Type uptake by muscle and fat cells and

Type 1 diabetes (T1D) is an autoimmune disease, it is caused by the destruction of b-cells that results in a deficiency of insulin. T1D  represents 10 % of all types of diabetes.  The prevalence of T1D increases with age.  It is commonly diagnosed in children, but can develop at any age. In T1D patients have a loss of insulin production, they therefore require regular insulin intake either by injection or by a insulin pump. (Diabetes UK,2016)Insulin is a major anabolic hormone produced by the pancreas it reduces blood sugar levels and stimulates cell replication and growth. It stimulates glucose uptake by muscle and fat cells and promotes glycogenesis, lipogenesis and protein synthesis.(Dyson and Goff, 2015) It has been estimated by public health England that 4.5 million people in the UK have T1D and 1.1 million are undiagnosed.  The symptoms include:·       Abnormal thirst·       Tiredness·       regular urination·       Unexplained weight loss·       Genital itchiness Symptoms of T1D should be acted upon, as without treatment these symptoms can progress and be deadly. (NHS,16) The aetiology of T1D is yet unknown , however research shows that as it is an autoimmune disease, the immune system may attack healthy body tissues in the pancreas.  That it may be due to an environmental trigger such as unknown viruses and diseases. T1D is inherited and may be geneticIf doctors suspect that patient has diabetes , several tests are used for diagnosed such as Ketone test, GAD autoantibodies test, C-peptide test. (Diabetes UK,16) TreatmentInsulin replacement is the main treatment available to substitute the loss of endogenous insulin. These are divided into: rapid?acting, short?acting (soluble), intermediate?acting, long?acting and mixed insulin. Intermediate acting and long acting have a longer action when compared to rapid acting insulin (8-12 hours). NPH insulin Neutral Protamine Hagedorn (NPH) is  an intermediate?acting insulin it has a peak of 1-3 hours and action of 6-8 hours. Long lasting analogue insulin gives a 24 hour cover. Basal bolus insulin treatment is a mixture of rapid and long acting insulin that is given with meals. It aims to imitate the the natural peaks of insulin when feeding and fasting. Most patients require 0.5–1 unit insulin per kilogramme of body weight, however insulin sensitivity varies between patients. In most cases small doses are normally used and then titrated to ensure the glucose levels have been met.(Dyson and Goff, 2015) An alternative treatment to basal?bolus treatment is the insulin pump. it is  rapid?acting insulin that is delivered continuous using an insulin pump. It can be adjusted to deliver insulin at a fixed rate or vary depending on activity and energy consumption. Lastly, another treatment option is the artificial pancreas. This treatment option offers  continuous glucose monitoring that measures glucose readings every minute, it depends and is adjusted based on real time glucose values.   (Dyson and Goff, 2015) Table 1 information on treatment types for T1D Insulin typeMethodOnset (hours)Peak (hours)Duration (hours)impact on everyday life and eating habits Rapid acting analogues5-15 minutes Before eating something0.25–0.51–1.54This insulin regimen is similar to the short acting, however it is more time efficient for patients, being on insulin treatment may be a barrier to some patients when eating out, as they may feel left out or embarassed of the whole process. Short acting30 minutes before meal, aims for peak action to correspond to the rise of blood glucose after the meals 0.5-12-46-8This is beneficial to some patients as it reduces snacks between meals and is more convenient. However it is not appropriate if the diet is high in carbohydrate. This can impact patients life as they may need to pre plan what they will eat before hand to allow time for the insulin to take action.  Intermediate actingBefore food or before bed1-46-88-12 Long actingOnce/twice dailyVariesThey have no peak20-24 can be mixed with short acting insulin, this is flexible for patients who have a irregular lifestyle. Here glycemic control is tightly controlled             Lifestyle and exercise and the impact on the life of a diabetic patient   lifestyle factor Impact physical activity Physical activity levels (PAL) can be undergone by patients who have maintained glucose, however some restrictions apply to certain sports that are aggressive. The way energy is used during exercise has an impact on blood glucose concentration. although PAL improves glycaemic control it may worsen the management to adjust CHO and insulin dosage. To allow patients to successfully manage their glucose levels , adjustments must be in place when it comes to glucose levels, insulin, and food intake. In more intense exercise, the free fatty acids become a substitute for energy and decreases glucagon stores within the liver and muscle. patients must follow a graded exercise regime and keep a diary of the strength and duration of their workout. Glycemic response must be considered and learnt by the patients in regards to the risk of hypoglycaemia and other complications. therefore, patients must consume enough CHO and stay hydrated to replace the lost fluids and to avoid fluid imbalance. Alcohol Alcohol in considerable amounts can be consumed safely by most diabetic patients. 1-2 units per day, it has shown that there are some benefits as it lowers the risk of CVD, However, Alcohol can cause hypoglycemia even if food is ingested by inhibiting gluconeogenesis and lipolysis, impairing glucose regulation and reduces hypoglycaemic awareness.                                                                                                                                                                              (Dyson and Goff, 2015) Aims of treatment of T1D  a mixture  of lifestyle, diet and drugs to reduce HbA1c to  a level of 48 mmol/mol (6.5%) or less, to decrease the risk of long?term vascular complications. and a fasting plasma glucose level of 5–7 mmol/litre on waking and 4–7 mmol/litre before meals at other times of the day. Educating patients on diabetes, nutritional advice, self monitoring and the ideal targets and finally symptoms and risk and treatment of hypoglycaemia. Providing patients with individualised lifestyle and dietary changes to promote physical activity and maintain or aid healthy weight. Lowering the risk of patients developing CVD ( CVD awareness).                                                                                          (NICE,2016,NG17 )  

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