Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus . Diabetes mellitus (DM) is a multisystem disease with both biochemical and anatomical/structural consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin, which results from the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells. (See Pathophysiology.)

Type 1 DM can occur at any age. It occurs most commonly in juveniles but can also occur in adults, especially in those in their late 30s and early 40s. (See Epidemiology.)

Unlike people with type 2 DM, those with type 1 DM generally are not obese and may present initially with diabetic ketoacidosis (DKA). The distinguishing characteristic of a patient with type 1 diabetes is that if his or her insulin is withdrawn, ketosis and eventually ketoacidosis develop. Therefore, these patients are dependent on exogenous insulin. (See Clinical Presentation.)

Treatment of type 1 DM requires a multidisciplinary approach by physician, nurse, and dietitian. In patients with new-onset type 1 diabetes, lifelong insulin therapy must be started. As a chronic disease, DM requires long-term medical attention both to limit the development of its devastating complications and to manage them when they do occur. (See Treatment and Management and Medication.)

DM is a disproportionately expensive disease; in 2002, the per-capita cost of health care was $13,243 for people with diabetes, while it was $2560 for those without diabetes. The emergency department (ED) utilization rate by people with diabetes is twice that of the unaffected population.^[1] Overall, the annual financial cost from diabetes exceeds $100 billion, almost $1 of every $7 dollars of US health expenditures in terms of medical care and loss of productivity.

 from : http://emedicine.medscape.com/article/117739-overview