Type 1 Diabetes Mellitus: Current Interventions and Targets for Management

Liz Foot, Leigh Osborne, Katherine Ratliff, Liz Sullivan

Bastyr University
INTRODUCTION

RESULTS

RESULTS

RESULTS

Type 1 diabetes is an autoimmune disease

characterized by the destruction of pancreatic
beta cells which results in a lack of insulin
production. There are a myriad of complications
that arise primarily due to hyperglycemia,
hypoglycemia, and dyslipidemia, including nerve
damage, kidney disease, and cardiovascular
disease. Administration of insulin is the primary
treatment, but dietary interventions are also used
to manage symptoms and prevent complications.
There is currently no cure for type 1 diabetes.
Future research is focusing on non-insulin
therapies.

Metabolism

Current Treatment Goals

Carbohydrate Recommendations

METHODS
What are the effects of glycemic variation in
poorly controlled type 1 diabetes?
What are the current treatments to best
manage type 1 diabetes?
What are the current nutrition
recommendations around carbohydrates?

RESULTS
Metabolism
Hyperglycemia following hypoglycemia causes
increased coagulation activation and oxidative
stress as compared to normoglycemia following
hyperglycemia. This leads to increased risk of
cardiovascular complications (Ceriello, et al,
2014).

Algorithms containing insulin feedback models

are being used as part of CLS therapy to
decrease incidences of hypoglycemia (Ruiz,
2012).
Islet cell transplants are being studied to help
type 1 diabetic patients achieve insulin
independence (Bellin, 2008).
Figure 2: Increase in Von Willebrand factor (used in platelet
activation) in patients going from hypo- to hyperglycemia
----Hypoglycemia + hyperglycemia.
Hypoglycemia + normoglycemia.
Hypoglycemia + hyperglycemia + vitamin C.
*p < 0.05 vs basal. p < 0.01 vs basal. p < 0.01 vs
hypoglycemia + hyperglycemia + vitamin C. p < 0.01 vs
hypoglycemia + normoglycemia.

This effect is particularly problematic because

patients with a history of hypoglycemia may opt
for hyperglycemia out of fear (Cox, 1987)(Harris,
2013)

RESEARCH POSTER PRESENTATION DESIGN 2012

www.PosterPresentations.com

Figure 3: Insulin pumps in the 1970s to the present

Current Treatment Goals

The goal of current treatment is to maintain
near normoglycemia (Goksen, 2014).
Two most common insulin therapies: Multiple
daily injections and continuous insulin
infusion. MDI therapy uses long-acting insulin
analogs for basal requirements and shortacting insulin with each meal (Aathira, 2014).

Figure 4: An example of carbohydrate counting

The amount of carbohydrates in a meal does

not affect glycemic control if pre-meal insulin is
adjusted to carbohydrate content (RabasaLhoret, 1999)
The glycemic index and fiber content of meals
do not affect pre-meal regular insulin
requirements (Rabasa-Lhoret, 1999)

Vitamin C attenuates detrimental effects of

the swing from hypo- to hyperglycemia,
pointing to oxidative stress as part of the cause.

In comparison to MDI therapy, patients

undergoing CLS therapy experienced a greater
decrease in HbA1c levels (Bergenstal, 2010).
Figure 1: Increase in prothrombin fragment 1 + 2 in patients
going from hypo to hyperglycemia

Studies using bionic pancreases look

promising as a dual hormonal approach for
managing blood glucose levels (Russell, 2014).

Carbohydrate Recommendations
Education about carbohydrate counting and
insulin adjustment helps patients maintain
glycemic control (Laurenzi, 2011) (Lowe, 2008).
For individuals who do not use carbohydrate
counting, consistency in the volume and source
of carbohydrate intake from day to day is linked
to improved blood glucose control (Wolever,
1999).
Without education, dietary carbohydrate intake
is not accurately estimated and is associated
with higher blood glucose variability (Brazeau,
2013).

Diets high in fiber are linked to a decreased

mortality risk, while diets high in glycemic load,
carbohydrates, and sugar are linked to an
increased mortality risk in normal weight
individuals (Burger, 2012)

DISCUSSION
Maintaining glycemic control is the main factor
in maintaining health and minimizing
complications.
Matching insulin administration with
carbohydrate intake can prevent the swings
between hyper and hypoglycemia.
It is important to find the right individualized
insulin administration technique that matches
patient budget and lifestyle considerations.
Clinicians must include patient education as a
part of a dietary and insulin management plan.