TYPE 1 DIABETES MELLITUS: OVERVIEW

o Pathophysiology: Autoimmune destruction of NORMAL glucose range

insulin-producing pancreatic beta cells in the 3.5 mmol/L (after newborn period) 5.6 mmol/L
islets of Langerhans, resulting in insulin
deficiency
!
Initiate Treatment when
o Age of presentation: Can present at any age; Plasma glucose (PG) < 4.0 mmol/L
Bimodal distribution of peaks at 4 - 6 years old and
early puberty (10 – 14 years old) RECOMMENDED GLYCEMIC TARGETS
o Risk factors: both genetic (relatives ü A1C ≤ 7.5 (7 in some guidelines) fasting PG 4.0 – 8.0
with T1DM) and environmental factors mmol/L, postprandial PG 5.0 – 10.0 mmol/L
• In genetically susceptible individuals, ü Pre-prandial targets of 6.0-10.0 mmol/L
exposure to one or more environmental ü Consider higher A1C target if prior significant
agents likely triggers immune response hypoglycemia or hypoglycemia unawareness

DIAGNOSIS
Clinical Presentation Investigations
§ Polyuria: osmotic diuresis due to increased q Diagnosis of diabetes:
urinary glucose excretion § Fasting PG ≥ 7 mmol/L
• Secondary enuresis or nocturia in children § Random PG ≥ 11.1 mmol/L
§ Polydipsia: result of increased serum osmolality § PG ≥ 11.1 2 hr post 75 g OGTT (OGTT not
§ Polyphagia frequently used for diagnosis in children)
§ Diabetic Keto Acidosis (DKA) § A1C not used to diagnose T1DM in children
§ Weight loss: due to hypovolemia, increased catabolism q If asymptomatic, second test always needed;
(impaired glucose utilization, increased muscle & fat breakdown) single test sufficient if symptomatic
§ Factors that may help differentiate T1DM vs T2DM : q Lab results to support T1DM vs T2DM: antibodies
• Body habitus: Obesity is important risk factor for T2DM (e.g., GAD65), insulin, C-peptide

MANAGEMENT ACUTE COMPLICATIONS

Education
ü Training for patients &
families by
multidisciplinary
teams:
§ Insulin; BG & ketone
monitoring; sick-day
management; DKA;
hypoglycemia;
correction factors
ü Anticipatory guidance
ü Dietician referral
ü Carbohydrate
counting to match
insulin to intake,
allows flexibility in
diet (I:C ratio)
Insulin ❗ Hypoglycemia (due to insulin)
❗ Diabetic Ketoacidosis (DKA)
Ø Treat to meet glycemic targets
Ø Two types of intensive insulin
regimens: Multiple daily SCREENING
injections (MDI) & continuous
subcutaneous insulin infusion Check for… Starting… Frequency
(CSII; insulin pump)
Glycemic control At Dx q3months
Ø Less intensive BID & TID
(A1C)
regimens
Ø Fingerstick or continuous Autoimmune thyroid At Dx q2years
glucose monitoring (CGM) (TSH & TPO)
Ø Hypoglycemia management:
• Mild & moderate: oral simple Celiac & Adrenal - As indicated
carbohydrate e.g., fruit juice insufficiency
• Severe: glucagon (IM, Nephropathy Age 12 (if Dx >5 Annually
intranasal, SC), IV dextrose years ago)
Retinopathy Age 15 (if Dx >5 Annually
years ago)

LONG TERM COMPLICATIONS Neuropathy Age 15 (with poor Annually (after

glycemic control) 5 years of Dx)
Microvascular Disease Macrovascular Disease
• Diabetic nephropathy • Cardiac disease (CAD, MI) Hypertension Dyslipidemia Age 12 (if no extra Repeat at 17
• Diabetic retinopathy • Peripheral vascular disease risk factors)
• Peripheral & autonomic • Cerebrovascular disease Dyslipidemia
neuropathy (stroke) Hypertension At Dx q6months

Published July 2021

Alyssa Kahane (Medical Student, University of Ottawa) and Dr. Alexa Marr (Pediatric Endocrinologist,
Children’s Hospital of Eastern Ontario) for www.pedscases.com