This report takes an approach of laying the first steps to create an artificial pancreassystem as treatment for type 1 diabetes. This includes a thoroughly performedanalysis of the most intrusive physical factors, such as hormonal activity, time offset,errors of measurement and metabolism. Such factors raise a need forcompensation. A compensation that will enable the development of the link betweena continuous glugose monitoring(CGM)-device and an insulin infusion pump,a system that can be described as an Artificial Pancreas.Through analysis of measured glucose series, a mathematicalapproximation is presented to solve the time offset of CGM.The approximation gives sufficient results but with room for improvementFrom the analysis of affecting factors, a compensation model isdeveloped. The model is designed as a closed loop which is suitable for timecontinuous systems. The output of the compensation model equation presented here is adirective that would be read by an insulin pump.

Background Carbohydrate counting is a method used to calculate insulin doses to meals, in the treatment of diabetes type 1. Few studies are available with a clear consensus on its efficacy and effect on anthropometrics in children and adolescents. Aim To evaluate if carbohydrate counting as treatment method in diabetes type 1 improved glycemic control and anthropometrics compared to conventional treatment, one and two years after onset in children and adolescents at Astrid Lindgren children’s hospital. A secondary aim was to explore patients and caregivers perception of insulin dosage to meals with focus on efficacy, time consumption and adherence. Method A clinical prospective study was performed on data collected from the Swedish pediatric quality registry (Swediabkids). Children with diabetes onset between 2010 and 2014 registered at Astrid Lindgren Children’s hospital (n=371) were included and divided into two groups, carbohydrate counters and non-carbohydrate counters. Normal distribution was assumed and parametric tests were performed. The registry data was complemented with a web-based questionnaire providing information on perception of carbohydrate counting, answered by 78 subjects. Results Carbohydrate counting reduced insulin requirements (p<0.001) and eliminated differences between pump- and pen users (p<0.001) as well as differences between boys and girls. Glycemic control was not improved by carbohydrate counting one and two years after diabetes onset (p=0.233, p=0.295). An adverse effect was increased body mass index standard deviation score (BMI-sds) (p=0.044), especially amongst girls (p=0.038). Conclusion Carbohydrate counting lowers insulin requirements with maintained glycemic control. Contradictory, greater weight gain was found in the carbohydrate counting group, especially among girls. A plausible explanation is that carbohydrates have taken focus off protein- and fat intake in combination with a more liberal approach to energy dense foods, causing excess energy intake. The strength of carbohydrate counting does not lie in its ability to lower HbA1c-values but as a helpful tool, which patients are happy to use. / Bakgrund Kolhydraträkning är en metod som används för att beräkna insulindoser till måltider, i behandlingen av diabetes typ 1. Få studier finns för att ge en samlad konsensus gällande dess effekt på glykemisk kontroll och tillväxt hos barn och ungdomar. Syfte Att utvärdera om införandet av kolhydraträkning som behandlingsmetod vid diabetes typ 1 påverkat metabol kontroll och tillväxt i jämförelse med konventionell metod, ett och två år efter diabetesdebut. Ett andra syfte var att utforska patienters och vårdnadshavares uppfattning om insulindosering till måltider med fokus på effektivitet, tidskonsumtion och följsamhet. Metod En klinisk prospektiv studie utfördes med data inhämtad från Nationellt kvalitetsregister för barn och ungdomar med diabetes (Swediabkids). Barn och ungdomar som debuterade med diabetes typ 1 på Astrid Lindgrens barnsjukhus mellan 2010 och 2014 (n=371) inkluderades i studien och delades in i två grupper baserat på debutdatum; kolhydraträknare och icke-kolhydraträknare. Materialet bedömdes som normalfördelat och parametriska test utfördes. En tvärsnittsenkät administrerades till studiedeltagarna för att införskaffa fördjupad information om patienters och vårdnadshavares uppfattning om insulindosering till måltider. Den webbaserade enkäten besvarades av 78 deltagare. Resultat Kolhydraträkning reducerade insulinbehovet (p<0.001) och jämställde insulinbehovet mellan pump- och pennanvändare (p<0.001) liksom skillnader mellan pojkar och flickor inom gruppen. Glykemisk kontroll förändrades inte av kolhydraträkning ett och två år efter debut (p=0.233, p=0.295). En oönskad effekt av kolhydraträkningen var en ökning i BMI-sds (p=0.044), speciellt hos flickor (p=0.038). Slutsats Kolhydraträkning från diabetesdebut sänker insulinbehov med bibehållen glykemisk kontroll. Motsägelsefullt, så fanns en viktökning i gruppen som använde kolhydraträkning, speciellt hos flickor. En möjlig förklaring är att kolhydrater har tagit fokus från protein- och fettintag tillsammans med en mer frikostig syn på energität mat, vilket har orsakat ökat energiintag. Styrkan i kolhydraträkning ligger inte i dess förmåga att förbättra glykemisk kontroll men som ett användarvänligt verktyg som patienterna är nöjda med.

Diabetes typ 1 är en av de sjukdomar som ständigt ökar. Sjukdomen för med sig stora kostnader för samhället och på individnivå kan komplikationer utgöra stor risk och livshotande tillstånd för patienten. Behandling vid diabetes typ 1 består till största del av insulininjektioner och noggrann kontroll av blodsockret. Vården som ges till de som insjuknat i diabetes typ 1 strävar efter att hjälpa patienten till god egenvård och som i längden kan bidra till bättre hälsa. I samband med att sjukdomen tar plats i den sjukes vardag, i detta fall hos barnet, kommer sjukdomen inte enbart påverka barnet utan även familjen. Författarna valde att belysa ämnet då de båda har erfarenheter och intresse inom ämnet. Syftet med denna studie är att belysa ur ett föräldraperspektiv hur familjen påverkas när ett barn har diabetes typ 1. Författarna valde att göra en litteraturstudie som innebär att redan befintlig kunskap sammanställs. Studien består av 10 artiklar av både kvalitativ och kvantitativ forskning. Resultatet i studien visade att föräldrarna uttryckt familjens upplevelse. Det visade sig att familjen upplevde att deras rutiner i vardagen förändrades i och med att barnet blev sjukt. Familjen är i behov av kunskap och stöd för att få den nya vardagen att fungera samt stöd från vårdpersonal och andra familjer. I diskussionen tar författarna upp de tre teman som framkom i resultatet.

Introduction: Diabetes type 1 is a common chronic disease in children and adolescents. The disease affect, not only the child, but also the parents in their everyday life. The specialist diabetic nurse has a huge responsibility in supporting the parents to feel confident in managing the child’s diabetes. Aims of the study: To investigate how parents of children with diabetes type 1 perceive the care given from the specialist diabetic nurse and what wishes they have concerning the care they receive. Design and methods: Searches for studies in electronic databases were conducted between January 2013 and march 2013. A literature review containing 16 studies was compiled. Both qualitative and quantitative studies were used and analyzed according to Friberg (2006). Findings: Several parents had a positive view of the diabetic care they had received from the specialist diabetic nurse. Great knowledge, expertise in diabetic care and ability to inform the family in a proficient way were considered as important by the parents. To receive knowledge regarding diabetic care the parents preferred to be given practical education from the nurse, but also appreciated to get written information. The parents would have liked to get more emotional support during the time of the diagnosis, especially in forms of counseling and encouragement. They also whished that caregivers would have been more eager to prepare them in managing the disease outside the hospital.  Conclusions: The majority of the parents had an optimistic experience of the care they had received from the specialist nurse in diabetic care. To prepare the family for a life with diabetes it’s necessary with adequate education, encouragement and emotional support from the specialist diabetic nurse.

Exposure to microorganisms is considered an environmental factor which can contribute to diabetes mellitus via cytotoxicity or autoimmune responses against pancreatic cells. Firstly, the effects on rat insulinoma pancreatic β-cell line of secondary metabolites pyrrolnitrin (Burkholderia spp), phenazine compounds (Pseudomonas aeruginosa and Burkholderia spp) were investigated. Both compounds separately showed significant cytotoxicity after 24 h and at concentrations of 10 & 100 ng/ml potentiated insulin gene transcription, Ca2+ content and glucose-stimulated insulin secretion (GSIS). Furthermore, the outward membrane current was inhibited by phenazine (100 ng/ml) or pyrrolnitrin (10 or 100 ng/ml). Secondly, the capacity of 45 microbial species to bind insulin was screened in order to assess how common insulin binding was amongst microorganisms Burkholderia multivorans, B. cenocepacia and Aeromonas salmonicida bound insulin. A genomic library of B. multivorans was constructed in λ Zap Express and screened successfully for insulin binding recombinants. Recombinant phagemids p1 & p2 were excised, p1, encoded an insulin binding protein (IBP1 30 kDa) with homology to the iron complex siderophore receptor. For p2, two IBPs were detected at 20 & 30 kDa (IBP2 & IBP3), representing an intracellular and outer membrane peptide transporter. Comparison of IBP1 and human insulin receptor (HIR) produced 6 linear epitopes, and for IBP2 & IBP3 produced 3 epitopes. Thirdly, glutamic acid decarboxylase GAD65 is a major pancreatic autoantigen contributing to autoimmune diabetes. To assess the likelihood that microorganisms possess epitopes that mimic regions on GAD, 45 microbial species were tested for homology. This was facilitated by purifying recombinant GAD protein which was used to produce GAD antiserum. Four E. coli cross-reacting proteins were identified using mass spectrometry, outer-membrane protein A, formate dehydrogenase, superoxide dismutase and DNA starvation protein. Epitopes occurred at the C-terminal region of GAD65 (residues 419–565), a region previously reported to be targeted by autoantibodies. This study suggests that pyrrolnitrin and phenazine are cytotoxic to pancreatic β-cells and B. multivorans IBPs linear epitopes may be diabetogenic, particularly in patients with cystic fibrosis related diabetes (CFRD) who suffer a long term infections with Pseudomonas and Burkholderia species. Furthermore, microbial GAD epitopes could potentially induce an autoimmune response leading to diabetes.

Background: Diabetes is a chronic metabolic disease and an increasing public health problem. Treatment of type 1 diabetes requires daily insulin injections. Young people living with diabetes may feel that they do not fit in among others of the same age. Aim: Illustrate young people's experiences of living with diabetes type 1. Method: This study was a qualitative literature-based study with an inductive approach. The result was based on 10 qualitative scientific articles. Result: The analysis resulted in three main themes and seven subthemes. The main themes were: To live in a process of adaptation, A buffet of challenges and How the social surroundings impact the life. Conclusion: The results showed that young people who lived with type 1 diabetes felt that they had to adapt their lives to the disease. For young people it was also important to become independent in their illness. It was obvious that living with type 1 diabetes was an experience of both physical and mental challenge, and the people in the studies expressed a desire to be normal and to be able to compare themselves with others. The social surroundings had a clear impact in many ways, though the support from the environment was perceived as valuable. / Diabetes typ 1 är en ständigt ökande folksjukdom som ofta drabbar unga människor. Diabetes typ 1 är en kronisk ämnesomsättningssjukdom som ställer krav på den unga individen och skapar utmaningar i vardagen. Unga som lever med diabetes påverkas av sin omgivning och är i behov av stöd på olika sätt. Diabetes innebär att individen ständigt har förhöjda blodsockernivåer, till följd av brist på insulin. Unga människor lever i en turbulent period av livet, och att leva med en kronisk sjukdom kan förhindra en utveckling av den egna identiteten. Egenvården upplevs som en viktig del på vägen mot självständighet hos de unga, och sjuksköterskan har en central del i att hjälpa den unga individen att främja hälsa. Syftet är att belysa unga människors upplevelse av att leva med diabetes typ 1. Tio kvalitativa vetenskapliga artiklar har använts som material i resultatet. Resultatet visar att sjukdomen kräver en anpassning av livet. Det är en dragkamp om ansvaret för sjukdomen mellan de unga och deras föräldrar, då självständighet anses viktigt av unga människor för att uppnå frihet, vilket relateras till begreppen livsvärld och hälsa. De unga upplevde både känslomässiga och praktiska utmaningar i livet med diabetes, vilket diskuteras i relation till livskvalitet. En önskan om att få vara normal och kunna jämföra sig med andra i samma ålder finns, eftersom det är en betydande del i de ungas sökande efter en egen identitet. De unga anser att omgivningen påverkar dem på olika sätt, stödet från vänner och familj upplevs som betydelsefullt.

Bakgrund: Diabetes typ 1 är en stor folksjukdom som främst drabbar yngre människor. Att drabbas av diabetes är påfrestande fysiskt och psykiskt. Det är därför ett viktigt ämne att belysa för att kunna underlätta och förbättra vården av barn och ungdomar med diabetes. Syfte: Syftet med litteraturstudien var att belysa barn och ungdomars erfarenheter av att leva med diabetes typ 1. Metod: Litteraturstudien är en sammanställning av 10 kvalitativa studier där samtliga kvalitetsgranskats, analyserats och sammanställts. Deltagarna i litteraturstudien var 6–22 år gamla. Resultat: Resultatet visade på barn och ungdomars erfarenheter av att leva med diabetes typ 1 från att få diagnosen, ta kontroll över sjukdomen, få stöd från hälsoprofessioner, familj och vänner till att lära sig leva ett förändrat men ”normalt” liv.Konklusion: Att leva med diabetes är en ständig kamp om att leva så normalt och självständigt som möjligt. Detta underlättas genom stöd och tillräcklig information från familj och vårdpersonal. Denna fördjupande kunskap och förståelse av barn och ungdomars erfarenheter av att leva med diabetes kan bidra till förbättrad diabetesvård som kan underlätta för dessa att leva ett gott liv trots diabetes. / Background: Diabetes type 1 is a large endemic disease that mainly affects younger people. Diabetes has shown to be straining physically and psychologically and is an important subject to highlight to ease and improve the care for adolescents with diabetes. Purpose: The aim with this literature study was to highlight children and adolescents experience of living with diabetes type 1. Method: The literature study is a compilation of 10 qualitative studies that has been quality reviewed, analysed and compiled. The participants in the study was 6-22 years old. Results: The result showed children and adolescents experiences of living with diabetes type 1. From being diagnosed, taking control of the disease, getting support from healthcare, family and friends to learning how to live a changed but “normal” life.Conclusions: To live with diabetes is a constant struggle to live as normal and independent as possible. This facilitates with care and information from family and health professionals. Increased knowledge and understanding of children and adolescence experience of living with diabetes may help to improve diabetes healthcare which can ease their life despite diabetes.

Abstract Introduction: Diabetes type 1 is a chronic autoimmune disease requiring lifelong insulin therapy. Type 1 diabetes is one of the most common endocrine disorders affecting children and adolescents and the disease is often accompanied by severe complications. Treatment of type 1 diabetes is greatly facilitated by self-motivation to achieve good self-care and thereby reduce the risk of complications. It is important with good treatment and support to reach young people with type 1 diabetes for them to accept their illness and learn to live with it. Purpose: The purpose of this literature study is to describe the support young people with type 1 diabetes may need to live with their disease. Method: Literature review made up of current scientific journal articles and scientific reports published the last 10 years. The articles were searched on the databases PubMed and Cinahl. Results:  Sixteen articles were found. In the analysis of the articles, 5 themes emerged: support from parents and family, support from healthcare, support from friends and support from others with diabetes. The result of the literature study shows that young people need positive support and feedback to manage their illness and self-care. Conclusions: The teenagers with type 1 diabetes need support to manage their illness. This is achieved through a good communication from health care, parents, family, friends and groups, and this in turn leads to a personal development which increases knowledge and gives them experience to take responsibility in their own care.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / A Diabetes mellitus à uma doenÃa de causa mÃltipla, ocorrendo quando hà falta de insulina ou quando a mesma nÃo atua de forma eficaz, causando um aumento da taxa de glicose no sangue (hiperglicemia). Ainda nÃo se sabe precisamente o mecanismo de aÃÃo da insulina, alguns trabalhos sugerem que pode ser possivelmente mediado atravÃs do fosfoglicano inositol (IPGs), cujas algumas formas foram identificadas como: mioinositol e D-quiroinositol. Hà estudos que relacionam a reduÃÃo da glicemia em indivÃduos diabÃticos com o aparecimento desses inositÃis nas secreÃÃes corpÃreas, embora ainda nÃo haja registro de identificaÃÃo dessas molÃculas na composiÃÃo salivar. O objetivo deste estudo foi determinar a relaÃÃo salivar do mioinositol e quiroinositol em crianÃas com diabetes tipo 1 e comparar a presenÃa e concentraÃÃo dessas substÃncias com um grupo de crianÃas sadias (nÃo diabÃticas). Um total de 45 (quarenta e cinco) voluntÃrios, 25 com diabetes tipo 1 descompensados e 20 sadios (nÃo diabÃticos), de ambos os sexos, com idades de 3 a 12 anos, foram selecionados e convidados a participar do estudo. Amostras de saliva foram coletadas e centrifugadas. Os sobrenadantes foram separados, liofilizados e purificados. Logo em seguida, foram analisados por cromatografia lÃquida de alta eficiÃncia (HPLC) para a identificaÃÃo do mioinositol e quiroinositol. A partir dessa anÃlise, foi observado uma menor concentraÃÃo de quiroinositol (p=0,001, Kruskal- Wallis ANOVA seguido por mÃtodo de Dunnâs) e uma maior da concentraÃÃo de mioinositol (p=0,001, Kruskal- Wallis ANOVA seguido por mÃtodo de Dunnâs) nas crianÃas afetadas em comparaÃÃo com as crianÃas saudÃveis. Os pacientes com diabetes tiveram a razÃo mio/quiroinositol maior que do grupo controle (p=0,001, Kruskal- Wallis ANOVA seguido por mÃtodo de Dunnâs) e apresentaram uma correlaÃÃo entre sua proporÃÃo o DM1(p= 0,001). O resultado desse estudo sugere que o mioinositol e o quiroinositol encontrado na saliva de crianÃas com DM1 podem influenciar no controle metabÃlico e desempenhar um papel de marcadores da DM1. / Diabetes mellitus is a disease of multiples causes that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces, causing a rise in blood glucose levels (hyperglycemia). It is not clear the action mechanism of insulin but it has been suggested that inositol phosphoglicans, such as myoinositol and D-chiro-inositol, can be important secondary messengers in insulin signal transduction. Although there are some studies linking a reduction in blood glucose levels in diabetic patients with the presence of these inositols in body secretions, there are not reports about the presence of these molecules in salivary composition. Thus, this study aimed to determinate the myoinositol and D-chiro-inositol salivary relation in children with type 1 diabetes and to compare the presence and concentration of these molecules with healthy children (non-diabetic). It has been selected and invited 45 volunteers of both sexes aged 3-12 years, 25 with decompensate type 1 diabetes and 20 healthy children. Saliva samples were collected and centrifuged. The supernatants were separated, purified and lyophilized. The identification of myoinositol and D-chiro-inositol were carried out by means of high-performance liquid chromatography (HPLC). The results showed that children with type 1 diabetes have a lower concentration of D-chiro-inositol and a higher concentration of myoinositol than healthy children. Consequently, the myo/chiro-inositol rate was higher in type 1 diabetes children and there is a correlation between the rate and type 1 diabetes incidence. In conclusion, our data suggests that myoinositol and chiroinositol found in the saliva of children with type 1 diabetes may influence in metabolic control and plays an important role as markers of type 1 diabetes.

Background: Diabetes is one of Sweden's national diseases. Around 7000 children live with type 1 diabetes in Sweden today. The diagnosis requires planning of everyday life and revaluation of routines which places great demands on the family. Aim: The aim of this study was to describe parents and siblings' experiences of living with a child or young adult diagnosed with type 1 diabetes. Method: The study was designed as a literature-based study to contribute to evidence-based nursing based on analysis of qualitative research to reach a deeper understanding of families' experiences. An analysis of thirteen qualitative articles resulted in four main themes and ten subthemes. Results: The results of the study showed that the whole family is affected when a child gets diabetes. That the child was diagnosed was a shock that caused many feelings with both parents and siblings. There was a constant concern for complications in both the long and short term, resulting in a fear to hand over responsibility, causing a huge pressure on parents who could feel isolated. Conclusion: The families experienced strong feelings when the child was diagnosed. The families needed support from the healthcare professionals to be able to handle the disease.