Scope of this assignment includes

• Early identification of Type 1 Diabetes Mellitus,
• Awareness creation in this regard for health care personnel, social workers, parents, teachers and public.
• Strengthening institutional mechanism for efficient and effective clinical and laboratory diagnosis of T1DM
• Providing free and comprehensive treatment, monitoring (clinical and home monitoring) and follow up of T1DM, using the most appropriate technology as it evolves time to time.
• Providing free and comprehensive treatment for complications of T1DM for children and adolescents, including acute and chronic conditions.
• Systematic and scientific nutritional management and monitoring

Type 1 diabetes

Type1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin, leading to insulin deficiency and thus resulting in high blood sugar levels in the body. The classical symptoms are frequent urination, increased thirst, increased hunger, and unexplained weight loss. Additional symptoms may include blurry vision, weakness and fatigue. Symptoms typically develop over a short period of time. The exact cause of type 1 diabetes is unknown and there is no known way to prevent type 1 diabetes & Insulin is the only option for treating it

What causes Type 1 diabetes?

The cause of type 1 diabetes is unknown. However, it is believed to involve a combination of genetic and environmental factors. Genetic factors: The risk of developing autoimmune diseases is related to alleles of HLA genes. Variations in HLA genes are an important genetic risk factor, but they alone do not account for the disease. Environmental factors: Viruses that have been associated with type 1 diabetes as environmental triggers include Coxsackie B, enteroviruses, adenovirus, rubella, cytomegalovirus and Epstein-Barr virus.

What happens within the body

The causative entities or risk factors leads to auto-immune responses which in turn results in the destruction of the pancreatic beta cells, which produce insulin. Without insulin, the body's cells cannot utilise the glucose (sugar) for energy production and thus resulting in high glucose levels in the body.

Signs & Symptoms

• Increased thirst & frequent urination
• Extreme hunger
• Unexplained weight loss
• Fatigue
• Irritability or behaviour changes (Mood swings)
• Blurred vision
• Persisting glycosuria
• Candidial vaginitis or balanitis
• Diabetic ketoacidosis

Diagnosis

• Fasting plasma glucose > 126 mg/dl ( fasting is defined as no caloric intake for at least 8 hours)
• 2 -hour plasma glucose > 200 mg/dl during an oral glucose tolerance test (OGTT). Test should be performed using a glucose load containing the equivalent of 75 g of anhydrous glucose dissolved in water
• In patients with classic symptoms of hyperglycemias, a random plasma glucose > 200 mg/dl
• HbA1C > 6.5%.

Management, Care and Treatment

Management of Type 1 diabetes involves a multidisciplinary framework that includes the following:

Insulin therapy:
Injections of insulin - either via subcutaneous injection or insulin pump

Lifestyle modification:
A low-carbohydrate diet, exercise, and medications are useful in type 1 DM. There are camps for children to teach them how and when to use or monitor their insulin without parental help. As psychological stress may have a negative effect on diabetes, a number of measures have been recommended including: exercising, taking up a new hobby, or joining a charity among others.

Long term monitoring:

• Blood glucose monitoring
• Growth assessment
• Injection site examination
• Examination of the hands, feet and peripheral pulses for signs of limited joint mobility, peripheral neuropathy and vascular diseases
• Evaluation for signs of associated autoimmune disease
• Blood pressure

Therapeutic procedures

Lifelong insulin therapy is the only option for treatment, as of now. Insulin is available as vial, pen, and pump. The former is cheaper but difficult to use. The pen is costlier but less painful and easy to administer and carry with the patient. And pump is very expensive and difficult to handle. Hence for this project focusing to children and adolescent, pen with cartridge are preferred. As part of the project, Insulin Pump shall be provided only if it's absolutely indicated, like in cases with "brittle diabetes" who experience frequent, extreme swings in blood glucose levels, causing hyperglycemia or hypoglycemia and after referral from diabetic clinic along with supportive findings obtained by continuous glucose monitoring regularly for a fixed period under our scheme, and after getting approval from the state technical committee. And only after getting the approval from the secretary social justice department Self-monitoring of blood glucose (SMBG) by parents/ caregivers is the best method of good glycemic control and is done with glucometers. All the beneficiaries will be provided with a glucometer if they don't have that. Continuous glucose monitoring systems (CGMS) are of great importance in children with uncontrolled diabetes, frequent attacks of hypoglycemia, nocturnal hypoglycemia, and in hypoglycemia unawareness. CGMS measures interstitial glucose and comprise of a glucose sensor, glucose monitor or reader and a display device or software. As part of this project CGMs are preferred over conventional glucometers. CGMS will be provided to each for a specific period. To begin with, the pediatrician enrolled at that specific T1DM center's set as part of the project will be taking care of these beneficiaries along with Trained Nurse (preferably with Msc in Pediatric nursing) and dietician (4 days a month)