Please consult your physician or health care professional before changing your treatment regimen.
Clinical Background
Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by an absolute or relative deficiency of insulin. Insulin is, an anabolic hormone produced by the beta cells of the Isles of Langerhans located in the pancreas. Type 1 diabetes arises from complete or partial insulin deficiency due to autoimmune destruction of the insulin-producing beta cells. Exogenous insulin therapy is required for survival. Type 1 Diabetes accounts for approximately 10% of all prevalent cases of diabetes and only less than 10% of people with type 1 diabetes have a family history of the disease. By contrast, Type 2 Diabetes increases in incidence with advancing age and obesity, although it is on the rise in physically inactive, overweight children and adolescents. It represents a heterogeneous group of disorders, characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production.
Diabetes requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed.
Pathophysiology
Insulin is essential to process carbohydrates, fat, and protein. Insulin reduces blood glucose levels by allowing glucose to enter muscle cells and by stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store. Insulin also inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat to triglycerides, free fatty acids, and ketones. It also stimulates fat storage. Additionally, insulin inhibits the breakdown of protein and fat for glucose production (gluconeogenesis) in both liver and kidneys.
Hyperglycemia (random blood glucose concentration more than 200 mg/dL or 11 mmol/L) results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose. The kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration. Increased fat and protein breakdown leads to ketone production and weight loss. Without insulin, a person with Type 1 Diabetes wastes away and eventually dies from diabetic ketoacidosis (DKA).
An excess of insulin prevents the release of glucose into the circulation and results in hypoglycemia (low blood glucose level). Glucose is the sole energy source for erythrocytes, kidney medulla, and the brain.
Insulin Therapy
Insulin is the mainstay of treatment for people with Type 1 Diabetes. Insulin is also an important treatment tool for people with Type 2 Diabetes, when their blood glucose levels cannot be controlled by diet, weight loss, exercise, and oral medications. The goal of insulin therapy is maintaining near normal blood glucose values while avoiding frequent episodes of hypoglycemia. In addition to insulin replacement, other factors come into play with regard to achieving good metabolic control. Nutritional intake, physical activity, life events such as illness and puberty, as well as emotions directly and indirectly impact the person’s degree of success in both the short and long term.
Importance of Frequent Blood Glucose Monitoring and Achieving Good Metabolic Control
Monitoring blood glucose is an essential part of diabetes management. It has been shown that frequent monitoring of blood glucose values and appropriate action taken according to the results is of invaluable assistance for achieving good metabolic Clinical studies have clearly demonstrated the benefits of good blood glucose control. Intensive glycemic management can delay or prevent the development of microvascular complications such as retinopathy, nephropathy, neuropathy, and macrovascular complications such as cardiovascular and cerebrovascular diseases.
Achieving good metabolic control is not easy. It is especially challenging in infants and toddlers with Type 1 Diabetes. Several factors contribute to the difficulty in managing diabetes in these young children. These include unpredictable insulin absorption, variable and unpredictable eating patterns and activity, increased sensitivity to small amounts of insulin, parental fear of hypoglycemia,) and difficulty in managing hypoglycemic events. These problems can lead to widely fluctuating blood glucose levels or frequent hypoglycemic episodes, which could have adverse developmental effects in the long term.
HbA1c (Glycosylated Hemoglobin)
Long-term metabolic control can be evaluated by measuring the glycosylated hemoglobin or hemoglobin A1c(HbA1c). Glycosylation is the process in which glucose attaches to the hemoglobin molecule which is found in the red blood cell. The red blood cell lasts in the blood stream for 90-120 days. Increased levels of blood glucose will increase the percentage of hemoglobin that is glycosylated and therefore will reflect the average glucose concentration for the preceding 2 to 3 months.