الفهرس 
DIABETES MELLITUSOnly 14 pages are availabe for public view
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Abstract
Type 1 diabetes (T1D) is an autoimmune disease characterized by loss of insulin producing beta cells and reliance on exogenous insulin for survival. T1D is one of the most common chronic diseases in childhood and the incidence is increasing,
especially in children less than 5 years of age.
The basic elements of type 1 diabetes management are insulin administration (either by injection or insulin pump), nutrition management, physical activity, blood glucose testing, and the development of strategies to avoid hypoglycemia and hyperglycemia that may lead to DKA.
The primary clinical goals to be achieved with insulin initiation are elimination of ketosis and hyperglycemia with prevention of chronic complications. Insulin therapy is the mainstay in management of type 1 diabetes, which should aim at achieving good glycemic control, with achievement of hemoglobin A1C (HbA1c) <7.5%.
Newer insulins are available for better glycemic control. The primary benefits of insulin analogues are that the rapid acting insulins work as soon as they are injected and long acting insulins have no peak activity.
151
Summary
Rapid acting insulins are particularly useful for children who are insulin dependent as they can help to minimize sharp rises (spikes) in blood sugar shortly after eating.
Long acting insulin analogues have become popular partly because the lack of a peak activity period allows for easier prediction of how they act and also gives some children more confidence that they will avoid night time hypoglycemias.
Insulin delivery systems that are currently available include syringes, infusion pumps, jet injectors and pens. The tedious part for the type 1 diabetes patients is to tolerate needle after needle injections while undergoing treatment for both glucose measurement and to deliver insulin. A rigorous research effort has been undertaken worldwide to replace the authentic subcutaneous route by a more accurate and non-invasive route.
Glucose monitoring allows patients to recognize and correct dangerous blood glucose levels, appropriately calculate and administer mealtime insulin boluses, and get feedback on their responsebody‘stocarbohydrate intake, insulin or medication use, and physical activity.
The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system.
152
Summary
The newer methods explored include the artificial pancreas with closed-loop system, bionic pancreas, transdermal insulin, and buccal, oral, pulmonary, nasal and ocular routes for insulin delivery.
Some of the non-invasive delivery systems include polymeric hydrogels and insulin loaded bioadhesivepoly(D,L-lactide-co-glycolide) nanoparticles for oral delivery, aerosolized liposomes with dipalmitoylphosphatidylcholine for
pulmonary delivery, β cyclodextr microneedle arrays fabricated from hyaluronic acid and
iontophoresis for transdermal delivery, chitosan-zinc-insulin complex for the controlled delivery of insulin.
In contrast to conventional insulin treatment, islet transplantation is far superior for achieving a constant normoglycemic state and avoiding hypoglycemic episodes. Insulin-producing beta cells are taken from a donor’s pancreas and transferred into a person with diabetes. Once transplanted, the donor islets begin to make and release insulin, actively regulating the level of glucose in the blood.
Cell therapy in the form of human islet transplantation has been a successful form of treatment for patients with type 1 diabetes for over 10 years, but is significantly limited by lack of suitable donor material.
153
Summary
A replenishable supply of insulin-producing cells has the potential to address this problem; however to date success has been limited to a few preclinical studies. Two of the most promising strategies include differentiation of embryonic stem cells and induced pluripotent stem cells towards insulin producing cells and transdifferentiation of acinar or other closely related cell types towards b-cells.
Nanotechnology-based approaches hold substantial potential for improving the care of patients with diabetes. Nanoparticles are being developed as imaging contrast agents to assist in the early diagnosis of type 1 diabetes. Glucose nanosensors are being incorporated in implantable devices that enable more accurate and patient-friendly real-time tracking of blood glucose levels, and are also providing the basis for
glucose-responsive nanoparticles that physiological needs for insulin. Finally, nanotechnology is
being used in non-invasive approaches to insulin delivery and to engineer more effective vaccines, cell and gene therapies for type 1 diabetes.