1. Type 1 Diabetes Mellitus

2. Pathophysiology of T1DM
Chronic autoimmune disorder occurring in genetically susceptible individuals
May be precipitated by environmental factors
Immune system is triggered to develop an autoimmune response
Altered pancreatic beta cell antigens
Molecules in beta cells that resemble a viral protein
~ 85% of T1DM patients have circulating islet cell antibodies
Maahs DM, et al. Endocrinol Metab Clin North Am. 2010;39:

3. Model for Pathogenesis of T1DM
van Belle TL, et al. Physiol Rev. 2011;91:

4. Pathophysiology of T1DM: Bottom Line
T1DM is associated with an (eventual) absolute insulin deficiency
Insulin treatment is a necessity
The treatment plan should also include:
Physical activity recommendations
Dietary recommendations
Diabetes self-management education/support (DSME/S)

5. Insulin and Glucose Metabolism

6. Normal Physiologic Insulin Secretion50
Insulin
(µU/mL) 25
Basal Insulin
Breakfast Lunch Dinner
150
Glucose
(mg/dL)
100 50
Basal Glucose 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9
A.M.
P.M.
Time of Day
Key points:
The role of basal insulin release is to cover hepatic glucose output (maintains fasting glucose concentrations).
The role of prandial insulin is to manage/process ingested carbohydrate/nutrients.

7. A1C Recommendations for Non-Pregnant People with Diabetes*
Obesity Series, Part II: Physical Activity
A1C Recommendations for Non-Pregnant People with Diabetes*
Youth (˂18 years)
˂7.5%
Adults+
˂7.0%
Older Adults
Healthy†
Complex/Intermediate
Very Complex/Poor Health
˂8.0%
˂8.5%
* Targets must be individualized based on patient’s circumstances.
+ More stringent goals may be recommended (˂6.5%) for select individuals.
† No comorbidities, long life expectancy.
Chiang JL, et al. Diabetes Care DOI: /dc
Copyright 2014 American Association of Diabetes Educators. All rights reserved.

8. ADA 2018: Summary of Glycemic Recommendations
Glycemic Targets: Standards of Medical Care in Diabetes Diabetes Care 2018; 41 (Suppl. 1): S55-S64.
References
American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S25–S26; Table 9
American Diabetes Association. Postprandial blood glucose. Diabetes Care 2001;24:775–778
Ceriello A, Taboga C, Tonutti L, et al. Evidence for an independent and cumulative effect of postprandial hypertriglyceridemia and hyperglycemia on endothelial dysfunction and oxidative stress generation: effects of short- and long-term simvastatin treatment. Circulation 2002;106:1211–1218 8