain at high risk of serious complications, including cardiovascular mortality [ 2 – 4 ]. New interventions are, therefore, urgently required to improve the prognosis for the increasing number of people who are diagnosed with type 1 diabetes each year.

The profile of the person with type 1 diabetes is evolving and, with that, our understanding of the disease. The overall pathophysiological feature is loss of functional beta cell mass in the pancreatic islets of Langerhans (Fig. (Fig.1) 1 ) [ 5 ]. Hypotheses suggest that the loss of functional beta cell mass occurs in a chain of events analogous to an ‘assisted suicide’ [ 6 , 7 ], where the demise of the beta cell is likely due to a combination of a dysfunctional beta cell that becomes more visible to the immune system, which, in turn, overreacts and destroys the beta cell.

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Object name is 125_2021_5398_Fig1_HTML.jpg

Hallmarks of the evolving profile of the individual with type 1 diabetes, and current and future options for the prevention of this disease and for the management of its associated complications. a According to some recent evidence [ 124 – 130 ]. This figure is available as a downloadable slide

In its early stage (Stage 1), type 1 diabetes is usually asymptomatic; however, the development of autoimmunity is often detectable in early life, with circulating autoantibodies targeting insulin or other proteins, such as GAD65, insulinoma-associated protein 2 (IA2) or zinc transporter 8 (ZNT8) [ 5 ]. When a large portion of the beta cell mass has become dysfunctional or lost, asymptomatic dysglycaemia (Stage 2) and, later, symptoms of hyperglycaemia (Stage 3) ensue due to insufficient or absent insulin secretion.

Type 1 diabetes is a polygenic disorder, in which susceptibility loci or genetic variation contributes to disease risk. The HLA region on chromosome 6 is the main susceptibility locus and, in recent years, many other loci across the genome have been associated with an increasing risk of the disease [ 8 ]. However, from studies in monozygotic twins, for whom the onset of type 1 diabetes can vary considerably [ 9 ], it has become evident that non-genetic factors play a major role in triggering or perpetuating overt type 1 diabetes. A multitude of efforts have failed at robustly identifying such factors, strongly indicating that no single pathogen is responsible. Viral infections have been suggested, including enteroviruses and human herpesvirus-6 [ 10 – 13 ]. Of note, however, studies (mainly in animals) have also suggested that several viral infections may prevent the development of type 1 diabetes [ 14 , 15 ], in line with the ‘hygiene hypothesis’ [ 16 , 17 ].

People living with type 1 diabetes remain dependent on exogenous insulins as the cornerstone therapeutic option [ 18 ]. Since the isolation of insulin in 1921, novel and versatile formulations, analogues and delivery vehicles have been introduced [ 19 , 20 ]. Together with much improved glucose monitoring, these advances have contributed to the increases in the survival and life expectancy of individuals with type 1 diabetes [ 21 ]. Still, only a minority of people with type 1 diabetes achieve recommended glycaemic and time-in-range targets [ 22 ], and hyperglycaemia continues to be a risk factor for short-term metabolic and long-term macro- and microvascular complications [ 2 , 23 – 25 ]. Further, the use of exogenous insulins requires unremitting glycaemic monitoring and dose titration to mitigate the risk of hypoglycaemia. The all-cause mortality risk is around threefold higher for the individual with type 1 diabetes than for the general population [ 2 – 4 , 26 ], and type 1 diabetes has been shown to be linked to cardiovascular outcomes more than any other disease, including type 2 diabetes [ 2 ].

As mentioned earlier, novel interventions are needed for the prevention and management of type 1 diabetes. Whilst progress has been limited, the evolving profile of a person with type 1 diabetes suggests that beyond ensuring accurate titration of exogenous insulin, efficient management of the disease should rely on other additional principles. First, there is an obvious need to act early to prevent or delay the destruction of functional beta cell mass by immunomodulatory intervention or other disease-modifying means. Second, stimulating or reprogramming the remaining beta cell mass to secrete insulin in a balanced way is required to avoid major blood glucose excursions with the lowest possible exogenous insulin dose. Third, reducing the risk of long-term complications, such as cardiovascular and renal outcomes, seems increasingly important (Fig. (Fig.1). 1 ). Below we review selected current and in-development interventions meeting these three criteria (Table (Table1 1 ).

Non-insulin agents for the prevention and management of type 1 diabetes

Mechanism of action/target	Agent	Reference of selected main studies or ClinicalTrials.gov registration no.
Systemic approaches
T effector cells	Teplizumab (anti-CD3)	[ – , ]; NCT03875729
	Otelixizumab (anti-CD3)	[ ]
	ATG	[ ]
	Abatacept (anti-CD80 and anti-CD86)	[ , ]
	Alefacept	[ ]
	Anti-IL-21 antibody	[ , , , ]
B cells	Rituximab (anti-CD20)	[ , ]
T regulatory cell expansion	Low-dose IL-2	[ – ]
Anti-inflammation	Infliximab, adalimumab, etanercept, golimumab (anti-TNF-α)	[ – ]
	Tocilizumab (anti-IL-6R)	[ , ]; NCT02293837
	GLP-1 RAs	[ – ]
Islet/beta cell-specific approaches
Islet-antigen tolerisation/immunisation	Oral insulin	[ – ]
	GAD65	[ ]
	Peptides	[ , ]
Beta cell stress relief and stimulation	GLP-1 RAs	[ , , – , – ]
Beta cell stress relief and stimulation	Verapamil	[ , ]
Cardiometabolic improvements
SGLT inhibition	Dapagliflozin, empagliflozin, sotagliflozin	[ – , , ]
GLP-1 agonism	Exenatide, liraglutide, dulaglutide, semaglutide	[ – , – ]
Other/unspecific	Amylin (pramlintide)	[ , ]
Other/unspecific	Metformin	[ – ]

a Including blood glucose levels, body weight, blood lipids, blood pressure and cardiorenal risk

Immune-focused therapies

The overarching goal of immune-focused therapies in type 1 diabetes is to prevent or delay the loss of functional beta cell mass. The traditional understanding of autoimmunity in type 1 diabetes has focused on systemic immune dysregulation and on autoreactive T cells that have evaded thymic selection and migrated to the periphery, where they destroy islets. This view on the pathogenesis of type 1 diabetes has been referred to as T cell-mediated ‘homicide’ [ 6 ]. Thus, recent efforts have concentrated on cell- or cytokine-directed interventions, which have been successful in other autoimmune diseases. Targeting T cells or proinflammatory cytokines remain valid efforts and many agents are in active development; so far, however, these approaches have been only partly successful. This arguably indicates a need to refocus hypotheses, as discussed later in this review (see ‘ Future perspectives ’ section), where we outline how the beta cell itself contributes to its own demise (the ‘assisted suicide’ hypothesis).

Cell-directed interventions

In line with the traditional immune-centric view on the pathogenesis of type 1 diabetes, many immunomodulatory strategies have focused on antibodies targeting T effector cells. The anti-CD3 antibodies teplizumab and otelixizumab have shown some attenuation of loss of beta cell function [ 27 – 30 ]. A Phase II trial with relatives with a high risk of developing type 1 diabetes indicated a more than 50% risk reduction with teplizumab (HR 0.41 vs placebo) and clinical type 1 diabetes diagnosis was delayed by 1.5–2 years [ 31 ]. Accordingly, teplizumab has recently been granted a breakthrough therapy status by the US Food and Drug Administration. An ongoing Phase III trial (PROTECT; ClinicalTrials.gov registration no. {"type":"clinical-trial","attrs":{"text":"NCT03875729","term_id":"NCT03875729"}} NCT03875729 ) aims to evaluate the benefits and safety of teplizumab in children and adolescents with recently diagnosed type 1 diabetes.

The presence of autoantibodies against beta cell antigens, such as GAD65 and insulin, has spurred attempts targeting B cell-related molecules. These efforts have been somewhat successful in animal models [ 32 , 33 ], as well as clinically, most prominently with the B cell-depleting anti-CD20 antibody rituximab. Although rituximab led to detectable protraction of beta cell function [ 34 ], the effect was transient [ 35 ], exemplifying the fact that B cell-directed therapy alone does not appear to sustainably prevent or ameliorate beta cell autoimmunity. So far, however, B cell-directed agents have not been tested in the early disease stage, precluding conclusions regarding the usefulness of such interventions in delaying or even preventing progression to later stages.

In clinical investigations, low-dose anti-thymocyte globulin (ATG) treatment significantly (vs placebo) preserved C-peptide secretion and improved glycaemic control in children, as well as adults, with new-onset type 1 diabetes [ 36 – 38 ]. The potential benefits of ATG appear to depend on the dose level and the age of the recipients, and the clinical utility of the approach remains to be established. ATG in combination with granulocyte colony stimulating factor (GCSF) was also explored based on the hypothesis of a synergistic benefit of the combination of transient T cell depletion via low-dose ATG with the upregulation of activated T regulatory cells and tolerogenic dendritic cells induced by GCSF. However, the combination did not appear to offer a synergistic effect; in contrast to the use of ATG alone, ATG plus GCSF did not appear to be better than placebo in preserving C-peptide secretion [ 37 ].

Tissue-resident memory T effector cells, which likely play a role in many organ-specific autoimmune diseases, such as type 1 diabetes, are very difficult to eliminate. Alefacept, a T cell-depleting fusion protein that targets CD2 and, therefore, memory T effector cells, was tested in adolescents and young adults with Stage 3 type 1 diabetes in the T1DAL trial [ 39 ]. Although the trial did not complete enrolment as planned, it reported a trend for benefits with regard to beta cell preservation, reduced insulin requirements and low risk of hypoglycaemia that persisted throughout the follow-up of 15 months after treatment.

Importantly, whether considering the targeting of the T or B cell in type 1 diabetes, sufficient long-term benefits via systemic cell pool depletion comes with an inherent risk of introducing equally long-term or even irreversible changes to the immune system. Such changes may predispose the patient to a less favourable prognosis for chronic viral infections. For example, reactivation of Epstein-Barr virus (EBV) has been observed after anti-CD3 therapies [ 40 , 41 ]. Mitigating such risks may be achieved using carefully tailored dosing regimens and monitoring; still, the seriousness of the risks may indicate an unfavourable benefit:risks balance. Therefore, non-depleting immunomodulation has been explored. For example, 24-month blockade of CD80 and CD86 via the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4)-immunoglobulin fusion molecule abatacept markedly prolonged beta cell function in new-onset type 1 diabetes and was accompanied by increased numbers of naive T cells [ 42 , 43 ].

Cytokine-directed interventions

Anti-inflammatory cytokine-specific compounds, which are successfully used, for example, in rheumatic diseases, have been tested as alternatives to directly targeting the T or B cell in type 1 diabetes, as briefly summarised below. In addition, to stimulate an increase in T regulatory cells, low-dose IL-2 treatment has also been tested and the results have been somewhat promising [ 44 – 48 ], with recent developments mitigating earlier caveats, which included an arguably narrow dose range and lack of full specificity for T regulatory cells.

Blockade or antagonism of the central proinflammatory cytokine TNF-α using infliximab, adalimumab or the receptor fusion protein etanercept have shown some potential in type 1 diabetes, with indications of improved glycaemic control and C-peptide secretion [ 49 , 50 ]. More recently, a C-peptide-sparing effect of TNF-α blockade was reported with golimumab use, after 1 year in children and young adults with type 1 diabetes [ 51 ].

IL-6 is another proinflammatory cytokine that has been targeted with success in multiple other autoimmune diseases [ 52 ]. Although its role in type 1 diabetes is not established, IL-6 has been suggested as a target [ 53 ]. Of note, IL-6 has been shown to protect the beta cell from oxidative stress and is constitutively expressed by pancreatic alpha and beta cells, indicating important physiological roles [ 54 ]. In type 1 diabetes, the EXTEND Phase II trial of tocilizumab, a monoclonal antibody against the IL-6 receptor, was recently completed ( ClinicalTrials.gov registration no. {"type":"clinical-trial","attrs":{"text":"NCT02293837","term_id":"NCT02293837"}} NCT02293837 ).

IL-21 has been proposed as an attractive target in type 1 diabetes [ 55 , 56 ]. Physiologically, IL-21 is important not only for the function of T helper (Th) cells (Th17 and T follicular helper cells) but also for the generation and migration of CD8 + T cells. CD8 + T cells are now considered the chief T cell type accumulating in and around islets [ 57 , 58 ] with pre-proinsulin emerging as a pivotal autoantigen driving their infiltration in type 1 diabetes [ 59 ]. IL-21 neutralisation has been shown to prevent diabetes in mice [ 60 ], and a C-peptide-sparing benefit of anti-IL-21 alone or in combination with the glucagon-like peptide-1 (GLP-1) receptor agonist (RA) liraglutide has been observed in a clinical proof-of-concept study [ 61 ], as described further below. Reassuringly, non-clinical models, including a viral type 1 diabetes model, showed a minor impact of IL-21 blockade on the immune repertoire [ 55 ].

Antigen vaccination

With the appeal of having no expected effect on acquired immunity, the overall aim of beta cell antigen vaccination is to induce tolerance by balancing the T cell population between auto-aggressive T effector cells and autoantigen-specific T regulatory cells. Induction of T regulatory cells carries the potential benefit of also downregulating the activity of proinflammatory antigen-presenting cells. The topic has been extensively reviewed in the past [ 62 ]. Briefly, inspired by successes with vaccination against, for example, peanut allergy, tolerisation of T effector cells has been attempted using administration of whole antigens, such as oral insulin, or of peptides. Whilst the concepts are promising and under active investigation, their effectiveness in humans is yet to be proven. For example, in at-risk children, oral insulin administration has previously failed to prevent type 1 diabetes [ 63 , 64 ], speculatively due to a suboptimal dose level or unclear effects across risk-specific subgroups [ 65 , 66 ], including those defined by insulin gene polymorphisms. Similar results and considerations have been reported for immunisation with GAD65 [ 67 ] and for peptide-based therapies [ 68 , 69 ]. Further, the lack of full clarity regarding the mechanisms at play with antigen-based therapies outlines a number of shortcomings, including the fact that no biomarker is currently available to assist in establishing the optimal dose regimen.

Non-immunomodulatory adjunctives

We next focus on selected compounds that have gained attention due to their potential benefits as adjuncts to insulin in type 1 diabetes.

Amylin deficiency is a recognised feature of type 1 diabetes [ 70 ]. As a neuroendocrine hormone, amylin inhibits glucagon secretion and contributes to reducing postprandial glucose variability. As an adjunct to meal-time insulin, the injectable amylin analogue pramlintide is approved only in the USA for the treatment of type 1 and type 2 diabetes alike [ 71 ]. In type 1 diabetes, pramlintide has been shown to improve postprandial glucose levels to some extent [ 72 ]. Its clinical use has been limited, arguably because of the modest efficacy alongside the occurrence of side effects, such as nausea and, most importantly, postprandial hypoglycaemia.

Metformin is a low-cost agent with glucose-lowering effects that mainly occur via decreased hepatic glucose production. It is not a guideline-recommended option in type 1 diabetes. However, partly because of its ameliorating effect on insulin resistance, metformin has been somewhat promising in managing the disease, especially in children and adolescents, as well as in obese people with type 1 diabetes, with studies indicating reduced insulin requirements and body weight reduction [ 73 – 75 ]. In the large REducing With MetfOrmin Vascular Adverse Lesions (REMOVAL) trial, however, metformin did not reduce the long-term insulin needs or improve glycaemic control in people with long-standing type 1 diabetes and multiple cardiovascular risk factors [ 76 ].

Sodium-glucose cotransporter inhibitors

Sodium-glucose cotransporter (SGLT) inhibitors lower blood glucose levels by restraining the absorption of glucose in the small intestine and promoting the renal excretion of glucose [ 77 ]. Results with dapagliflozin, empagliflozin and sotagliflozin have indicated benefits of SGLT inhibition in managing type 1 diabetes when added to insulin [ 78 – 83 ]. Significant benefits included reduced insulin dose requirements, improved glycaemic control and reduced body weight [ 84 ]. So far, sotagliflozin and dapagliflozin are approved in Europe and Japan (but not the USA) as adjuncts to insulin for the management of overweight or obese people with type 1 diabetes when optimally titrated insulin alone does not provide adequate glycaemic control. Importantly, however, data suggest that the use of SGLT inhibitors in type 1 diabetes is associated with markedly increased risk of diabetic ketoacidosis [ 85 – 87 ]; for sotagliflozin, a 5–17-fold risk increase was noted [ 88 ]. These observations prompted the formation of an international consensus on recommendations for the use of SGLT inhibition in type 1 diabetes [ 89 ] as well as a suggestion that treatment should be overseen by specialists [ 88 ].

GLP-1 is a hormone of the incretin system that is secreted upon food intake. A marked uptake has been seen in the use of GLP-1 RAs in type 2 diabetes due to their pleiotropic glucose-dependent effects that improve glycaemic control and reduce body weight [ 90 ]. In contrast, GLP-1 agonism for the treatment of type 1 diabetes remains unproven, with initial results from smaller investigator-conceived studies being inconclusive. Recently, Phase II findings with the short-acting GLP-1 RA exenatide in adults with type 1 diabetes were negative. In two larger Phase III trials (ADJUNCT ONE and ADJUNCT TWO), the GLP-1 analogue liraglutide used as an adjunct to insulin appeared well-tolerated and improved HbA 1c and reduced body weight [ 91 , 92 ]. Both ADJUNCT trials indicated a minor increase in the risk of hypoglycaemia and hyperglycaemia with ketosis with liraglutide use, whereas the risk of diabetic ketoacidosis was negligible. Subsequently, a plethora of investigations have reached similar conclusions [ 93 – 101 ]. Nonetheless, the use of GLP-1 RAs in type 1 diabetes remains potentially useful, as discussed below.

Verapamil is a common calcium-channel blocker used for decades as an anti-hypertensive agent. In mouse models of type 1 diabetes, verapamil promoted survival of functional beta cells via a mechanism that involves reduced expression of the cellular redox regulator thioredoxin-interacting protein [ 102 ]. In a smaller Phase II trial, verapamil was better than placebo for preserving meal-stimulated C-peptide secretion in adults with type 1 diabetes and no safety concerns were identified [ 103 ]. Despite these findings, however, the place for verapamil as a disease-modifying agent in type 1 diabetes remains to be fully established.

Future perspectives

Although research into type 1 diabetes prevention and disease modification continues to produce encouraging data, none of the approaches discussed above appears sufficiently effective alone in preventing or managing type 1 diabetes. Future endeavours will, therefore, require a novel focus, leveraging prior experience with regard to the immunopathophysiology of type 1 diabetes, whilst also exploring the promise of combination therapies that integrate tried or new treatment modalities. In addition, lessons learned from type 2 diabetes with regard to the beneficial effects of certain agents on, for example, body weight and cardiorenal risk may also prove relevant in type 1 diabetes. We review selected future prospects addressing these aspects below.

Of further note, the lack of sufficient efficacy of previously tested therapies may also be related to the fact that type 1 diabetes is a heterogenous disease with diverse disease stages (Stages 1 to 3) and modifiers, such as age of onset or clinical diagnosis. Identifying the optimal timing of each type of intervention relative to the disease stages and the age of the patient is, therefore, important. For example, initiating an immunomodulatory intervention at Stage 1 (i.e. prior to clinical diagnosis) is not a straightforward decision and may be associated with clinical inertia. Moreover, an increased focus on disease endotypes (i.e. different biological processes under the type 1 diabetes umbrella) was recently suggested to ensure a precision-medicine approach to type 1 diabetes research and management [ 104 ].

Immune interventions

It is becoming increasingly clear that autoreactivity to islet antigens is also present in healthy individuals [ 59 ] and autoimmunity recurs after autologous nonmyeloablative haematopoietic stem cell transplantation [ 105 , 106 ]. Thus, in line with the ‘assisted suicide’ theory introduced earlier [ 6 , 7 ], it is also increasingly apparent that the development of type 1 diabetes does not only involve dysfunctional islets, but also beta cells that ‘unmask’ themselves to immune recognition and destruction. This notion supports two central realisations; first, it might explain why, in previous studies, immune therapy alone has failed to protect beta cell function over longer periods of time after onset of diabetes. Second, looking forward, novel type 1 diabetes therapies should pursue the holy grail of type 1 diabetes immune therapy: essentially agents that act locally in the islets, within the pancreas, either targeting the immune cells destroying the beta cell or the beta cell itself. Knowledge gained over the years regarding the beta cell has suggested multiple, yet putative reasons for the ‘unmasking’ of these cells. Potential reasons include the facts that beta cells are especially biosynthetically active and systemically exposed [ 107 ] and, therefore, susceptible to stress-induced production of autoantigenic proteins during, for example, infections [ 108 – 110 ]. Moreover, the beta cell might be vulnerable to both cytokine-mediated destruction [ 111 ] and various types of endoplasmic reticulum stress [ 112 ]. Relieving the beta cell of these burdens may provide an opportunity to save the beta cell without resorting to aggressive immune suppression.

With this in mind, we see the following two promising avenues as deserving increased focus going forward: (1) therapies aimed at inducing tolerance to beta cell antigens; and (2) the use of GLP-1 RAs that directly target the beta cells to enhance their function whilst also protecting them from immune-mediated inflammatory stress.

As discussed above, achieving antigenic tolerance has, so far, proven elusive but carries the crucial potential of leaving the overall capacity of the immune system intact whilst suppressing only the diabetogenic cell populations. Future studies need to establish whether inducing tolerance in humans can be achieved by clonal anergy or clonal deletion of effector cells, or whether antigen-specific regulatory cells may be able to suppress autoreactivity locally. Moreover, it needs to be clarified to what extent tissue-resident memory effector cells can be eliminated.

Recent evidence from rodent models indicates a role for GLP-1 RAs in protecting beta cells from apoptosis and in promoting beta cell replication and mass [ 113 – 117 ]. As such, although this remains to be confirmed, it is conceivable that GLP-1 RAs may offer a way to prevent the ‘unmasking’ of the beta cell to immune effector cells, for example, by downregulating expression of MHC class I proteins. Intriguingly, unpublished non-clinical evidence shows that liraglutide also limits immune cell infiltration into pseudo-islets (M. von Herrath, unpublished results). In addition, studies in NOD mice have shown that GLP-1 RAs administered in combination with various immunomodulatory agents, including anti-CD3 compounds [ 118 ], were more efficient in inducing diabetes remission than when given as monotherapy [ 119 ]. Furthermore, the anti-inflammatory effects of GLP-1 RAs are well-documented, with liraglutide being associated with reduced systemic levels of C-reactive protein and of proinflammatory cytokines, such as TNF-α, IL-1β and IL-6 [ 120 – 123 ]. Whilst these findings have mainly been observed in animal models or in type 2 diabetes, their relevance to (clinical) type 1 diabetes is conceivable but, so far, largely unexplored.

Management of cardiometabolic complications

A person diagnosed with type 1 diabetes faces a high risk of serious complications and of premature death, primarily for cardiovascular causes. This warrants a therapeutic focus on the broad pathophysiology of the disease.

Further, whilst the exact connections between excess body weight and type 1 diabetes remain debatable [ 124 ], the increased incidence of type 1 diabetes seems to coincide with the rapid rise in the prevalence of obesity [ 125 , 126 ]. Recent evidence suggests that a high BMI may exacerbate the early-stage immune-mediated beta cell destruction in type 1 diabetes, especially in children and adolescents [ 127 ]. Evidence also points to an impact of rapid growth in early childhood [ 128 ], and a positive correlation between the age of type 1 diabetes onset and BMI has been observed [ 129 ]. The ‘accelerator hypothesis’ views high BMI and low insulin sensitivity as triggers for type 1 diabetes onset [ 130 ] and the term ‘double diabetes’ has been suggested to describe an amalgam of type 1 diabetes with parallel and separate pathophysiological processes typically associated with type 2 diabetes, such as obesity and insulin resistance [ 131 ].

Use of SGLT inhibitors or GLP-1 RAs as adjuncts to insulin admittedly holds promise in ameliorating multiple type 1 diabetes complications. For example, evidence suggests that SGLT inhibitors offer cardiorenal protection [ 132 , 133 ], at least in type 2 diabetes, putatively owing to clinically unproven mechanisms of action beyond improved glucose homeostasis [ 134 ]. Moreover, a few GLP-1 RAs (dulaglutide, liraglutide and semaglutide) are now indicated to reduce cardiovascular risk in people with type 2 diabetes and established cardiovascular disease, and a protective effect of GLP-1 RAs on the kidneys is suggested from a range of cardiovascular outcome trials (CVOTs) in type 2 diabetes [ 135 – 138 ]. In addition, both SGLT inhibitors and GLP-1 RAs, especially second-generation GLP-1 RAs (e.g., semaglutide), are associated with a meaningful reducing effect on body weight.

Combination therapies

Combination therapies that work via two mechanistically distinct targets to integrate immune modulation with a beta cell-specific component have been suggested [ 139 – 141 ] and encouraged [ 142 ]. Truly advantageous combination therapies are arguably those in which the components target different pathogenic pathways (for example, systemic vs beta cell-specific pathways), thereby synergising in terms of the beneficial effects. These combination therapies should also be safe and well-tolerated alone and in combination.

Known ongoing efforts are sparse but include the combination of ATG and GCSF (as discussed above) and the combination of targeted immune modulation via an anti-IL-21 antibody in combination with a GLP-1 analogue (liraglutide). In addition to the potential of preserving functional beta cell mass by leveraging the immunomodulatory and anti-inflammatory properties of both the anti-IL-21 antibody and liraglutide, their combination addresses the need to manage the symptoms and complications of established type 1 diabetes, as discussed earlier. As previously mentioned, results from a clinical proof-of-concept trial recently found that anti-IL-21 plus liraglutide was significantly better than placebo in preserving C-peptide secretion over a period of 54 weeks [ 61 ]. The benefits diminished after treatment cessation; however, the treatment appeared safe and well-tolerated.

Stem cell replacement therapy

On the horizon, we approach the promise of stem cell-based therapies [ 143 ], offering a potential cure by replacing or supplementing beta cells that have been lost or have become dysfunctional. Stem cell-derived beta cells, however, also need to be rescued from immune-mediated destruction, suggesting that some degree of immunomodulation will be needed, even in the advent of viable stem cell therapy in type 1 diabetes, unless a fully effective immune-defying capsule is available [ 144 ]. In this context, better prevention or treatment regimens will also be useful for enabling longer-term beta cell graft acceptance.

Closing thoughts

Whilst many intriguing non-insulin therapies have failed to fully meet their potential in the past few decades, hope remains that the knowledge gained has carved out paths towards better options for the prevention and management of type 1 diabetes. Taken together, in our view, stem cell replacement therapies and a refocused development of safe and well-tolerated combination therapies are the most promising emerging preventive or therapeutic avenues. In parallel, reinforced efforts to predict or diagnose type 1 diabetes as soon as possible are equally important in light of the fact that even the best interventions need to be introduced as early as possible to effectively preserve or rescue beta cells in individuals with this condition.

(PPTX 230 kb)

Authors’ relationships and activities

All authors are employees of Novo Nordisk A/S, Denmark.

Abbreviations

ATG	Anti-thymocyte globulin
GCSF	Granulocyte colony stimulating factor
GLP-1	Glucagon-like peptide-1
RA	Receptor agonist
SGLT	Sodium-glucose cotransporter
Th	T helper

Contribution statement

All authors contributed substantially to the preparation of the review and approved the version to be published.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Type 1 Diabetes Essays

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What Every Provider Needs to Know About Type 1 Diabetes

Miriam E. Tucker

August 16, 2024

In July 2024, a 33-year-old woman with type 1 diabetes was boating on a hot day when her insulin delivery device slipped off. By the time she was able to exit the river, she was clearly ill, and an ambulance was called. The hospital was at capacity. Lying in the hallway, she was treated with fluids but not insulin, despite her boyfriend repeatedly telling the staff she had diabetes. She was released while still vomiting. The next morning, her boyfriend found her dead.

This story was shared by a friend of the woman in a Facebook group for people with type 1 diabetes and later confirmed by the boyfriend in a separate heartbreaking post. While it may be an extreme case, encounters with a lack of knowledge about type 1 diabetes in healthcare settings are quite common, sometimes resulting in serious adverse consequences.

In my 50+ years of living with the condition, I've lost track of the number of times I've had to speak up for myself, correct errors, raise issues that haven't been considered, and educate nonspecialist healthcare professionals about even some of the basics.

Type 1 diabetes is an autoimmune condition in which the insulin-producing cells in the pancreas are destroyed, necessitating lifelong insulin treatment. Type 2, in contrast, arises from a combination of insulin resistance and decreased insulin production. Type 1 accounts for just 5% of all people with diabetes, but at a prevalence of about 1 in 200, it's not rare. And that's not even counting the adults who have been misdiagnosed as having type 2 but who actually have type 1.

As a general rule, people with type 1 diabetes are more insulin sensitive than those with type 2 and more prone to both hyper- and hypoglycemia. Blood sugar levels tend to be more labile and less predictable, even under normal circumstances. Recent advances in hybrid closed-loop technology have been extremely helpful in reducing the swings, but the systems aren't foolproof yet. They still require user input (ie, guesswork), so there's still room for error.

Managing type 1 diabetes is challenging even for endocrinologists. But here are some very important basics that every healthcare provider should know:

We Need Insulin 24/7

Never, ever withhold insulin from a person with type 1 diabetes, for any reason. Even when not eating — or when vomiting — we still need basal (background) insulin, either via long-acting analog or a pump infusion. The dose may need to be lowered to avoid hypoglycemia, but if insulin is stopped, diabetic ketoacidosis will result. And if that continues, death will follow.

This should be basic knowledge, but I've read and heard far too many stories of insulin being withheld from people with type 1 in various settings, including emergency departments, psychiatric facilities, and jails. On Facebook, people with type 1 diabetes often report being told not to take their insulin the morning before a procedure, while more than one has described "sneaking" their own insulin while hospitalized because they weren't receiving any or not receiving enough.

On the flip side, although insulin needs are very individual, the amount needed for someone with type 1 is typically considerably less than for a person with type 2. Too much can result in severe hypoglycemia. There are lots of stories from people with type 1 diabetes who had to battle with hospital staff who tried to give them much higher doses than they knew they needed.

The American Diabetes Association recommends that people with type 1 diabetes who are hospitalized be allowed to wear their devices and self-manage to the degree possible. And please, listen to us when we tell you what we know about our own condition.

Fasting Is Fraught

I cringe every time I'm told to fast for a test or procedure. Fasting poses a risk for hypoglycemia in people with type 1 diabetes, even when using state-of-the-art technology. Fasting should not be required unless absolutely necessary, especially for routine lab tests.

Saleh Aldasouqi, MD, chief of endocrinology at Michigan State University, East Lansing, Michigan, has published several papers on a phenomenon he calls "Fasting-Evoked En Route Hypoglycemia in Diabetes," in which patients who fast overnight and skip breakfast experience hypoglycemia on the way to the lab.

"Patients continue taking their diabetes medication but don't eat anything, resulting in low blood sugar levels that cause them to have a hypoglycemic event while driving to or from the lab, putting themselves and others at risk," Aldasouqi explained, adding that fasting often isn't necessary for routine lipid panels .

If fasting is necessary, as for a surgical procedure that involves anesthesia, the need for insulin adjustment — NOT withholding — should be discussed with the patient to determine whether they can do it themselves or whether their diabetes provider should be consulted.

But again, this is tricky even for endocrinologists. True story: When I had my second carpal tunnel surgery in July 2019, my hand surgeon wisely scheduled me for his first procedure in the morning to minimize the length of time I'd have to fast. (He has type 1 diabetes himself, which helped.) My endocrinologist had advised me, per guidelines, to cut back my basal insulin infusion on my pump by 20% before going to bed.

But at bedtime, my continuous glucose monitor (CGM) showed that I was in the 170 mg/dL's and rising, not entirely surprising since I'd cut back on my predinner insulin dose knowing I wouldn't be able to eat if I dropped low later. I didn't cut back the basal.

When I woke up, my glucose level was over 300 mg/dL. This time, stress was the likely cause. (That's happened before.) Despite giving myself several small insulin boluses that morning without eating, my blood sugar was still about 345 mg/dL when I arrived at the hospital. The nurse told me that if it had been over 375 mg/dL, they would have had to cancel the surgery, but it wasn't, so they went ahead. I have no idea how they came up with that cutoff.

Anyway, thankfully, everything went fine; I brought my blood sugar back in target range afterward and healed normally. Point being, type 1 diabetes management is a crazy balancing act, and guidelines only go so far.

We Don't React Well to Steroids

If it's absolutely necessary to give steroids to a person with type 1 diabetes for any reason, plans must be made in advance for the inevitable glucose spike. If the person doesn't know how to adjust their insulin for it, please have them consult their diabetes provider. In my experience with locally injected corticosteroids, the spike is always higher and longer than I expected. Thankfully, I haven't had to deal with systemic steroids, but my guess is they're probably worse.

Procedures Can Be Pesky

People who wear insulin pump and/or CGMs must remove them for MRI and certain other imaging procedures. In some cases — as with CGMs and the Omnipod insulin delivery device that can't be put back on after removal — this necessitates advance planning to bring along replacement equipment for immediately after the procedure.

Diabetes devices can stay in place for other imaging studies, such as X-rays, most CT scans, ECGs, and ultrasounds. For heaven's sake, don't ask us to remove our devices if it isn't totally necessary.

In general, surprises that affect blood sugar are a bad idea. I recently underwent a gastric emptying study. I knew the test would involve eating radioactive eggs, but I didn't find out there's also a jelly sandwich with two slices of white bread until the technician handed it to me and told me to eat it. I had to quickly give myself insulin, and of course my blood sugar spiked later. Had I been forewarned, I could have at least "pre-bolused" 15-20 minutes in advance to give the insulin more time to start working.

Another anecdote: Prior to a dental appointment that involved numbing my gums for an in-depth cleaning, my long-time dental hygienist told me "be sure to eat before you come." I do appreciate her thinking of my diabetes. However, while that advice would have made sense long ago when treatment involved two daily insulin injections without dose adjustments, now it's more complicated.

Today, when we eat foods containing carbohydrates, we typically take short-acting insulin, which can lead to hypoglycemia if the dose given exceeds the amount needed for the carbs, regardless of how much is eaten. Better to not eat at all (assuming the basal insulin dose is correct) or just eat protein. And for the provider, best to just tell the patient about the eating limitations and make sure they know how to handle.

Duh, We Already Have Diabetes

I've heard of at least four instances in which pregnant women with type 1 diabetes have been ordered to undergo an oral glucose tolerance test to screen for gestational diabetes. In two cases, it was a "can you believe it?!" post on Facebook, with the women rightly refusing to take the test.

But in May 2024, a pregnant woman reported she actually drank the liquid, her blood sugar skyrocketed, she was vomiting, and she was in the midst of trying to bring her glucose level down with insulin on her own at home. She hadn't objected to taking the test because "my ob. gyn. knows I have diabetes," so she figured it was appropriate.

I don't work in a healthcare setting, but here's my guess: The ob. gyn. Hadn't actually ordered the test but had neglected to UN-order a routine order for a pregnant patient who already had diabetes and obviously should NOT be forced to drink a high-sugar liquid for no reason. If this is happening in pregnancies with type 1 diabetes, it most certainly could be as well for those with preexisting type 2 diabetes. Clearly, something should be done to prevent this unnecessary and potentially harmful scenario.

In summary, I think I speak for everyone living with type 1 diabetes in saying that we would like to have confidence that healthcare providers in all settings can provide care for whatever brought us to them without adding to the daily burden we already carry. Let's work together.

Reviewed by Saleh Aldasouqi, MD, chief of endocrinology at Michigan State University.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR's Shots blog, and Diatribe. She is on X @MiriamETucker.

Send comments and news tips to [email protected] .

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Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study

Affiliations.

1 Department of Health and Human Performance, Texas State University, San Marcos, Texas.
2 Department of Health Science, The University of Alabama, Tuscaloosa, Alabama.
3 Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.
4 Department of Family and Community Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
5 Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, Arkansas.
PMID: 39162332
DOI: 10.1177/26350106241268412

Purpose: The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management.

Methods: A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States.

Results: Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia.

Conclusions: Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

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What Is ‘Smart’ Insulin? Can It Cure Type 1 Diabetes? How Will It Control Blood Sugar Levels In Real Time?

Curated By : News Desk

Edited By: Shilpy Bisht

Last Updated: August 22, 2024, 12:17 IST

New Delhi, India

The new glucose-responsive insulins promise to end constant glucose monitoring, and could allow patients to swallow a pill or inject insulin once every morning.

People with type 1 diabetes will in future need to take insulin once a week, say experts... The effect of new glucose-responsive insulins would be similar to that produced by a functioning pancreas, which only releases insulin when it is needed in the body

Type 1 Diabetes patients can now rely on a “holy grail” insulin, which will respond rapidly to changing blood sugar levels in real time. Until now, patients had to inject synthetic insulin up to 10 times a day in order to survive, but with ‘smart’ insulin, scientists have come close to a cure for type 1 diabetes.

Researchers in the US, Australia and China have successfully designed next-generation or novel insulins that mimic the body’s natural response to changing blood sugar levels and respond instantly in real time.

“The funded six new research projects address major shortcomings in insulin therapy. Potentially minimising the risk of hypoglycaemia through an insulin-glucagon combination would ease one of the major concerns associated with insulin therapy today. Therefore, these research projects, if successful might do no less than heralding a new era in insulin therapy,” Tim Heise, Vice Chair of Novel Insulins Scientific Advisory Panel of the Type 1 Diabetes Grand Challenge, said.

What is Type 1 Diabetes?

Blood sugars, also called blood glucose, are the primary source of energy in the body. When you eat food, the body breaks down most of it into glucose, which is released into the bloodstream. When glucose levels go up, the pancreas releases the hormone insulin, which helps glucose to be used as energy by your cells.

Those with type 1 diabetes have a pancreas that either cannot produce insulin or produces very little of it. High levels of glucose can lead to heart disease, kidney problems, extreme fatigue and other serious illnesses.

What is the Difference Between Type 1 and Type 2 Diabetes?

Type 1 diabetes is an autoimmune disease in which the body cannot make any insulin at all. The insulin-producing cells have been attacked and destroyed by the body’s immune system. While in type 2 diabetes, the body does not make enough insulin.

Type 1 diabetes affects 8% of people living with diabetes and type 2 diabetes affects 90% of people living with diabetes.

The risk of developing type 1 diabetes depends on family history and genes, and is often diagnosed in childhood or when you are under 40.

Type 2 diabetes develops with age, and your ethnicity can increase your risk. For instance, if you are white and over 40, the risk of developing type 2 diabetes is higher, whereas in African-Caribbean, Black African, Chinese or South Asians, chances of developing the illness increase if you are over 25.

In India, there are around 8.6 lakh people with Type 1 diabetes, with one in six young people dying without a diagnosis. An estimated 77 million people above the age of 18 years are suffering from type 2 diabetes, and nearly 25 million are prediabetics (at a higher risk of developing diabetes in near future), according to the World Health Organization.

The 10 countries with the highest estimated prevalence — USA, India, Brazil, China, Germany, UK, Russia, Canada, Saudi Arabia and Spain — account for 5.08 million or 60% of global cases of Type 1 diabetes.

What is the Need for a Better Insulin?

The glucose levels in the body constantly change depending on your stress levels, whether you have exercised, the foods you eat and the hormone levels. This makes it hard for the people with type 1 diabetes to maintain a stable blood sugar level, even with the latest technology to administer insulin.

A standard insulin can stabilise blood sugar levels for a certain time, but it cannot typically help with future fluctuations. It means patients often need to inject more insulin again within just a few hours.

Faster insulins are also needed to improve the function of insulin pumps and hybrid closed loop technology – a system that relies on the stored insulin responding in real-time to changing blood sugar levels.

What is a Smart Insulin?

The new glucose-responsive insulins (GRIs) become active when they detect a change in sugar levels in the blood to prevent hyperglycaemia (high blood glucose). They become inactive again when levels drop below a certain point, avoiding hypoglycaemia (low blood glucose). In future, patients may only need insulin once a week, experts believe.

The effect of a smart insulin would be similar to that produced by a functioning pancreas, which only releases insulin when it is needed in the body.

The GRIs promise to end constant glucose monitoring, and could allow patients to swallow a pill or inject insulin once every morning.

What are the 6 Research Projects for Smart Insulins?

The six projects include teams at Stanford University in the US, Monash University in Australia and Zhejiang University in China. The aim is to accelerate development and launch trials as soon as possible.

The Monash University project involves development of a second generation of nano sugar-insulin system, based on advanced nanotechnology. These nano sugars react to very small changes in blood glucose and release insulin only when glucose levels are outside a range, without any intervention from the patient.

Researchers at the Wayne University are working to develop a “smart insulin” which can detect changes in blood glucose levels and respond by releasing the right amount of insulin at the right time.

The third project, conducted by researchers at the Jinhua Institute of Zhejiang University in China, involves novel insulins that respond immediately to rising blood glucose levels.

At the University of Notre Dame, US, researchers developed a smart insulin delivery system that uses tiny particles called nanocomplexes, which contain insulin. These nanocomplexes can also be injected under the skin to create a reservoir to automatically release insulin if blood sugar rises.

Scientists at the Stanford University, US are working on developing and testing an ultrafast-acting insulin that’s only active when needed and could reduce the risk of blood glucose highs and lows in people with type 1 diabetes.

A team of researchers at the Indiana University, US will combine insulin and glucagon in their project, to prevent the highs and lows in blood glucose.

Dr Elizabeth Robertson, the director of research at Diabetes UK, said, as quoted by The Guardian , the projects had the potential to revolutionise type 1 diabetes treatment. “By supporting these groundbreaking research projects, we are aiming to develop new insulins that more closely mimic the body’s natural responses to changing blood sugar levels.

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Endocrine Side Effects of Cancer Treatment in Type 1 Diabetes

August 18, 2024

By Lily Tranchito, DO and UH

Innovations in Diabetes & Metabolic Care | Summer 2024

A cancer diagnosis is a life-altering event that takes a significant toll on an individual’s physical and emotional well-being. Cancer treatment can also present unique endocrine challenges, exacerbating Type 1 diabetes mellitus (DM) or, in rare cases, causing new-onset insulin deficiency.

At the University Hospitals Diabetes and Metabolic Care Center , experts are available to guide individuals through their treatment plan, monitor metabolic symptoms and keep blood glucose at safe levels.

“We counsel patients based on what medications they are receiving for their cancer, specifically when they are receiving steroids,” says Lily Tranchito, DO , an endocrinologist within the UH Diabetes and Metabolic Care Center. “Steroids significantly raise blood sugar in a unique pattern and require careful management.”

Typically, patients with Type 1 DM receive daily basal and bolus insulin. Dr. Tranchito explains that during chemotherapy, individuals often need a third type, NPH insulin, to be administered at the same time as steroid dosing because both medications have a similar time of action in the body.

It is also important to understand how patients with Type 1 DM manage their mealtime insulin while undergoing cancer treatment. “Some individuals count carbohydrates, and others are on fixed-meal dosing and give themselves specific insulin units before each meal,” Dr. Tranchito says. “During chemotherapy, symptoms like reduced appetite or nausea often affect how much people eat and require changes to their insulin regimen.”

Throughout cancer treatment, a patient’s status can change quickly. Glucose levels should be carefully tracked to avoid steroid-induced hyperglycemia or dangerous drops in blood sugar that can lead to hypoglycemic shock. The American Diabetes Association recommends that everyone with Type 1 DM use an automated insulin delivery system.

“A hybrid, closed-loop system with a continuous glucose monitor and insulin pump is considered the standard of care and should be considered for all patients with Type 1 diabetes,” Dr. Tranchito says. “We have an excellent team within our diabetes and metabolic center that can provide multiple touchpoints for people to receive the care, education and follow-up they need to manage their Type 1 diabetes through their cancer journey and beyond.”

Immune Checkpoint Inhibitors

Some types of cancer are treated with immune checkpoint inhibitors (ICIs), a newer class of immunotherapy medications that work by blocking negative checkpoint proteins that stop T-cells from attacking cancer cells and boosting the body’s immune response. While early clinical trials show promise in increasing the probability of long-term survival, ICIs can cause significant side effects, including dangerous endocrinopathies.

“One serious disruption to the endocrine system is insulin-deficient diabetes, which is essentially ICI-induced Type 1 diabetes,” says Alina Galant, PharmD , a Medical Oncology Clinical Pharmacy Specialist at University Hospitals Seidman Cancer Center . “Although extremely rare, these side effects can happen at the first dose or months into therapy and can be rapid and severe at onset.” Symptoms, including diabetic ketoacidosis, can be life-threatening and require hospital admission and treatment with insulin therapy.

Patients treated at the UH Seidman Cancer Center are carefully monitored for adverse side effects and counseled on symptom monitoring. “All of our oncologists are very much aware of these rare inflammatory responses and work to catch symptoms before they progress in severity,” Dr. Galant says. “We also have an outstanding endocrinology team at University Hospitals that follows patients who develop insulin sensitivity.”

When metabolic complications related to cancer treatment do occur, diabetes educators provide bedside support and training to help patients administer insulin and develop an understanding of how to utilize diabetes devices and supplies. This helps ensure individuals and family members feel able to manage glucose levels outside the controlled environment of the hospital. Coordinated discharge planning helps patients receive continuation of care in the outpatient setting.

Most of the time, ICI-induced Type 1 DM is not reversible and requires lifelong insulin therapy. “For patients who previously did not have diabetes or maybe had Type 2 and are now completely insulin deficient, it can be an overwhelming life change,” Dr. Tranchito says. “Fortunately, we can connect patients to diabetes tools and technology that can help them adapt to their new normal and keep their blood glucose within safe and comfortable levels.”

For more information about the endocrine side effects of cancer treatment in Type 1 diabetes, please contact the UH Diabetes and Metabolic Care Center at 216-286-8988 .

Contributing Experts: Lily Tranchito, DO Endocrinologist University Hospitals Diabetes and Metabolic Care Center University Hospitals Cleveland Medical Center

Alina Galant, PharmD Medical Oncology Clinical Pharmacy Specialist University Hospitals Seidman Cancer Center

Tags: Innovations in Diabetes and Metabolic Care Summer 2024 , Diabetes

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Pre-diabetes medication dramatically reduces risk of type 2 diabetes, study says

A new drug shows promising signs of reducing the risk of type 2 diabetes. Tirzepatide, better known by the brand names Zepbound and Mounjaro, reduced diabetes risk by 94% in adults who are overweight, obese or who have pre-diabetes, the pharmaceutical company Eli Lilly and Company said Tuesday .

What You Need To Know

Tirzepatide, better known by the brand names zepbound and mounjaro, reduced diabetes risk by 94% in adults who are overweight, obese or who have pre-diabetes, the pharmaceutical company eli lilly and company said tuesday a three year-study of patients who took the injectable medication once a week found patients who took a 15-milligram dose also lost an average of 22.9% of their body weight throughout the treatment period obesity is a chronic disease that puts nearly 900 million adults worldwide at an increased risk of other complications such as type 2 diabetes a type of glp-1 agonist, tirzepatide is one of a growing class of drugs that improve blood sugar control and help reduce weight.

A three year-study of patients who took the injectable medication once a week found patients who took a 15-milligram dose also lost an average of 22.9% of their body weight throughout the treatment period.

“Obesity is a chronic disease that puts nearly 900 million adults worldwide at an increased risk of other complications such as type 2 diabetes,” Lilly Senior Vice President of Product Development Jeff Emmick said in a statement.

Tirzepatide works by regulating appetites and caloric intake. It also stimulates the secretion of insulin. A type of GLP-1 Agonist, tirzepatide is one of a growing class of drugs that improve blood sugar control and help reduce weight.

Drugs including Trulicity, Ozempic and Rybelsus used to treat type 2 diabetes may also lead to weight loss.

For its study, Lilly evaluated 1,032 adults with prediabetes or who were obese or overweight for 176 weeks of treatment.

During a 17-week follow-up period after treatment, patients who stopped using tirzepatide began to regain weight and had a slight increase in their progression to type 2 diabetes, the study found.

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