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Type 1 Diabetes Diabetes

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Type 1 diabetes mellitus (T1DM) is a serious, chronic, life-long condition resulting in hyperglycemia due to destruction of pancreatic beta-islet cells as a result of auto-reactive T-cells targeting self-antigens (Caroll et al., 2016). In contrast to type 2 diabetes, it is not the insensitivity to insulin but lack of insulin causing hyperglycemia that marks micro- and macrovascular complications in multiple organs over time (Miller at al., 2015). A Scottish cohort (Livingstone et al., 2010) estimated a loss of 11 years in male and 13 years in female life expectancy compared to the general population. However, comorbidities and functional status also play a vital role in determining the life expectancy (Chiang et al., 2014). While most of …show more content…

Bode and Garg (2016) state that intensive insulin therapy is required to prolong the onset of micro and macrovascular complications in T1DM. American Diabetes Association has recommended reduction of A1c targets to 7.5% in all pediatric populations, and A1c of 7.0% in adult population, where even normal levels can be aimed for in patients with short duration of disease, larger life expectancy and no cardiovascular disease history as long as severe, recurrent hypoglycemia is avoided (Chiang et al., 2014). But along with numerous limitations of insulin use (Bode and Garg, 2016), intensive insulin therapy’s most common side effect remains to be increased frequency of hypoglycemia (George and McCrimmon, 2012). Recurrent hypoglycemia can lead to autonomic dysfunction with decreased sympatho-adrenal response causing decline in awareness of hypoglycemia (Chiang et al., 2014; and Bode and Garg, 2016). Complications from hypoglycemia can result in death from ventricular dysrhythmia, 3.4 times increase in risk of mortality over 5 years, and double the risk of cardiovascular diseases. Weight gain can also result from ‘defensive eating’ and decreased physical activity from the fear of hypoglycemia in T1DM patients (Bode and Garg, 2016).
Since endogenous and exogenous insulin work differently in vivo, exogenous insulin can disturb glucose homeostasis significantly from lack of

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