TYPE 1 DIABETES: ILLUSTRATIVE CASES  - UNCOMPLICATED TYPE 1 DIABETES WITH PREDIABETIC PHASE AND C-PEPTIDE SECRETIONA 42-year-old Caucasian woman reported that she had an elevated blood glucose transiently in 1980 and gestational diabetes (GDM) in 1995, which required 50 U of insulin daily. For 9 months after delivery, she was managed on diet alone but in 1996 was placed on insulin because of HbA1 c of 7.1 %. Pancreatic islet cell antibody tests were positive. Since then she has maintained HbAlc values in the range of 5.8-6.2%. Usual insulin doses are 5 U NPH before breakfast and 5 U NPH at bedtime with premeal lispro insulin, 1-3U. Her weight is steady at 60 kg; total insulin dose/24 hr = 0.33 U/kg. Blood Dressure and lipid profile are normal. She has had fasting c-peptide levels of 0.6-0.8 ng/dl. She has no retinopathy and urine microalbumin levels are 5-7 mg/24 hours. She has hypothyroidism that is well controlled on 0.125 mg of L-thyroxine/day.Comment. Type 1 diabetes may follow GDM, particularly in nonobese Patients with positive islet antibodies. The presence of hypothyroidism is another clue to an autoimmune process in the thyroid and pancreas. This Patient has maintained excellent glycemic control on low doses of insulin ’0-33 U/kg), probably because of the presence of residual insulin secretion as shown by fasting c-peptide levels of 0.6-0.8 ng/ml. Although laboratories may vary, we have found that a fasting level of < 1.0 ng/ml is insistent with type 1 diabetes, although higher levels are usually found type 2 diabetes. Experience has indicated that the patient may have a gradual loss of insulin secretion in the future. If so, her insulin requirements will rise and precise glycemic control will be more difficult. Bedtime insulin glargine with premeal lispro or aspart may be tri or she may be placed on insulin pump therapy.*68\357\8*

PROTEIN FOR PEOPLE WITH DIABETES The third major constituent of food, besides carbohydrate and fat, is protein. In addition to supplying kilojoules, protein also provides the building blocks for growth and repair of muscles, bones and connective tissue.Although protein is essential for life, most westerners eat too much of it. The meat and potatoes approach to food may have been needed in earlier days, but our modern lifestyle does not require such an emphasis on meat.Indeed, as a person with diabetes, your intake of protein may be critical to your risks for development of complications affecting kidney function. Research has shown that the higher the amount of protein in the diet of a person with poorly controlled diabetes, the more likely the kidneys are to suffer increased damage over the years.If you have been diagnosed as also having kidney function problems in addition to your diabetes, you may be advised to greatly reduce the amount of protein you eat. Even if you don’t have kidney problems, it’s important that you routinely be tested to find out if your kidneys are spilling protein – an early warning sign of kidney function problems. Another recommended test is a creatine clearance assay to determine how well your kidneys are functioning.*16/210/5*

You might think of carbohydrate as the all important ingredient that makes foods taste sweet. It is also the starchy part of foods like rice, bread, potatoes and pasta. In fact, carbohydrate is the most widely consumed nutrient in the world, after water. It’s important to the human body because it yields glucose. Glucose is so important that if your diet doesn’t provide enough carbohydrate, your brain signals a shortage of glucose, and muscle tissue will be broken down to supply the shortfall. This basically means that you lose body muscle to feed your brain. Carbohydrate also displaces fat from the diet. While not all fats are bad (monounsaturated and polyunsaturated are fine), they are all easy to overconsume, i.e. eat in excess of your requirements. It’s easy to put on excess weight if your diet is dominated by fats. Ideally, 50 to 60 per cent of your daily kilojoule intake should come from carbohydrate.

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It is wise for your child to wear some means of identification at all times.

It is perhaps most unlikely that an emergency will arise when no one that knows him is with your child, but as the possibility does exist, you should be prepared.

Accidents can happen on the way to school or visiting friends, or perhaps he may have a hypo while he is away from home. In either event he may not be able to tell anyone he has diabetes, and this could mean he is not given the appropriate treatment promptly.

Most children now wear identification as a bracelet on the wrist or on a chain. You may have your own engraved or use one supplied by organizations such as the S.O.S. Talisman or Medic Alert bracelet.

Teenagers may carry a card

Teenagers may prefer to have a card giving full information.

It is suggested that you have your child’s name, address and telephone number, the word ‘Diabetes’ and the name and telephone number of his own doctor or hospital to be called in an emergency.

If your child carries this information at all times you will have the security of knowing he would be properly cared for in the unlikely event of a severe hypo reaction or accident when away from home.

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