Type 1 Diabetes; how does it happen, how do we manage it? School - - PowerPoint PPT Presentation

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Type 1 Diabetes; how does it happen, how do we manage it? School - - PowerPoint PPT Presentation

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Type 1 Diabetes; how does it happen, how do we manage it? School of Medicine Saleh Adi, MD Clinical Professor Pediatric Endocrinology September, 2013 Family Voices, September 2013 Outline Normal physiology Types of diabetes Type

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Type 1 Diabetes; how does it happen, how do we manage it?

Saleh Adi, MD Clinical Professor Pediatric Endocrinology

September, 2013

School of Medicine

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School of Medicine

Outline

  • Normal physiology
  • Types of diabetes
  • Type 1 diabetes
  • Autoimmunity
  • Management: insulin and devices

Family Voices, September 2013

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Normal physiology

Family Voices, September 2013

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Normal physiology: Nutrition

Family Voices, September 2013

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Family Voices, September 2013

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Sugar

Family Voices, September 2013

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Glucose Metabolism

Family Voices, September 2013

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Insulin

Family Voices, September 2013

(energy)

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Insulin

Family Voices, September 2013

(energy)

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Insulin

Family Voices, September 2013

An islet

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Diabetes

  • Glucose cannot enter the cells
  • No insulin = Type 1 Diabetes
  • Insulin not working = Type 2 Diabetes
  • Other types, less common

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Diabetes

  • Glucose accumulates in the blood
  • Spills over in the urine (when level is >180)

(Normal is 70-110, up to 140)

  • Takes water with it
  • Increased urine and thirst

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Type 2 Diabetes

Insulin not working

  • Overweight and lack of physical activity

lead to insulin resistance

  • We make more insulin to compensate
  • Eventually, islet cells burn out,

cannot make enough

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Type 2 Diabetes

Treatment

  • Eliminate the cause:

Decrease weight, increase activity

  • Drugs

Help make more insulin Help insulin work better Lower blood sugar (in other ways)

  • Insulin

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Type 1 Diabetes

No Insulin

  • Trauma – Infection - Surgery
  • Cystic Fibrosis
  • Autoimmune (true T1D)

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Autoimmunity

Family Voices, September 2013

Gland

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The immune system (very simplified)

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Autoimmunity against Beta cells

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Autoimmunity

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Type 1 Diabetes

No Insulin

  • Treatment: Take insulin!

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Type 1 Diabetes; Management

In normal physiology, glucose metabolism is exquisitely controlled; – Blood Glucose (BG) has a tight range – BG levels are sensed continuously – Instantaneous response in the β-cells – Almost immediate and quick effect of insulin – Short lived effect

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Type 1 Diabetes; Management

We’re not even close

  • We check BG every few hours
  • We deliver insulin every few hours
  • Insulin action is still too slow
  • Deliver insulin in subcutaneous space

(it takes a while to reach the blood)

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Insulin

1922

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Insulin

Family Voices, September 2013

Frederick Banting & Charles Best

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Insulin

1990

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Type 1 Diabetes; Management

We need insulin all the time

  • Long acting insulin, 1 or 2 doses/day
  • Short acting insulin, for every meal

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Type 1 Diabetes; Management

Insulin pump, continuous infusion of short acting insulin

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Type 1 Diabetes; Management

Daily tasks, before each meal

  • Check BG
  • Count the carbohydrates in the meal
  • Calculate dose of insulin
  • Deliver insulin, by injection or insulin pump

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Insulin pumps

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Insulin pumps

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Insulin pumps

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Glucose sensors

(Continuous Glucose Monitors)

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Glucose sensors

(Continuous Glucose Monitors)

Family Voices, September 2013

A: pump B: infusion set C: sensor D: transmitter

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Type 1 Diabetes; Management

Lots of cool tools, but they don’t think for us

  • What kind of food (fat, fiber, protein)
  • Activity (before and after)
  • Time of day
  • Time of month
  • Constantly making adjustments

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Diabetes logs

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Diabetes logs

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Closing the loop

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Closing the loop

The Artificial Pancreas

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