Bakgrund: Diabetes mellitus typ-1 är en autoimmun sjukdom som varje år kräver människors liv. Att undersöka unga vuxna personer med typ-1 diabetes erfarenheter av diabetesvården kan bidra till att identifiera problemområden som kan förbättras, samt stärka relevansen för redan insatta behandlingsmetoder.  Syfte: Studiens avsikt var att beskriva unga vuxna personer med typ-1 diabetes erfarenheter av diabetesvården. Metod: En allmän litteraturöversikt enligt Polit och Becks niostegsmodell. Elva artiklar inhämtades från databaserna PubMed och CINAHL. Data analyserades med kvalitativ innehållsanalysmetod av Graneheim och Lundman.  Resultat: I studien identifierades två kategorier och fyra underkategorier. Personen i fokus utgjorde en kategori med underkategorierna: att klandras och att inte få tillräckligt med stöd. Tillgänglighet utgjorde den andra kategorin med underkategorierna: att ställas inför förändring och behov av kontinuerlig samverkan. Resultatet visar att erfarenheter talar för en undermålig diabetesvård.  Slutsats: Diabetes typ-1 är en omställning i livet som innebär stora påfrestningar och krav på patienten, men också för vården i hantering av patienten i förhållande till behandlingsstrategier och den personcentrerade vården. Det krävs mer forskning för att få ett bredare perspektiv på den individuella patienten i förhållande till den skildring som ska förändra vårdstrategier på en global nivå. / Background: Diabetes mellitus type-1 is an autoimmune disease that claim lives every year. Investigating the experiences of diabetes care, can identify problem areas and improve them to strengthen already implemented treatment methods.  Aim: The purpose of the study was to describe the experiences of young adults with type-1 diabetes of diabetes care. Method: A general literature review according to Polit and Beck's nine-step model. Eleven articles were retrieved from the databases PubMed and CINAHL. The data was analyzed using the qualitative content analysis method by Graneheim and Lundman. Results: In the study two categories and four subcategories were identified. The person in focus constituted the first category, with subcategories: to be blamed and not receiving enough support. Availability formed the second category with the subcategories: to be faced with change and need for continuous collaboration. The results speak for a substandard diabetes care. Conclusions: Diabetes type-1 entails great stress and demands on patients and the healthcare system in relation to treatment strategies and the person-centered care. Further research is needed to gain a broader perspective in relation to the portrayal that will change care strategies on a global level.

Bakgrund: Diabetes typ 1 är en vanlig sjukdom bland unga. Föräldrarna bär det största ansvaret över vården och behandlingen av sjukdomen vilket medför många utmaningar. Sjuksköterskan har därför en stor roll i att hjälpa och vägleda föräldrarna genom den förändrade vardagen. Syfte: Att belysa föräldrars erfarenheter av att ta hand om sitt barn med diabetes typ 1. Metod: En kvalitativ litteraturstudie där nio studier har granskats och analyserats. Databassökningarna gjordes i fyra olika databaser. Vid analys användes beskrivande metasyntes. Resultat: Resultatet bestod av tre kategorier med nio tillhörande subkategorier. Kategorierna som framkom var “behov av stöd och förståelse”, “att utföra egenvård” och “att skapa tillit”. Konklusion: Att ta hand om sitt barn med diabetes typ 1 var utmanande för föräldrarna och de krävde mycket stöd för att klara av vardagen. De hade dock svårt att lita på att någon annan kunde ta hand om barnet. Framtida forskning kan ge ökad kunskap till sjukvården om hur man bör bemöta drabbade familjer samt skapa en förståelse för vilket stöd som behövs för att ge familjen en förbättrad livskvalité. Nyckelord: Barn, diabetes typ 1, egenvård, erfaren / Background: Type 1 diabetes is a common disease among young people. The parents bear the greatest responsibility for the care and treatment of the disease, which entails many challenges. The nurse has a great role in helping and guiding parents through the changing everyday life. Aim: To highlight parents' experiences of caring for their child with type 1 diabetes. Methods: A qualitative literature study in which nine studies have been reviewed and analyzed. Database search was done in four different databases. In analysis, descriptive metasynthesis was used. Result: The result consisted of three categories with nine associated subcategories. The categories that emerged were "need for support and understanding", "to perform self-care" and "to create trust". Conclusion: Caring for a child with type 1 diabetes was challenging for parents and they required a lot of support to cope with everyday life. They had difficulty trusting that someone else could take care of the child. Future research can provide increased knowledge to the health care system on how to respond to affected families and create an understanding of what support is needed to give the family an improved quality of life.

Background: Type 1 Diabetes mellitus (TIDM) is a chronic disorder in which the insulin producing beta cells are selectively self-destroyed. Although the etiology of the disease has not been determined, genetic dispositions such as SLC11A1 polymorphism in suffering patients have been reported. The role of pathogenic microorganisms such as Mycobacterium avium subspecies paratuberculosis (MAP) in TIDM has also been recently debated. MAP is already known to cause paratuberculosis in cattle and now it is a strong suspect of causing autoimmune diseases in humans such as Crohn’s disease, multiple sclerosis, autoimmune Thyroiditis, rheumatoid arthritis and autoimmune diabetes. We hypothesis that molecular mimicry between MAP Heat shock protein 65K (Hsp65) and human Glutamic Acid Decarboxylase 65K (GAD65) can be the trigger which leads to the autoimmune destruction of beta cell in patients exposed to MAP . Method: To test the hypothesis, peptide sequences of MAP Hsp65 and human GAD65 were investigated using BLAST and PyMOL bioinformatics tools. Moreover, 18 blood samples from humans with TIDM and controls, and 100 sera samples from cattle with paratuberculosis and controls were evaluated for the presence of MAP, MAP DNA and its antibodies. Glucose, insulin and GAD65 antibodies were also determined in some of the clinical samples. Results: Peptide BLAST analysis revealed 44% identity between the two proteins with 75% positive identities in a 16 amino acid region. PyMOL structural analysis identified possible shared epitope regions of the proteins in its 3D conformation. Immunoblot analysis revealed a strong cross reactivity between lysate of E.coli recombinant of MAP Hsp65 and plasma from human subject with TIDM. A weak cross reactivity was also observed between healthy rat pancreatic homogenate and rabbit anti MAP IgG. Nested PCR using IS900-specific iv oligonucleotide primers did not detect MAP DNA in peripheral blood from 18 subjects with Type I Diabetes, Type II Diabetes and non-diabetic controls. Long term culture of leukocytes from blood samples from same subjects resulted in the presence of MAP in 3/10 (30%) TIDM and 4/8 (50%) control subjects. However anti MAP IgG were detected in 5/10 (50 %) TIDM samples compared to 3/8 (37.5 %) controls. Insulin level was measured in sera from paratuberculosis cattle and controls. In MAP infected cattle, insulin level ranged from below 0.1ng/ml to 2.456 ng/ml with an average of 0.36 +/- 0.57ng/ml compared to below 0.1ng/ml to 13.47ng/ml with an average of 2.86 +/- 3.00ng/ml in healthy cattle. Conclusion: Bioinformatics analysis between MAP Hsp65 and human GAD65 through BLAST and PyMOL analysis revealed a homology of 16 amino acid motif and possible shared epitope regions; immunohistochemistry analysis revealed a cross reactivity between rabbit antiMAP IgG and pancreatic cell homogenate from a healthy rat. Moreover, plasma from patient with TIDM (TD8), who was confirmed to be positive for MAP DNA and MAP IgG, reacted strongly with MAP Hsp65 in MAP protein lysate and MAP Hsp65 recombinant clone pmptb20. Culture of MAP from human leukocytes is significant despite the lack of correlation between MAP in samples from TIDM and controls. It is worth noting that some of the control subjects have not been evaluated for other autoimmune diseases possible MAP role. Additionally, antiMAP IgG levels in TIDM subjects compared to controls have raised a suspicion on the involvement of MAP in TIDM. The poor correlation of MAP in blood versus either the antiMAP IgG or the insulin level may be related with the fastidious nature of MAP and in vitro cultivation. Since MAP is the sole causative agent of Johne’s disease, it is significant that the insulin level is 8 folds less in MAP infected cattle compared to MAP free cattle. Overall, the data v is mixed and suggest that further study is needed to investigate the intriguing question to whether MAP is involved in TIDM or not.

This study examines physical activity intervention outcome measures in children with Type 1 Diabetes (T1D). Additionally, it explores medical and psychosocial outcomes. Five databases (CINAHL, PsycINFO, MEDLINE, PubMed, Scopus) were used in this study. The selection of articles was done by using exclusion and inclusion criteria. The articles chosen for this study were restricted to those written in English and had to be peer-reviewed and published between 2012 and 2023. Besides, the focus was on quantitative studies. Six articles were eligible to be used in this study. Intervention types, durations, and outcome measurements have been reported. Results showed that the length of intervention should be more than twelve weeks to see the actual effect of interventions.  Additionally, while an effect of physical activity on glycemic control was observed, generalizable psychosocial outcomes could not be obtained. In future research, to reach generalizable conclusions, the sample of this study should be expanded. Also, in addition to clinical data, getting psychosocial data can provide helpful insights. It can offer tips to improve participants' quality of life.

Bakgrund Typ 1 diabetes är en kronisk sjukdom som kräver livslång vård och anpassning. Det är en av de vanligaste kroniska sjukdomarna hos barn samtidigt som prevalensen tycks öka världen över. Risken för både akuta och långsiktiga allvarliga komplikationer är stor varpå en adekvat egenvård är viktig. Eftersom föräldrar fortfarande har det yttersta ansvaret för sina ungdomar så faller ansvaret över egenvården på dem. Syfte Syftet är att beskriva erfarenheter av att vara förälder till en ungdom med diabetes typ 1. Metod ​​En litteraturöversikt baserad på tio vetenskapliga artiklar utförda i kvalitativ design. Artikelsökningarna utfördes i PubMed samt CINAHL Complete. Analysen utfördes inspirerad av Fribergs metod.​ Resultat Litteraturöversikten resulterade i tre centrala teman: 1. Den förändrade vardagen, 2. Att konstant känna oro och 3. Att släppa kontrollen. Slutsats ​​Denna litteraturöversikt undersökte föräldrars erfarenheter av att ha en ungdom med typ 1 diabetes mellitus. Den visade att dessa föräldrar möter betydande utmaningar, med tre huvudteman: 1. Den förändrade vardagen, 2. Att konstant känna oro och 3. Att släppa kontrollen. Det är viktigt att ha förståelse för dessa föräldrars verklighet för att kunna ge bättre stöd och en mer personcentrerad vård.​ / Background Type 1 diabetes is a chronic disease that requires lifelong care and adaptation. It is one of the most common chronic diseases in children, and its prevalence appears to be increasing worldwide. The risk of both acute and long-term serious complications is significant, making proper self-care essential. Since parents still bear the ultimate responsibility for their adolescents, the responsibility for self-care falls on them. Aim The purpose is to describe the experience of being a parent of an adolescence with type 1 diabetes. Method Searches were performed in PubMed and CINAHL Complete. The analysis was conducted in accordance with Friberg's method. Results The literature review resulted in three central themes: 1. Altered daily life, 2. Constant feelings of anxiety, and 3. Letting go of control. Summary This literature review explored parents' experiences of having a teenager with type 1 diabetes mellitus. It revealed that these parents face significant challenges, with three main themes: 1. Altered daily life, 2. Constant feelings of anxiety, and 3. Letting go of control. Understanding the reality of these parents is crucial for providing better support and more person-centered care.

Bakgrund: Diabetes mellitus typ 1 [DMT1] är en sjukdom som drabbar barn och ungdomar. Incidensen ökar globalt. Egenvård innebär dagliga kontroller av bland annat blodsocker. Forskning visar att ungdomen är en skör period och svårigheterna med att kombinera den tiden med en kronisk sjukdom.  Syfte: Att undersöka erfarenheter av egenvård hos barn och ungdomar med DMT1. Metod: En litteraturstudie grundad i åtta artiklar med kvalitativ ansats samt en artikel med mixad metod. Innehållsanalys från Graneheim och Lundman (2004) användes som analysmetod.  Resultat: Studien visade att barn och ungdomar med DMT1 känner sig annorlunda från de som inte har sjukdomen. Två kategorier; Egenvård kopplat till yttre faktorer och Egenvård kopplat till inre faktorer samt fem underkategorier identifierades; Att hantera sin egenvård i skolan; Upplevda hinder för egenvård; Omgivningens påverkan på egenvården; Att ta ansvar för sin egenvård samt Att inte vara som alla andra.  Slutsats: Barn och ungdomar upplever den komplicerade egenvården vid DMT1 som ett hinder i vardagen. En god egenvård kan förbättra deras livskvalitet och förhindra framtida komplikationer. Fortsatt forskning kan minska stigmatiseringen och öka medvetenheten kring DMT1. / Background: Type 1 Diabetes Mellitus [DMT1] is a disease that affects children and adolescents. The incidence increases globally. Self-care includes controls of blood glucose levels among other tasks. Previous research shows that youth is a delicate time, and it is hard to combine with a chronic illness.  Aim: To study the experience of self-care in children and adolescents with DMT1.  Method: A literature review with eight articles with qualitative approach and one mixed method article. Content analysis from Graneheim and Lundman (2004) was the analysis method.  Results: This study showed that children and adolescents with DMT1 feel different than their friends. Two categories were identified; Self-care linked to external factors and Self-care linked to internal factors, as well as five under categories; To deal with self-care in school; Perceived obstacles for self-care; The surroundings effect on self-care; To take responsibility for their self-care and To not be like everybody else.  Conclusion: Children and adolescents with DMT1 experience the complicated self-care as an obstacle in their everyday lives. Good self-care can improve their quality of life and prevent future complications. Continued research can reduce the stigma and increase awareness about DMT1.

Treatment-induced neuropathy in diabetes (TIND) is defined by the occurrence of an acute neuropathy within 8 weeks of an abrupt decrease in glycated hemoglobin-A1c (HbA1c). The underlying pathogenic mechanisms are still incompletely understood with only one mouse model being explored to date. The aim of this study was to further explore the hypothesis that an abrupt insulin-induced fall in HbA1c may be the prime causal factor of developing TIND. BB/OKL (bio breeding/OKL, Ottawa Karlsburg Leipzig) diabetic rats were randomized in three groups, receiving insulin treatment by implanted subcutaneous osmotic insulin pumps for 3 months, as follows: Group one received 2 units per day; group two 1 unit per day: and group three 1 unit per day in the first month, followed by 2 units per day in the last two months. We serially examined blood glucose and HbA1c levels, motor- and sensory/mixed afferent conduction velocities (mNCV and csNCV) and peripheral nerve morphology, including intraepidermal nerve fiber density and numbers of Iba-1 (ionized calcium binding adaptor molecule 1) positive macrophages in the sciatic nerve. Only in BB/OKL rats of group three, with a rapid decrease in HbA1c of more than 2%, did we find a significant decrease in mNCV in sciatic nerves (81% of initial values) after three months of treatment as compared to those group three rats with a less marked decrease in HbA1c <2% (mNCV 106% of initial values, p 0.01). A similar trend was observed for sensory/mixed afferent nerve conduction velocities: csNCV were reduced in BB/OKL rats with a rapid decrease in HbA1c >2% (csNCV 90% of initial values), compared to those rats with a mild decrease <2% (csNCV 112% of initial values, p 0.01). Moreover, BB/OKL rats of group three with a decrease in HbA1c >2% showed significantly greater infiltration of macrophages by about 50% (p 0.01) and a decreased amount of calcitonin gene related peptide (CGRP) positive nerve fibers as compared to the animals with a milder decrease in HbA1c. We conclude that a mild acute neuropathy with inflammatory components was induced in BB/OKL rats as a consequence of an abrupt decrease in HbA1c caused by high-dose insulin treatment. This experimentally induced neuropathy shares some features with TIND in humans and may be further explored in studies into the pathogenesis and treatment of TIND.

Bakgrund Typ 1-diabetes är en autoimmun sjukdom och kräver en livslång behandling. Kontinuerlig glukosmätning (CGM) sker dagligen då sjukdomen medför att insulin måste tillföras exogent flera gånger per dag. Tiden som ungdom och ung vuxen kan ses som en utmaning i sig då det är under denna period i livet identiteten utvecklas, självständigheten prövas och nya relationer skapas. Syfte Studiens syfte var att sammanställa forskningsbaserad kunskap kring ungdomars upplevelser av att leva med typ 1-diabetes. Metod Studien har genomförts som en strukturerad litteraturöversikt. Ramverket PEO användes för att bryta ner syftet och bilda sökord. Sökningar gjordes i databaserna CINAHL, PubMed och PsycInfo. När sökningarna av materialet till litteraturstudien genomförts, gjordes en analys med syftet att organisera, strukturera och förstå betydelsen av det material som framgick. Resultat Resultatet visade att ungdomars upplevelse av att leva med typ 1-diabetes var utmanande och frambringade en mängd känslor och tankar. Resultatet delades in i två huvudkategorier: Att kastas in i något nytt och främmande samt Att handskas med sjukdomen och vården. / Background Type 1-diabetes is an autoimmune disease and requires lifelong treatmet. Continuous glucose measurement takes place several times a day as the disease requires that insulin must be supplied exogenously several times a day. The time as an adolescent can be seen as a challenge in itself as it is during this period in life that identity develops, independence is tested and new relationships are created. Aim The aim of the study was to compile research-based knowledge about adolescent´s experiences of living with type 1 diabetes. Method The study has been conducted as a structured literature review. The PEO framework was used to break down purpose and form keywords. Searches are made in the databases CINAHL, PubMed and PsycInfo. When the searches for the material for the literature study are carried out, an analysis was made with the aim of organizing, structuring and understanding the meaning of the material that appeared. Results The results showed that young people's experience of living with type 1-diabetes was challenging and produced a range of emotions and thoughts. The results were divided into two main categories: Being thrown into something new and strange and Dealing with the illness and care. Conclusions Young people's experience of living with type 1-diabetes is stressful and that their identity is affected. The care staff's treatment is significant for young people with type 1-diabetes, however, the results show that there are shortcomings that should be improved in order to create an optimal care process.

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<p>Hypercholesterolemia is the presence of high levels of cholesterol in the blood, and it is one of the major factors for the development of long-term complications in T1D patients.</p> <p>In the thesis, we studied 1303 Caucasians with type 1 diabetes in the Diabetes Control and Complications Trial (DCCT). With the experience of diabetes study, many factors are associated with diabetes complications, they are age, gender, cohort, treatment, diabetes duration, body mass index (BMI), exercise, insulin dose, etc. We mainly focus on which factors are associated with total cholesterol (CHL) analysis in the thesis.</p> <p>Many measures were collected monthly, quarterly or yearly for average 6.5 years from 1983 to 1993. We used annually lipid measures of DCCT because of their values are sufficient and complete, and they belong to longitudinal data.</p> <p>Different methods are discussed in the study, and linear mixed effect models are the appropriate approach to the study. The details of model selection with CHL model analysis are shown, which includes fixed effect selection, random effects selection, and residual correlation structure selection. Then the SNPs were added on three models individually in GWAS. We found locus (rs7412) is not only genome-wide associated with CHL, but also genome-wide associated with LDL.</p> <p>We will assess whether these SNPs are diabetes-specific in the future, and we will add dietary data in the three models to identify locus are associated with the interaction of diet and SNPs.</p> / Master of Science (MSc)