13. Type 1 Diabetes Mellitus

Summary

Type 1 diabetes is common. Understanding its pathology is easy but controlling it and preventing complications of diabetes starting in children is formidably difficult. This chapter aims to help. Distinguishing type 1 diabetes mellitus from type 2 diabetes mellitus can be challenging; the presence of autoantibodies and measurable concentrations of C-peptide can aid in the diagnosis. Children with type 1 diabetes mellitus should be treated by a team which includes an endocrinologist, a specialist nurse educator, and a mental health professional. Therapy must be individualized. Type 1 diabetes mellitus should be intensively treated to reduce the incidence and progression of long-term complications. Hypoglycemia is a serious barrier to “tight” control. Diabetic ketoacidosis is a preventable, potentially fatal complication of established diabetes which is most commonly due to omission of insulin or the administration of inadequate insulin during infection. Long-term micro- and macrovascular complications are inevitable but rare before puberty. Screening for them should start within 5 years of the onset of disease and countermeasures be introduced as early as possible.