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Oliver1
Alex Oliver
Anatomy & Physiology II
Professor Craner
April 16, 2014
Diabetes Mellitus Type I
There are many diseases that have infiltrated the human population throughout
its existence. Diseases can sneak up on people and infiltrate their bodies without
warning at any time. One disease that does not discriminate who it infects, no matter
someone’s age, sex or race is Diabetes Mellitus Type I; more commonly known as Type I
diabetes.
History and Definition
To understand Diabetes Mellitus Type I in its entirety, a person must first
become familiar with the origination and history of this infectious disease. (Guthrie D.
and Guthrie R., 1999) The word diabetes originates in Greece and is defined as to
siphon, and in the case of this disease, it means to get rid of sugar in the body. The
word mellitus is a Latin word that has been defined as sweet tasting, referring to
glucose. In ancient Egypt, people were diagnosed with diabetes depending on how
sweet of a taste their urine possessed (Guthrie and Guthrie, 1999). Contrary to popular
belief, diabetes is actually a group of diseases that work in unison due to sharing the
same trait of having high glucose, otherwise known as high blood sugar (Izenberg et al.,
Oliver2
2003). Those who are unfamiliar with diabetes believe it to be a singular disease, which
is a common error.
Etiology
With Type I diabetes being around for this long, there has been an abundance of
information found to try and help explain the cause of it. (Izenberg et al., 2003) When
the pancreas is producing insufficient insulin or if it is not secreting any insulin
whatsoever, diabetes is developed over time. Type I diabetes can take anywhere from
months to years to be contracted. This is believed to develop because of genes encoded
in a person’s DNA, and or environmental triggers. The gene for Type I diabetes is
inherited through biological parents. As for environmental triggers, these are defined as
a virus which causes an individual’s immune systemto destroy beta cells like an
autoimmune disease. Beta cells secrete insulin. Once destroyed, insulin is no longer able
to be produced from the beta cells in the pancreas. A person’s genetic make-up is what
can make them vulnerable to this scenario, thus environmental triggers go hand in hand
with genes in developing Type I diabetes (Izenberg et al., 2003).
Insulin is a very important hormone for proper body function. (Saudek et al.,
1997) Its function is to help the body use sugar as an energy source. Insulin makes cells
susceptible to absorb sugar from the blood stream, which originates in a person’s food.
For a person with Type I diabetes, their beta cells are completely destroyed, thus no
insulin is being secreted from the pancreas. This means that a person with Type I
diabetes has to inject insulin into their body to regulate their blood sugar and provide an
Oliver3
energy source for their body. The disease can target anyone, but usually infects humans
at a young age. It can develop earliest as childhood and can even be contracted around
age thirty or even later in life (Saudek et al., 1997). Type I diabetes is a disease that
infiltrates a person’s body like a parasite without warning and has no cure except
regulation.
Signs and Symptoms
There are multiple symptoms and signals that help alert an individual that they
may have diabetes and need to see a physician for confirmation. (A.D.A.M., National
Library of Medicine, 2013) A great indication to possessing diabetes is high blood sugar.
A few symptoms of high blood sugar are: Excessive thirst, hunger, frequent drowsiness,
blurred vision, a numbing or tingling sensation in the feet, unintentional weight loss, and
frequent urination. There is also a list of more serious symptoms of Type I diabetes:
having dryness of the mouth or skin, color flushing the face, fruit smelling breath,
inability to keep down fluids causing nausea and/or vomiting, stomach pains, and fits of
deep rapid breaths (A.D.A.M., National Library of Medicine, 2013). Granted there is a
large list of symptoms associated with diabetes, but if someone is experiencing multiple
symptoms from these lists, they should be open to the possibility that they are living
with the disease.
One of the most potent symptoms of Type I diabetes is uncontrollable deep,
rapid breathing. One group of investigators (The et al., 2013) studied the correlation
between cardiovascular risks and medical nutrition therapies or MNTs. This research
Oliver4
was also conducted by selecting subjects with different sociodemographic backgrounds.
The study rounded up 1,191 persons with Type I diabetes from Ohio, Colorado, South
Carolina, and Washington of different races/ethnicities, parental education, and physical
activity levels if the subject was older than 10. The MNTs that the researchers compared
to cardiovascular risks were tracking fat grams, calories, glycemic index and their diet.
Data from their study showed that individuals who grow up in an environment with less
educated parents with a lower income (dominantly minorities) learn multiple MNTs, but
have a tougher time regulating glycemic index which puts them at a higher risk for
cardiovascular struggles. Carbohydrate counting was deemed as the most used MNT
and is believed to be the most helpful in preventing cardiovascular risks. The
investigators believe that using only one MNT to regulate Type I diabetes is the best
strategy, but say more information is needed to solidify their theory. Physical activity
levels ended up not playing a large factor in the researcher’s collection of data, rather
the various MNTs were what was used to compare the risks of cardiovascular problems
in individuals (The et al., 2013).
Diagnosis
After an individual realizes that they have multiple symptoms of Type I diabetes,
the next best plan of action is heading to a physician so that they can diagnose whether
or not they have developed the disease. To find out whether or not an individual’s
suspicions of having Type I diabetes are correct, the physician will conduct a series of
tests on them. (A.D.A.M., National Library of Medicine, 2013) the first test someone can
Oliver5
be put through is having their fasting blood glucose levels checked. In other words, not
eat and see what level their blood sugar is at from a blood sample. If blood glucose
levels are higher than 126 mg/dL at least twice throughout the test, the individual will
be diagnosed with the disease. The second test that can be conducted is done by taking
an individual’s blood glucose at a random time, with them carrying about their regular
dieting routine. In this test, if blood glucose levels are past 200 mg/dL along with signs
of thirst, excessive urination, and fatigue the subject may have diabetes and the fasting
blood glucose test will be done for confirmation. The third test is an oral glucose
tolerance test. Type I diabetes will be diagnosed if the patient’s glucose levels are higher
than 200 mg/dL two hours after they have been asked to ingest a sugary beverage. The
fourth test can be done by testing an individual’s hemoglobin A1C. A person shall be
diagnosed with the disease if these levels are at 6.5% or higher. In drastic measures a
ketone test can also be conducted to be positive whether or not the disease is present
by testing a urine sample (A.D.A.M., National Library of Medicine, 2013).
Once a person is diagnosed with diabetes they have to decide how they are
going to cope with this major change in their health and life. It is said that when going
into hearing the news on whether or not someone has a life altering disease that they
bring someone else with them in case they zone out into their thoughts once the news
is unveiled. (Saudek et al., 1997) Patients will be overcome with emotions such as fear,
anger, vulnerability or loss of control in their life. Tears may be shed once hearing the
news or the person may take their diagnosis in stride and realize that they still have a
life to live, no matter if Type I diabetes shall be with them throughout it like a monkey
Oliver6
on their back until they take their last breath. Depression may befall someone once they
are trying to decide how to deal with contracting this disease, which means support
from friends and family is imperative. People generally aren’t thrown loads of
information as to how to regulate the disease right away so that they have a chance to
cope. But once they are ready, learning how to treat and regulate Type I Diabetes is the
next step (Saudek et al., 1997).
Treatment
There are ways to treat and regulate Type 1 diabetes. Just because a person is
diagnosed with the disease does not mean that they are going to drop dead on the spot.
(Izenberg et al., 2003) Regulating one’s diet is a way to make sure that glucose levels
stay stable throughout the day. Counting the carbohydrates taken in is key because this
is where glucose is stripped from food. Meals are more so planned out, and if someone
feels that their blood sugar is low they will consume something sugary to raise their
levels (Izenberg et al., 2003).
For someone with Type I Diabetes, getting insulin their body is the main goal,
due to the fact that their pancreas is not secreting it. This is where the innovation of
injecting insulin comes in handy. (Saudek et al., 1997) Insulin is injected into the body
through a syringe to help lower blood glucose levels. When someone is feeling the
symptoms of their diabetes kicking in and know that they are in dire need of insulin, this
would be when they inject themselves. In addition to lowering blood glucose, insulin
slows down glucose production in the liver. This is why many people inject insulin at
Oliver7
night, in an attempt to shut down the production of glucose from the liver as they sleep.
Insulin is also a large factor in building muscle and allows the body to store calories in
the form of glycogen and fat that the body can use when in need of an energy source.
Insulin is involved in many chemical reactions in the body, so for someone with Type I
diabetes to be able to live life as normal as possible they need to inject it into their body
(Saudek et al., 1997).
Another way that an individual can treat Type I diabetes is by exercising.
(Izenberg et al., 2003) Regular exercise is shown to help insulin control blood glucose
more efficiently. Exercise also helps regulate and maintain a healthy weight, which in
turn helps keep a healthy cardiovascular system. People with the disease must plan
ahead for blood glucose levels to drop throughout exercise by either eating more prior
to exercise or keep insulin nearby. Exercise is also an activity that helps an individual feel
better about his/herself in general due to the fact that they are up moving around and
helping to improve their body image, fitness level and overall health (Izenberg et al.,
2003).
Personal hygiene is also a great way to regulate diabetes. (Guthrie D. and
Guthrie R., 1999) Infections can lead to an increase in blood glucose. Taking care of
one’s teeth is a way to prevent this. Teeth should be brushed at least twice a day to help
get rid of plaque, usually done in the morning and at night before bed. Also the dentist
recommends that an individual come in to have their teeth cleaned one every six
months. Skin care, such as bathing regularly is recommended. Foot care is important in
Oliver8
the aspect of making sure feet are not dry and susceptible to cracks and cuts. Eye care is
also a hygienic act. Keeping hands clean and out of the eyes is important with how easy
it is to pick up germs. A person with Type I diabetes should visit an eye professional at
least once a year (Guthrie D. and Guthrie R., 1999).
Just like any other disease, treatment costs money. In a study (Cobas et al.,
2013) conducted in Brazil a group of investigators wanted to find the cost of treating
Type I diabetes. They found that the overall total treatment cost on average was
US$1216.33. Insulin used by the patients rounded out to be US$696.78 of the total cost.
Medical procedures had an average cost of US$75.64 and consultations rounded out to
be US$25.62. This data was found through evaluating 3180 patients with an average age
of twenty-two years old with being diagnosed with the disease on an average of 10.3
years (Cobas, et al., 2013). The fact that this data was obtained in the year 2013 shows
that these costs for treatment of Type I diabetes are still relevant.
Prognosis
Type I diabetes is a life-long disease once contracted. It is something that no one
asks for, but instead just happens to befall them like a plague. (Daneman, 2006)
Strangely enough Type I diabetes only makes up for 5-10% of cases of diabetes
throughout the world. Though genes are the main cause for developing the disease,
more research is needed to find the specific cause of it. Since the origination of Type I
diabetes, the medical community has made strides in treating it more efficiently. From
regulating blood glucose, to planning out meals, and most importantly using injections
Oliver9
of insulin. When this disease first appeared, people diagnosed with it had their lives
shortened immensely. Now they have a chance to live a much longer and fulfilling life
due to advancements in treatment with insulin (Daneman, 2006). Just like with any
other disease there is always room for improvement in treatment until there is a day
when a cure is found.
Oliver10
Literature Cited
A.D.A.M., National Library of Medicine. 2013. “Type 1 Diabetes.”
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/ (February 21,
2014).
Cobas, R.A., Ferraz, M.B., Saldanha de Mattos Matheus, A., Righeti Monteiro Tannus, L.,
Antonio Negrato, C., Antonio de Araujo, L., Atala Dib, S., Brito Gomes, M. 2013.
The cost of type 1 diabetes: a nationwide multicentre study in Brazil. Bulletin of
the World Health Organization 91(6): 434-440.
Daneman, D. 2006. Type 1 diabetes. The Lancet 367(9513): 847-858.
Guthrie, D.W., Guthrie, R.A. 1999. The Diabetes Sourcebook: Today's Methods and Ways
to Give Yourself the Best Care. Lowell House, Los Angeles, CA, pp. 2-7, 95-102.
Izenberg, N., Dowshen, S.A., Eppes, S.C., Masci, J. 2003. Human Diseases and Conditions,
Vol. 2. Scribner, NY, pp. 511-519.
Saudek, C.D., Rubin, R.R., Shump, C.S. 1997. The Johns Hopkins Guide to Diabetes: For
Today and Tomorrow. Johns Hopkins UP. Baltimore, MD, pp. 6-34, 159-161.
The, N.S., Crandell, J.L., Thomas, J., Couch, S.C., Shah, A.S., Maahs, D.M., Dabelea, D.,
Marcovina, S.M., D’Agostino Jr., R.B., Mayer-Davis, E.J. 2013. Correlates of
medical nutrition therapy and cardiovascular outcomes in youth with type 1
diabetes. Journal of Nutrition Education & Behavior 45(6): 661-668.

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Type 1 Diabetes

  • 1. Oliver1 Alex Oliver Anatomy & Physiology II Professor Craner April 16, 2014 Diabetes Mellitus Type I There are many diseases that have infiltrated the human population throughout its existence. Diseases can sneak up on people and infiltrate their bodies without warning at any time. One disease that does not discriminate who it infects, no matter someone’s age, sex or race is Diabetes Mellitus Type I; more commonly known as Type I diabetes. History and Definition To understand Diabetes Mellitus Type I in its entirety, a person must first become familiar with the origination and history of this infectious disease. (Guthrie D. and Guthrie R., 1999) The word diabetes originates in Greece and is defined as to siphon, and in the case of this disease, it means to get rid of sugar in the body. The word mellitus is a Latin word that has been defined as sweet tasting, referring to glucose. In ancient Egypt, people were diagnosed with diabetes depending on how sweet of a taste their urine possessed (Guthrie and Guthrie, 1999). Contrary to popular belief, diabetes is actually a group of diseases that work in unison due to sharing the same trait of having high glucose, otherwise known as high blood sugar (Izenberg et al.,
  • 2. Oliver2 2003). Those who are unfamiliar with diabetes believe it to be a singular disease, which is a common error. Etiology With Type I diabetes being around for this long, there has been an abundance of information found to try and help explain the cause of it. (Izenberg et al., 2003) When the pancreas is producing insufficient insulin or if it is not secreting any insulin whatsoever, diabetes is developed over time. Type I diabetes can take anywhere from months to years to be contracted. This is believed to develop because of genes encoded in a person’s DNA, and or environmental triggers. The gene for Type I diabetes is inherited through biological parents. As for environmental triggers, these are defined as a virus which causes an individual’s immune systemto destroy beta cells like an autoimmune disease. Beta cells secrete insulin. Once destroyed, insulin is no longer able to be produced from the beta cells in the pancreas. A person’s genetic make-up is what can make them vulnerable to this scenario, thus environmental triggers go hand in hand with genes in developing Type I diabetes (Izenberg et al., 2003). Insulin is a very important hormone for proper body function. (Saudek et al., 1997) Its function is to help the body use sugar as an energy source. Insulin makes cells susceptible to absorb sugar from the blood stream, which originates in a person’s food. For a person with Type I diabetes, their beta cells are completely destroyed, thus no insulin is being secreted from the pancreas. This means that a person with Type I diabetes has to inject insulin into their body to regulate their blood sugar and provide an
  • 3. Oliver3 energy source for their body. The disease can target anyone, but usually infects humans at a young age. It can develop earliest as childhood and can even be contracted around age thirty or even later in life (Saudek et al., 1997). Type I diabetes is a disease that infiltrates a person’s body like a parasite without warning and has no cure except regulation. Signs and Symptoms There are multiple symptoms and signals that help alert an individual that they may have diabetes and need to see a physician for confirmation. (A.D.A.M., National Library of Medicine, 2013) A great indication to possessing diabetes is high blood sugar. A few symptoms of high blood sugar are: Excessive thirst, hunger, frequent drowsiness, blurred vision, a numbing or tingling sensation in the feet, unintentional weight loss, and frequent urination. There is also a list of more serious symptoms of Type I diabetes: having dryness of the mouth or skin, color flushing the face, fruit smelling breath, inability to keep down fluids causing nausea and/or vomiting, stomach pains, and fits of deep rapid breaths (A.D.A.M., National Library of Medicine, 2013). Granted there is a large list of symptoms associated with diabetes, but if someone is experiencing multiple symptoms from these lists, they should be open to the possibility that they are living with the disease. One of the most potent symptoms of Type I diabetes is uncontrollable deep, rapid breathing. One group of investigators (The et al., 2013) studied the correlation between cardiovascular risks and medical nutrition therapies or MNTs. This research
  • 4. Oliver4 was also conducted by selecting subjects with different sociodemographic backgrounds. The study rounded up 1,191 persons with Type I diabetes from Ohio, Colorado, South Carolina, and Washington of different races/ethnicities, parental education, and physical activity levels if the subject was older than 10. The MNTs that the researchers compared to cardiovascular risks were tracking fat grams, calories, glycemic index and their diet. Data from their study showed that individuals who grow up in an environment with less educated parents with a lower income (dominantly minorities) learn multiple MNTs, but have a tougher time regulating glycemic index which puts them at a higher risk for cardiovascular struggles. Carbohydrate counting was deemed as the most used MNT and is believed to be the most helpful in preventing cardiovascular risks. The investigators believe that using only one MNT to regulate Type I diabetes is the best strategy, but say more information is needed to solidify their theory. Physical activity levels ended up not playing a large factor in the researcher’s collection of data, rather the various MNTs were what was used to compare the risks of cardiovascular problems in individuals (The et al., 2013). Diagnosis After an individual realizes that they have multiple symptoms of Type I diabetes, the next best plan of action is heading to a physician so that they can diagnose whether or not they have developed the disease. To find out whether or not an individual’s suspicions of having Type I diabetes are correct, the physician will conduct a series of tests on them. (A.D.A.M., National Library of Medicine, 2013) the first test someone can
  • 5. Oliver5 be put through is having their fasting blood glucose levels checked. In other words, not eat and see what level their blood sugar is at from a blood sample. If blood glucose levels are higher than 126 mg/dL at least twice throughout the test, the individual will be diagnosed with the disease. The second test that can be conducted is done by taking an individual’s blood glucose at a random time, with them carrying about their regular dieting routine. In this test, if blood glucose levels are past 200 mg/dL along with signs of thirst, excessive urination, and fatigue the subject may have diabetes and the fasting blood glucose test will be done for confirmation. The third test is an oral glucose tolerance test. Type I diabetes will be diagnosed if the patient’s glucose levels are higher than 200 mg/dL two hours after they have been asked to ingest a sugary beverage. The fourth test can be done by testing an individual’s hemoglobin A1C. A person shall be diagnosed with the disease if these levels are at 6.5% or higher. In drastic measures a ketone test can also be conducted to be positive whether or not the disease is present by testing a urine sample (A.D.A.M., National Library of Medicine, 2013). Once a person is diagnosed with diabetes they have to decide how they are going to cope with this major change in their health and life. It is said that when going into hearing the news on whether or not someone has a life altering disease that they bring someone else with them in case they zone out into their thoughts once the news is unveiled. (Saudek et al., 1997) Patients will be overcome with emotions such as fear, anger, vulnerability or loss of control in their life. Tears may be shed once hearing the news or the person may take their diagnosis in stride and realize that they still have a life to live, no matter if Type I diabetes shall be with them throughout it like a monkey
  • 6. Oliver6 on their back until they take their last breath. Depression may befall someone once they are trying to decide how to deal with contracting this disease, which means support from friends and family is imperative. People generally aren’t thrown loads of information as to how to regulate the disease right away so that they have a chance to cope. But once they are ready, learning how to treat and regulate Type I Diabetes is the next step (Saudek et al., 1997). Treatment There are ways to treat and regulate Type 1 diabetes. Just because a person is diagnosed with the disease does not mean that they are going to drop dead on the spot. (Izenberg et al., 2003) Regulating one’s diet is a way to make sure that glucose levels stay stable throughout the day. Counting the carbohydrates taken in is key because this is where glucose is stripped from food. Meals are more so planned out, and if someone feels that their blood sugar is low they will consume something sugary to raise their levels (Izenberg et al., 2003). For someone with Type I Diabetes, getting insulin their body is the main goal, due to the fact that their pancreas is not secreting it. This is where the innovation of injecting insulin comes in handy. (Saudek et al., 1997) Insulin is injected into the body through a syringe to help lower blood glucose levels. When someone is feeling the symptoms of their diabetes kicking in and know that they are in dire need of insulin, this would be when they inject themselves. In addition to lowering blood glucose, insulin slows down glucose production in the liver. This is why many people inject insulin at
  • 7. Oliver7 night, in an attempt to shut down the production of glucose from the liver as they sleep. Insulin is also a large factor in building muscle and allows the body to store calories in the form of glycogen and fat that the body can use when in need of an energy source. Insulin is involved in many chemical reactions in the body, so for someone with Type I diabetes to be able to live life as normal as possible they need to inject it into their body (Saudek et al., 1997). Another way that an individual can treat Type I diabetes is by exercising. (Izenberg et al., 2003) Regular exercise is shown to help insulin control blood glucose more efficiently. Exercise also helps regulate and maintain a healthy weight, which in turn helps keep a healthy cardiovascular system. People with the disease must plan ahead for blood glucose levels to drop throughout exercise by either eating more prior to exercise or keep insulin nearby. Exercise is also an activity that helps an individual feel better about his/herself in general due to the fact that they are up moving around and helping to improve their body image, fitness level and overall health (Izenberg et al., 2003). Personal hygiene is also a great way to regulate diabetes. (Guthrie D. and Guthrie R., 1999) Infections can lead to an increase in blood glucose. Taking care of one’s teeth is a way to prevent this. Teeth should be brushed at least twice a day to help get rid of plaque, usually done in the morning and at night before bed. Also the dentist recommends that an individual come in to have their teeth cleaned one every six months. Skin care, such as bathing regularly is recommended. Foot care is important in
  • 8. Oliver8 the aspect of making sure feet are not dry and susceptible to cracks and cuts. Eye care is also a hygienic act. Keeping hands clean and out of the eyes is important with how easy it is to pick up germs. A person with Type I diabetes should visit an eye professional at least once a year (Guthrie D. and Guthrie R., 1999). Just like any other disease, treatment costs money. In a study (Cobas et al., 2013) conducted in Brazil a group of investigators wanted to find the cost of treating Type I diabetes. They found that the overall total treatment cost on average was US$1216.33. Insulin used by the patients rounded out to be US$696.78 of the total cost. Medical procedures had an average cost of US$75.64 and consultations rounded out to be US$25.62. This data was found through evaluating 3180 patients with an average age of twenty-two years old with being diagnosed with the disease on an average of 10.3 years (Cobas, et al., 2013). The fact that this data was obtained in the year 2013 shows that these costs for treatment of Type I diabetes are still relevant. Prognosis Type I diabetes is a life-long disease once contracted. It is something that no one asks for, but instead just happens to befall them like a plague. (Daneman, 2006) Strangely enough Type I diabetes only makes up for 5-10% of cases of diabetes throughout the world. Though genes are the main cause for developing the disease, more research is needed to find the specific cause of it. Since the origination of Type I diabetes, the medical community has made strides in treating it more efficiently. From regulating blood glucose, to planning out meals, and most importantly using injections
  • 9. Oliver9 of insulin. When this disease first appeared, people diagnosed with it had their lives shortened immensely. Now they have a chance to live a much longer and fulfilling life due to advancements in treatment with insulin (Daneman, 2006). Just like with any other disease there is always room for improvement in treatment until there is a day when a cure is found.
  • 10. Oliver10 Literature Cited A.D.A.M., National Library of Medicine. 2013. “Type 1 Diabetes.” http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001350/ (February 21, 2014). Cobas, R.A., Ferraz, M.B., Saldanha de Mattos Matheus, A., Righeti Monteiro Tannus, L., Antonio Negrato, C., Antonio de Araujo, L., Atala Dib, S., Brito Gomes, M. 2013. The cost of type 1 diabetes: a nationwide multicentre study in Brazil. Bulletin of the World Health Organization 91(6): 434-440. Daneman, D. 2006. Type 1 diabetes. The Lancet 367(9513): 847-858. Guthrie, D.W., Guthrie, R.A. 1999. The Diabetes Sourcebook: Today's Methods and Ways to Give Yourself the Best Care. Lowell House, Los Angeles, CA, pp. 2-7, 95-102. Izenberg, N., Dowshen, S.A., Eppes, S.C., Masci, J. 2003. Human Diseases and Conditions, Vol. 2. Scribner, NY, pp. 511-519. Saudek, C.D., Rubin, R.R., Shump, C.S. 1997. The Johns Hopkins Guide to Diabetes: For Today and Tomorrow. Johns Hopkins UP. Baltimore, MD, pp. 6-34, 159-161. The, N.S., Crandell, J.L., Thomas, J., Couch, S.C., Shah, A.S., Maahs, D.M., Dabelea, D., Marcovina, S.M., D’Agostino Jr., R.B., Mayer-Davis, E.J. 2013. Correlates of medical nutrition therapy and cardiovascular outcomes in youth with type 1 diabetes. Journal of Nutrition Education & Behavior 45(6): 661-668.