Bakgrund: Användandet av modern diabetesteknik ökar ständigt. De diabetestekniska produkterna utvecklas fortgående med nya funktioner som möjliggör individanpassning och stärker egenvården. I utländska studier beskrevs en stress över diabetestekniken hos vårdpersonal som arbetade med patienter med diabetes på grund av bristande rutiner och hög arbetsbelastning. Syfte: Syftet med studien var att undersöka hur diabetessjuksköterskor i Sverige upplevde arbetet med modern diabetesteknik i vården av vuxna patienter med typ 1 diabetes. Metod: Kvalitativ intervjustudie med induktiv ansats, semistrukturerade intervjuer genomfördes med elva diabetessjuksköterskor som arbetade med vuxna patienter diagnostiserade med typ 1 diabetes. Intervjuerna spelades in, transkriberades ordagrant och analyserades genom kvalitativ innehållsanalys. Resultat: I analysen framkom tolv underkategorier och tre huvudkategorier: Patienten och tekniken, Diabetessjuksköterskan och tekniken, Organisationen. Diabetestekniken sågs som en tillgång för patienternas egenvård men krävde individanpassning och ansvarstagande från patientens sida. Den fungerade som ett pedagogiskt verktyg för diabetessjuksköterskorna samtidigt som den skapade hög arbetsbelastning. Diabetessjuksköterskan var den diabetestekniska experten i teamet. I arbetet med diabetestekniken var det betydelsefullt med kollegialt stöd och en fungerande fysisk arbetsmiljö. Slutsats: Användningen av modern diabetesteknik gynnar patienterna och diabetesvården. Diabetestekniken både underlättar och är en utmaning för diabetessjuksköterskor i Sverige.

People who live with Type 1 diabetes (T1D) have to carefully self-administer insulin to keep blood glucose levels in a safe healthy range – a complex and demanding task (WHO, 2016). Social support has been found to alleviate diabetes-stress and increase management behaviors (Mackey et al., 2016). Social support from family members is especially advantageous, however currently no single family-based intervention has been established to show reliable improvements in T1D outcomes (Rosland et al., 2010). A review of the literature reveals that social support promoting autonomy is associated with the best T1D outcomes; social support that undermines autonomy is associated with worse T1D outcomes (Kelly & Berg, 2018). These findings are consistent with the self-determination theory (SDT), which identifies autonomy as a psychological need (Ng et al., 2012). The findings of this literature review support the need for a disease-specific family-based intervention that is built on the foundations of SDT.

Type 1 Diabetes (T1D) is organ-specific autoimmune disease which causes pancreatic beta cells to be irreversibly destroyed. The only possible treatment represents life-lasting insulin administration. The real trigger of destructive insulitis isn't known. T1D is a multi- factorial disease involving both external and internal factors in the disease pathogenesis. The presence of autoreactive T lymphocytes in pancreas is necessary for development of diabetes. T regulatory cells have protective function in the destructive insulitis. The aim of this diploma thesis was to study cord blood T regulatory cells and their connection to type 1 diabetes development. We tried to find the difference among T regulatory cells in mononuclear cord blood cells (CBMC) in different study groups. Samples were collected from mothers suffering from T1D, gestational diabetes. Healthy controls were tested as well. Sixty-eight samples of cord blood were included in the study among the years 2009 - 2011. Samples were divided into 3 groups (CBMC from children born to T1D mothers, mothers with gestational diabetes and healthy mothers without T1D). CBMC were ana- lysed by flow cytometry. T regulatory cells (defined as CD4+CD25+) were isolated by magnetic separation (MACS). The functional capacity of these cells was studied as well by...

Due to a growing demand and need for faster results, effectivization as a concept has been pushed to the forefront of medical research. Here, a method transfer between 2 fully automized ELISA instruments is highlighted. The instruments were the Tecan Freedom EVOlyzer and the Dynex DSX.  The Tecan instrument is a more modern instrument with a more extensive LIMS integration, better automatization and increased capacity for samples and assays. The method being transferred was an Anti-GAD ELISA for the diagnosis of Type 1 Diabetes Mellitus. The study design was a result comparison of 20 samples with varying Anti-GAD concentration and 15 replicates of a single sample for a precision study. To successfully transfer the method, acceptance criteria concerning percentual difference in result, intermediate precision, and repeatability had to fall below 20 %. The assay was set up as a sandwich ELISA in accordance with the kit used at the laboratory (Euroimmun), where each sample was set as duplicates. Preliminary programming and testing was performed to ensure proper function. An average bias of +33 % was reported, as was an intra-run variation and an inter-run variation of ca 11 %. Additionally, a recurring issue with samples and calibrators in specific locations on the plate was reported. The issue was deemed systemic and possible solutions include changing programming parameters, or instrument part replacement. Ultimately the method transfer was left incomplete, and several technical details must be overcome before taking Anti-GAD analysis into routine use on the instrument.

Background: Type 1 diabetes mellitus is the most common autoimmune disease among children and adolescents worldwide. The diagnosis leads to lifestyle change. Parents are mainly responsible for self-care. Nurses can support parents in this life adjustment through patient participation and family-focused nursing. Aim: The aim was to illustrate parents' experience of living with a child diagnosed with type 1 diabetes mellitus. Method: A literature review based on 13 scientific studies with a qualitative method, analyzed with thematic analysis. Results: 2 themes with 6 sub-themes were identified. 1) Time after diagnosis: Emotions that arise during diagnosisand Lack of support and understanding from others. 2) A new normal: Changes in everyday life, The relationship with their child, Fear of child's health and Letting go of control. Parents experienced difficulty sleeping, worry, anxiety and stress living with children with type 1 diabetes mellitus. Conclusions: Parents initially experienced feelings such as anxiety and worrying. The family's life changes with new routines. The diagnosis affects parents' health and quality of life. Further research on the experience of living with chronically ill children is needed to optimize and improve treatment in health care. / Bakgrund: Diabetes mellitus typ 1 är den vanligaste autoimmuna sjukdomen bland barn och ungdomar i världen. Diagnostisering innebär en livsstilsförändring i vardagen. Huvudansvaret för egenvården av sjukdomen ligger hos föräldrarna. Sjuksköterskan kan stötta föräldrarna i livsomställningen genom patientdelaktighet och familjefokuserad omvårdnad.  Syfte: Syftet var att belysa föräldrars upplevelse av att leva med barn diagnostiserad med diabetes mellitus typ 1. Metod: Allmän litteraturöversikt baserad på 13 vetenskapliga originalartiklar med kvalitativ ansats som analyserades med tematisk analysmetod.  Resultat: Föräldrars upplevelser beskrivs utifrån 2 teman med 6 subteman. 1) Tiden efter diagnosen: Känslor som uppkommer vid diagnostisering och Bristen av stöd och förståelse från andra. 2) Ett nytt normalt: Förändringar i vardagen, Relationen till sitt barn, Rädslan för barnets hälsa och Släppa kontrollen. Föräldrar upplevde varierande grad av sömnsvårigheter och ångest av att leva med barn med diabetes mellitus typ 1.  Slutsats: Föräldrar upplevde känslor som ångest, oro och stress inledningsvis, men även livet ut. Familjens livssituation förändras när nya rutiner införs. Diagnosen påverkar föräldrars hälsa samt livskvalitet. Vidare forskning om upplevelsen att leva med kroniskt sjuka barn behövs för att optimera och förbättra bemötandet i hälso- och sjukvården.

Mucosal immune system comprises not only the major compartment of the immune system but also important interface with the outer environment. It is responsible in maintaining an intricate balance with the danger and non-danger stimuli of the outer world by employing specific anatomical features and unique functional mechanisms. Mucosal immune system has been long understudied, perhaps due to the limited accessibility, and its biological importance is thus still underevaluated. However, it has become evident that it is important to study mucosal immune system not only in local mucosal affections but also when uncovering pathogenic mechanisms and novel prevention strategies of organ specific autoimmune diseases such as type 1 diabetes. Thus, the first, more clinically oriented part of this thesis is focused on mucosal immune system of the upper respiratory tract in disease conditions - in nasal polyposis (NP). Because there is a substantial accumulation of eosinophils and neutrophils in the most frequent type of NP, we investigated and described increased expression of chemokine receptors CCR1 and CCR3 in NP versus nasal mucosa. Both innate immune mechanisms as well as homeostasis of epithelial cells may participate in NP. We have documented increased numbers of iNOS-positive and insulin-like growth...

Introduction: Type 1 diabetes mellitus is a chronic metabolic disease caused by autoimmune destruction of pancreatic beta cells. The theory of the disease onset is derived from study of a disease course in non-obese diabetic (NOD) mice, in which the diabetes occurs due to a dysregulation of the immune system. Experimental and clinical studies showed that the autoimmunity may be abrogated by immune intervention, which if initiated early enough may at least slow down the ongoing beta cells lost and preserve residual insulin secretion. But immune intervention alone is not sufficient to restore normoglycemia in the majority of cases. Several interventional studies showed that stimulation of proliferation and/or regeneration of beta cells are necessary to restore normoglycemia in animal models. Aim of the study: To find out, if the combination of a potent immunosuppression (murine anti-thymocyte globulin (mATG), gusperimus) together with stimulation of islet regeneration (sitagliptin) will be able to slow down or reverse the course of the disease. Another aim is to identify the mechanism by which the substances act. Material and methods: All experiments were performed in female NODShiLtJ (H2g7 ) mice. The following parameters were examined at day 0, 7, 14 and 28: blood glucose, subpopulations of...

Typ 1-diabetes mellitus är en kronisk sjukdom som orsakas av en försämrad insulinproduktion som på sikt leder till total insulinbrist och kräver därmed livslång behandling med insulin. Typ 1-diabetes mellitus debuterar främst under barn- eller tonåren. Att leva med sjukdomen kräver att individen ska själv kunna hantera och utföra egenvården. Övergången från barn till tonåring kan därmed vara en svår period då ansvaret för egenvården förflyttas från föräldrarna till tonåringen, samtidigt som fysiologiska, psykologiska samt sociala förändringar sker. / Type 1-diabetes mellitus is a chronic disease caused by impaired insulin production which eventually leads to insulin deficiency and thus requires lifelong treatment with insulin. Type 1-diabetes mellitus debuts mainly during childhood or adolescence. Living with the disease requires the individual to be able to manage and perform self-care. The transition from child to adolescent can thus be a difficult period when the responsibility for self-care is transferred from the parents to the adolescent. While at the same time physiological, psychological and social changes take place.

Introduction: The diploma thesis deals with the issue of compensation of type 1 diabetes mellitus during pregnancy and its relation to the health of mother and child. It further summarizes and describes the variable factors that may have a direct effect on current glycemic variability and long- term compensation of diabetes. Aims: The theoretical part describes the characteristics of type 1 diabetes mellitus and the possibilities of therapy in pregnancy. Subsequently, factors influencing the compensation of diabetes in this period are summarized and described in more detail, especially food composition and possibilities of influencing postprandial glycemia, effects of type and intensity of physical activity and psychosocial aspects related mainly to stress from potential negative effects of glycaemia on the fetus. At the end of the theoretical part, the risks and complications for the mother and the fetus arising from long-term unsatisfactory compensation of diabetes are presented. The aim of the practical part of the thesis was to determine the extent of women's knowledge about the compensation of diabetes in pregnancy, followed by determining the effect of the extent of knowledge on long-term compensation, expressed by glycated hemoglobin. Methods: Data for the diploma thesis were obtained on the...

Bakgrund: Diabetes typ- 1 är en kronisk sjukdom och en av de största folksjukdomarna i världen som blir allt vanligare i Sverige. Sjukdomen påverkar kroppen genom att blodsockernivån är för hög eftersom kroppen saknar förmåga att producera insulin. Metod: En litteraturstudie baserad på 10 vetenskapliga artiklar som granskats utifrån Fribergs analysmodell. Syfte: Att belysa vuxna individers upplevelser av att leva med diabetes typ- 1.Resultat: Analysen resulterade i 3 teman med 8 underteman: (1) En förändrad livsstil med underteman; begränsad vardag, daglig prioritering, utanförskap. (2) Upplevelse av stöd med underteman; att sakna stöd, att känna stöd. (3) Inställning till sjukdomen med underteman; bristande acceptans, individuell egenvård, betydelsen av framtidstro. Resultatet redovisar att individerna behöver få visad förståelse och stöttning i sin sjukdom för att bli mer delaktiga i sin egenvård. Konklusion: Diabetes typ- 1 påverkar individers liv på flera olika sätt. Sjukdomen leder till många tankar, känslor och fysisk påverkan, eftersom sjukdomen skapar en ofrivillig och förändrad livsstil. Sjuksköterskans engagemang är betydelsefullt då det kan bidra till en god livskvalitet för individen. / Background: Type 1 diabetes is a chronic disease and one of the most common diseases in the world and it’s becoming more common in Sweden. The disease affects the body because the blood sugar levels are too high as a result of the body’s inability to produce insulin. Method: A literature study based on 10 scientific articles that was analyzed using Friberg’s analysis model. Aim: To shed light on adults’ experiences of living with type 1 diabetes. Findings: The analysis resulted in 3 themes with 8 subthemes. (1) Changed lifestyle with subthemes, limited everyday life, daily priorities, exclusion. (2) The importance of support with subthemes; lack of support, to feel support. (3) Attitude towards the disease with subthemes; lack of acceptance, individual self-care, the importance of faith in the future. The results show that the adults need to be shown understanding and support in their illness to become more involved in their self-care. Conclusion: The study shows that type 1 diabetes is a disease that affects an individual’s life in several different ways. The disease leads to, among other things, many thoughts, feelings and somatic impact, as the disease creates an involuntary and changed lifestyle. The nurse's commitment is important as it can contribute to a good quality of life for the individual.