Type 1 Diabetes Mellitus

Justin M. Gregory; Daniel J. Moore; Jill H. Simmons

doi:10.1542/pir.34-5-203

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Justin M. Gregory, MD*
Daniel J. Moore, MD, PhD^†
Jill H. Simmons, MD^‡

^*Pediatric Endocrinology Clinical Fellow, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN.
^†Assistant Professor of Pediatrics, Assistant Professor of Pathology, Microbiology, and Immunology, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN.
^‡Assistant Professor of Pediatrics, Ian Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN.

Author Disclosure
Drs Gregory and Moore have disclosed no financial relationships relevant to this article. Dr Simmons has disclosed she has a research grant from Alexion Pharmaceuticals, Inc. This commentary does not contain discussion of unapproved/investigative use of a commercial product/device.

Abbreviations

ADA:: American Diabetes Association
DKA:: diabetic ketoacidosis
HbA1c:: glycosylated hemoglobin
I:C ratio:: insulin-to-carbohydrate ratio
IV:: intravenous
TDD:: total daily dose
T1DM:: type 1 diabetes mellitus
T2DM:: type 2 diabetes mellitus

Practice Gaps

All children with type 1 diabetes mellitus (T1DM) should have their blood sugar managed with basal-bolus insulin treatment by either multiple daily injections or an insulin pump.
All children with T1DM should have access to a pediatric endocrinologist with a diabetes management team with resources to support patients and families.
All children with T1DM should be monitored for symptoms and/or screened for commonly associated conditions such as thyroid and celiac disease.

Objectives

After completing this article, readers should be able to:

Recognize the presenting signs and symptoms of type 1 diabetes mellitus (T1DM).
Know the key principles of effective diabetes self-management and the diabetes care team’s role in facilitating effective self-management.
Know the acute and chronic complications of (T1DM).
Identify how different categories of insulin analogues are used in daily insulin regimens.

True, it is a fight, but there is pleasure in the struggle. Victory comes to the courageous; and without courage and common sense, success awaits no one. I look upon the diabetic as charioteer and his chariot as drawn by three steeds named Diet, Insulin, and Exercise. It takes skill to drive one horse, intelligence to manage a team of two, but a man must be a very good teamster who can get all three to pull together.EP Joslin, 1933

Introduction

Type 1 diabetes mellitus (T1DM) is a disorder of glucose homeostasis characterized by autoimmune destruction of the insulin-producing pancreatic β-cell that progressively leads to insulin deficiency and resultant hyperglycemia. If left untreated, insulin deficiency leads to progressive metabolic derangement, with worsening hyperglycemia, ketoacidosis, starvation, and death. In …