Diabetes mellitus type 1 accounts for 5% to 10% of all cases of diabetes. Type 1 diabetes is often diagnosed in children, adolescents, and young adults, but can occur at any age.
Ask patients or caregivers about classic acute symptoms of the disease such as polyuria.
Perform a physical exam to look for signs of acute complications, such as volume depletion and diabetic ketoacidosis, and precipitating factors such as infection.
Measure plasma glucose to confirm the diagnosis. Check other laboratory studies to document metabolic and end-organ complications.
Differentiate type 1 diabetes from other forms of diabetes based primarily on clinical factors.
Set an individualized target for glycemic control, generally with a goal of HbA1c <7%.
Treat patients with multiple daily insulin injections to achieve glycemic targets and prevent complications.
Take measures to avoid severe hypoglycemia.
Aggressively manage blood pressure, preferably with an ACE inhibitor or angiotensin-receptor blocker with a goal blood pressure < 140/90 mm Hg, or lower in select patients.
Provide moderate- or high-intensity statin therapy.
Treat diabetic nephropathy with ACE inhibitors.
Provide pneumococcal vaccination and annual influenza vaccination for all patients with type 1 diabetes.
Encourage smoking cessation and exercise.
Follow and treat retinopathy.
Treat foot ulcers aggressively.
Treat painful peripheral neuropathy using tricyclic antidepressants as first-line agents.