type 1 diabetes
Introduction
Introduction to type 1 diabetes Type 1 diabetes, also known as insulin-dependent diabetes, occurs in children and adolescents and can occur at all ages. The onset is relatively sharp, the insulin in the body is absolutely insufficient, and ketoacidosis is prone to occur, which will cause blood sugar levels to continue to rise and diabetes. basic knowledge The proportion of illness: 0.002% Susceptible people: mostly in children and adolescents Mode of infection: non-infectious Complications: Diabetic nephropathy
Cause
Causes of type 1 diabetes
Autoimmune system defects (20%):
A variety of autoimmune antibodies, such as glutamate decarboxylase antibodies (GAD antibodies) and islet cell antibodies (ICA antibodies), can be detected in the blood of patients with type 1 diabetes. These abnormal autoantibodies can damage insulin-producing B cells in human islets, making them unable to secrete insulin normally.
Genetic factors (15%):
Current research suggests that genetic defects are the basis of type 1 diabetes, and this genetic defect is manifested in HLA antigen abnormalities in human chromosome 6. Research suggests that type 1 diabetes is characterized by familial morbidity - if parents have diabetes, they are more likely to develop the disease than those without this family history.
Viral infection may be the cause (15%):
Many scientists suspect that the virus can also cause type 1 diabetes. This is because patients with type 1 diabetes often have a history of viral infection for a period of time before onset, and the occurrence of type 1 diabetes often occurs after the spread of viral infection. Viruses that cause mumps and rubella, as well as the Coxsackie virus family that causes polio, can play a role in type 1 diabetes.
Other factors (10%):
Such as milk, oxygen free radicals, some rodenticides, etc., whether these factors can cause diabetes, scientists are studying.
Prevention
Type I diabetes prevention
1. Health Education: Prevention of diabetes is the cause of prevention. The most important measure is to educate the public about health and raise awareness of the dangers of diabetes in the whole society. The education target is not only for diabetic patients and their families, but also for the purpose of prevention. Public education has enabled society as a whole to raise awareness of the dangers of diabetes to change bad lifestyles.
2. Prevention and control of obesity: Obesity is a positive risk factor for diabetes. Obese people, especially those with high blood pressure and obesity, can reduce the incidence of diabetes by losing weight. Obese people should strictly limit the consumption of high-sugar and high-fat foods, and eat vegetables and fruits rich in cellulose and vitamins to prevent excessive intake of energy.
3. Strengthen physical exercise and physical activity: Regular participation in appropriate physical activities can reduce weight and enhance cardiovascular function, thereby preventing diabetes and its complications.
4. Promote dietary balance: To promote dietary balance, we must first adjust the diet to avoid excessive intake of energy. Complex carbohydrates can be used to replace easily absorbed carbohydrates. Dietary fiber is good for controlling blood sugar and improving lipoprotein composition. Therefore, natural foods rich in cellulose such as cereals, fruits and vegetables should be preferred. Second, reduce the intake of saturated fatty acids. Serum cholesterol is a hallmark of high levels of saturated fatty acids. People with a positive family history of diabetes and high serum cholesterol should pay special attention to avoid excessive intake of saturated fatty acids. Promote a low-fat, high-carbohydrate dietary structure. Carbohydrates can account for 50%-60% of total calories, limiting fat intake to less than 30% of total calories. The ratio of saturated fatty acids, polyunsaturated fatty acids and unsaturated fatty acids is 1:1:1.
5. Smoking cessation and alcohol restriction.
Complication
Type I diabetes complications Complications, diabetic nephropathy
Diabetes has many complications and can be divided into acute complications and chronic complications. Acute complications include diabetic ketoacidosis and diabetic hyperosmolar nonketotic coma (more common in type 2 diabetes); chronic complications accumulate throughout the body and tissues, including major blood vessels (such as cardiovascular, cerebrovascular, renal blood vessels and Large blood vessels of the extremities, microvessels (such as diabetic nephropathy and diabetic retinopathy) and neuropathy (such as autonomic and somatic nerves).
Symptom
Type I diabetes symptoms common symptoms polyuria fatigue visual impairment weight loss
3 characteristics of type 1 diabetes
The first characteristic: the disease occurs in children or adolescents. In addition to children, type 1 diabetes may actually occur in all ages of life, especially menopause.
The second characteristic: type 1 diabetes is generally more rapid, thirst, polydipsia, polyuria, polyphagia and fatigue, weight loss, and a sharp drop in weight are very obvious, and some patients have ketoacidosis in the first episode.
The third characteristic: Type 1 diabetes is ultimately treated with insulin without exception, so type 1 diabetes was originally called insulin-dependent diabetes.
Examine
Examination of type 1 diabetes
Urine check
(1) Urine sugar: The glucose filtered out from the renal tubules of normal people is almost completely absorbed by the renal tubules. Only a small amount of glucose (32-90 mg) is excreted from the urine every day. Generally, the glucose qualitative test cannot be detected. Diabetes usually refers to the discharge of glucose >150 mg per day in the urine. Urine sugar can be detected when the blood sugar of a normal person exceeds 8.9-10 mmol/L (160-180 mg/dl). This blood sugar level is called the renal sugar threshold. Older people and people with kidney disease, kidney sugar threshold increased, blood glucose more than 10mmol / L, even 13.9 ~ 16.7mmol / L can be no diabetes; on the contrary, pregnant women and some renal tubular or renal interstitial lesions, kidney sugar The threshold is lowered, and diabetes can also occur when blood sugar is normal. For the examination of diabetes, Ban's method (reduction reaction by copper sulfate) and glucose oxidase are commonly used. Ban's method is often affected by drugs such as lactose, fructose, pentose, ascorbic acid, cephalosporin, isoniazid and salicylate in urine, which is false positive and is inconvenient to operate. It has been gradually eliminated; glucose The oxidase method has a strong specificity because the enzyme is only positive for glucose, but it can also be false positive when taking large doses of ascorbic acid, salicylic acid, methyldopa and levodopa. Urine sugar is not used as a diagnostic indicator for diabetes. It is generally used only for the monitoring of diabetes control and for indicators that may require further examination for diabetes. In addition to the renal sugar threshold and the interference of certain reducing substances, the factors affecting urine sugar are often affected by the amount of urine and the emptying of the bladder.
(2) Urine ketone: Urine ketone body measurement provides an indicator of insulin deficiency, warning that diabetic patients may or may have ketoacidosis, suggesting further blood ketone determination and blood gas analysis. The urine ketone body was determined by reacting sodium nitrate with acetoacetate to form a purple substance, suggesting that the ketone body was positive. However, the sodium nitroprusside-based reaction could not detect the amount of -hydroxybutyrate in the ketone body (acetone, acetoacetate, and -hydroxybutyrate). It has been reported that false positives can be produced when a thiol-containing drug such as captopril is used, and a false negative can be produced if the urine sample is exposed to the air for a long time.
Diabetic patients, especially those with type 1 diabetes, should have a ketone body test when combined with other acute illnesses or severe stress, and during pregnancy, or when there are unexplained gastrointestinal symptoms such as abdominal pain, nausea, or vomiting.
(3) Urinary albumin: The urine albumin assay can sensitively reflect the damage and extent of diabetic kidney. In the early stage of diabetic nephropathy, 24h urine protein is generally <150mg, and is intermittent. Strict control of blood sugar can make urine protein disappear. Urinary protein can be significantly increased after exercise. Mogensen believes that exercise testing is a sensitive test for early diagnosis of diabetic nephropathy.
2. Blood test
(1) Blood sugar: The blood sugar is increased, most of which is 16.65 to 27.76 mmol/L (300 to 500 mg/dl), sometimes up to 36.1 to 55.5 mmol/L (600 to 1000 mg/dl) or more, and blood glucose 36.1 mmol/L is often used. Accompanied by hyperosmolar coma.
(2) Blood ketone: ketone body formation is qualitatively positive. However, because the ketone body in the blood is often -hydroxybutyric acid, the blood concentration is 3 to 30 times that of acetoacetic acid, and is parallel to the ratio of NADH/NAD, such as clinical ketoacidosis and blood - When the hydroxybutyric acid is dominant and the qualitative test is negative, the specific enzyme test should be further carried out to directly measure the -hydroxybutyric acid level.
(3) Acidosis: mainly related to the formation of ketone bodies. The ketone bodies include -hydroxybutyric acid, acetoacetic acid and acetone, and acetoacetic acid and acetone react with sodium nitroprusside, while -hydroxybutyric acid does not react with sodium nitroprusside. In most cases, in DKA, a large amount of acetoacetate in the serum reacts with sodium nitroprusside. Metabolic acidosis of this disease, the pH of the compensation period can be within the normal range, when decompensated, the pH is often lower than 7.35, and sometimes less than 7.0. The CO2 binding force is often lower than 13.38 mmol/L (30% volume), and when it is severe, it is lower than 8.98 mmol/L (20% volume), and HCO3- can be reduced to 10-15 mmol/L. Blood gas analysis showed an increase in alkali residue, a significant decrease in buffer base (<45mmol/L), and a decrease in SB and BB.
(4) Electrolytes: attention should be paid to the determination of blood sodium, blood potassium, blood phosphorus and blood magnesium.
(6) Serum creatinine and urea nitrogen: often elevated due to loss of water, circulatory failure (prerenal) and renal insufficiency. It can be recovered after rehydration.
Other auxiliary inspection
Diabetic retinopathy is a part of diabetic microangiopathy, often associated with diabetic nephropathy, so the presence of retinopathy in the fundus examination should be alert to the presence of renal microangiopathy. According to the condition, you can choose B-ultrasound, electrocardiogram and other tests.
Diagnosis
Diagnosis and diagnosis of type I diabetes
Pay attention to the identification of type 1 diabetes and type II diabetes
Type I diabetes itself is absolutely incapable of producing insulin, so the need for lifelong use of insulin therapy for type 1 diabetes has been described as an autoimmune disease - the body's immune system attacks islet cells in the pancreas and ultimately destroys their ability to make insulin. Without insulin, the body cannot convert glucose into energy, so patients with type 1 diabetes must inject insulin to survive.
Insulin in type II diabetes is relatively insufficient, so the first use of drugs to promote the production and action of human insulin, but more than half of them eventually cause islet failure due to long-term drug stimulation, and need to use external insulin treatment. After insulin is used in type 2 diabetes, insulin can still be withdrawn again.
