Note. Lecture 4a 3 February 2014 Type 1 Diabetes Pathology Nutritional Intervention-pre- and post-onset.

Note

Lecture 4a

3 February 2014 Type 1 Diabetes

•Pathology•Nutritional Intervention-pre- and post-onset

Pathology of Type 1 diabetes-must first discuss the role of insulin Insulin 

-produced in the beta cells of the pancreas 

-initially synthesised as a single chain 86 amino acid (86 mer) polypeptide (called pre-

proinsulin) 

-post-translational modification removes the amino terminal signal peptide

what is a signal peptide?

Role of insulin

-removal of the signal peptide give rise to proinsulin -insulin is created via the cleavage of an internal peptide and the A and B chains of insulin are then linked together by a disulphide linkage (enzyme responsible?)

-upon glucose arriving at the pancreas insulin is secreted into blood

Role of insulin

-upon insulin arriving via the blood at its cellular receptors it sets up a series of steps that ultimately lead to glucose being brought inside the cell

Causes of Type 1 diabetes•Genetic-pre-disposition to autoimmune attack

•Autoimmune-beta cells in pancreas are attacked and destroyed by one’s own immune system-this attack stops insulin production and secretion

•Nitroamines-derived in stomach from nitrogen containing preservatives in meats (eg hot dogs, baloney)- nitrosamines attack the pancreatic beta cells-system-this attack stops insulin production and secretion

•Casein (milk, cheese, yoghurt)-sets up immune response that attack the pancreatic beta cells-system-this attack stops insulin production and secretion

•Viruses – cocksackie and rubella-system-this attack stops insulin production and secretion

Dietary management of type 1 diabetes-prevention

•avoid cows’ milk, cream , cheese and yogurt (anything else with whole casein in it) if under 1 year of age•avoid nitrosamines to the extent possible-hot dogs and baloney to give but two examples•Avoid cocksackie and rubella viruses in food to the extent possible

Dietary management of type 1 diabetes-post-onset management•insulin prescription and healthy diet are matched•largely the same as type 2 diabetes with some points directed at type 1 diabetes specifically (see nutrition section at end of lecture 4D today)

Dietary management of type 1 diabetes-post-onset

Whole idea with nutrition post-onset is along with diet and exercise and insulin prescription to meet target HbA1c, lipids(including cholesterol), blood pressure goals to attempt to minimise vascular complications (the major cause of death and disability in type 1 diabetics)

For exercise see the exercise notes at the end of lecture 4D today-many similarities between type 1 and type 2 diabetes in terms of exercise