2 - Pathophysiology and Management of Type 1 Diabetes

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Abstract

Chronic hyperglycemia defines diabetes mellitus and is associated with several pathogenic processes affecting the secretion and/or action of the major regulatory hormone of blood-glucose concentration, i.e., insulin. Tight glycemic control is fundamental to diabetes management; however, the increased risk of hypoglycemia impedes the realization of its long-term benefits. This chapter introduces the basic concepts of both normal physiology of glucose metabolism and pathophysiology of diabetes, where special focus is placed on the glucose counterregulatory system, responsible for the prevention or correction of hypoglycemia. In addition, current approaches to the assessment of glycemic control and to the treatment of diabetes, especially of type 1 diabetes, are discussed. The clinical impact of more advanced, though less commonly used, glucose monitoring [i.e., continuous glucose monitoring (CGM)] and controlling [i.e., continuous subcutaneous insulin infusion (CSII)] technologies is also pointed out, as these technologies are the key components of future closed-loop glycemic control systems.

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