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What Is Type 1 Diabetes?
Type I diabetes usually starts in childhood, but can occur in adults (30 to 40-year-olds). The pancreas cannot make insulin to help body cells convert sugar into energy, which causes the sugar to build up in the blood that can cause life-threatening complications. Individuals with type I diabetes must take some form of insulin for the rest of their lives.
Warning Sign: Unusual Thirst
Symptoms of type I diabetes may appear suddenly and can include the following:
- Frequent urination (polyuria)
- Drinking more water because of excessive thirst (polydipsia)
- Feeling excessively hungry (polyphagia)
- Dry mouth
- Fruity breath
- Weight loss
Warning Sign: Weight Loss
Because the blood sugar levels remain high and the body then metabolizes fat for energy, people with type I diabetes develop unintentional weight loss, and an increase in appetite. Because glucose metabolism is disrupted, they also feel a lack of energy and may be drowsy for extended periods.
Warning Sign: Skin Problems
The disruption in glucose metabolism in people with type I diabetes causes other problems such as a higher risk for bacterial infections, fungal infections, and skin changes that result in itching and dry skin. Poor blood circulation in the skin also may occur. Girls with type I diabetes are at risk for vaginal yeast infections, while babies who have the disease can develop severe diaper rash due to the yeast Candida albicans. The diaper rash can spread to other areas of the body such as the stomach and legs.
More Dangerous Signs
People with untreated type 1 diabetes can experience serious symptoms such as blurry vision, numbness or tingling in the extremities (especially the feet), loss of consciousness, and diabetic coma. In contrast to high sugars in the blood, occasionally people with type I diabetes can get low blood sugars (hypoglycemia) when their blood glucose level falls suddenly.
In people with type 1 diabetes loss of consciousness, diabetic coma, and in some cases hypoglycemia are medical emergencies. Some people who are undiagnosed may have no warning signs, yet still can develop diabetic coma or hypoglycemia.
More Dangerous Signs: Ketoacidosis
The problem with type I diabetes is that the person’s cells are deprived of the sugar they need for energy. Without the insulin produced by the pancreas, sugar has difficulty entering the body’s cells. Consequently, the body cells start burning fat for energy, which causes ketones to build up in the blood. These acids can change the person’s blood pH level and can trigger a life-threatening coma. This is termed diabetic ketoacidosis. Diabetic ketoacidosis is a medical emergency that needs to be treated quickly, usually in a hospital setting.
Type 1 vs. Type 2 Diabetes
In people with type I diabetes, the body’s immune system attacks and destroys pancreatic cells (Beta cells) that produce insulin. In people with type II diabetes, the pancreas is not attacked and usually produces insulin. However, people with type II diabetes, for numerous reasons, cannot use the available insulin effectively. People with type II diabetes can have the same symptoms as people with type I diabetes, but people with type I diabetes usually have the symptoms occur more rapidly.
What Causes Type I Diabetes?
Researchers are not sure why a person's immune system attacks its own insulin producing cells. However, researchers and clinicians suspect that genetic susceptibility and environmental factors raise the risk for developing type I diabetes. Scientists have identified genes and gene regions that raise the risk of developing type I diabetes, but they are not the only factors that cause the disease. Researchers suggest that environmental triggers such as a viral infection or perhaps dietary or pregnancy-related factors may also play a role in developing type I diabetes.
Who Gets Type 1 Diabetes?
Although type I diabetes can develop at any age, about two-thirds of new cases are diagnosed in individuals under the age of 19. Researchers have noted two peak times for development of type I diabetes; the first is in early childhood and the second occurs at puberty. Type I diabetes affects males and females equally, and is more common in Caucasians than in other ethnic groups.
Diagnosing Type 1 Diabetes
Simple blood tests can indicate the presence of abnormal sugar levels in the blood. If a person has any symptoms of diabetes, a fasting blood sugar test or even a random blood sugar test is usually the first step in diagnosis. A hemoglobin A1c test can reveal average blood sugar levels for the past 2 to 3 months. In most cases these tests are repeated on at least two separate days. Other tests used are the glucose tolerance test or testing for certain specific antibodies in the blood.
Unfortunately, undiagnosed or prolonged high blood sugar levels can result in damage to organ systems in the body over time. People with type I diabetes have a high risk of vision problems, heart disease, stroke, kidney failure, gum disease, tooth loss, and nerve damage (especially in the hands and feet). Other organs may also be damaged.
Monitoring Your Blood Sugar
For people with diabetes, complications that can damage organ can be prevented or reduced by regulating their blood sugar (glucose level). This is done by pricking the finger and putting a drop of blood on a test strip. The strip is in placed in a monitor that reads the glucose level. Close monitoring of glucose levels allows the individual to regulate their blood sugar by either medication if the sugar is high, or taking in sugar if the level is low. If a person with diabetes is able to keep blood sugar level in or near the normal range, they will decrease the likelihood of developing complications and have more energy and fewer problems related to diabetes.
Continuous Glucose Monitoring
Another device that measures glucose is termed a continuous glucose monitoring system. Although it’s not designed for day-to-day monitoring or long-term use, it is designed to discover trends in blood sugar levels. It’s a cell phone sized device that records an average glucose value every five minutes for about 72 hours.
Diabetes Treatment: Insulin Shots
Every person with type I diabetes needs to take insulin to help their body process sugar in the blood. Most people with type 1 diabetes take insulin in the injectable form and require several shots per day. You and your doctor can adjust your insulin shots based on results of blood sugar testing. As stated previously, the goal is to keep glucose levels in the blood within normal range as often as possible.
Insulin Reaction Warning Signs
Although insulin is a wonderful drug that helps people with diabetes, it needs to be used carefully. If a person takes too much insulin it is possible the blood sugar level will lower into dangerous levels. This situation is termed an insulin reaction (low blood sugar due to excessive insulin). Too much insulin can result in symptoms that may be mild, moderate, or severe, depending on how low and how long the low blood sugar levels exist in a person's blood. Some signs and symptoms of low blood sugar include fatigue, excessive yawning, mild confusion, decreased coordination, sweating, muscle twitching, and pale skin. As these symptoms get progressively worse, seizures, loss of consciousness, and even death may occur.
Neutralizing an Insulin Reaction
Although most people with diabetes who take insulin daily are careful, mistakes can result in an insulin reaction (low blood sugar). People with diabetes, especially type I diabetes, are advised to carry about 15 grams of a quick-acting carbohydrate at all times. Quick-acting carbohydrates are foods or drinks containing glucose that is rapidly absorbed into the body and the blood. Examples include a half-cup of fruit juice or a non-diet soda, five Life Savers (small hard candies), two tablespoons of raisins, one cup of milk, or three glucose tablets. These carbohydrates may resolve mild to moderate insulin reactions. For severe reactions, a drug called glucagon should be injected under the skin by a family member or friend familiar with treating severe insulin reactions and the person should be seen by a medical health care professional.
Diabetes Treatment: Insulin Pump
Although many people administer insulin through several shots per day, some people may be able to utilize an insulin pump. This pump delivers insulin round-the-clock by pushing insulin through a thin tube inserted into the person's skin. People with diabetes are encouraged to discuss the advantages and disadvantages of this insulin delivery system with their doctor.
How Well Is Your Treatment Working?
There is a test called the hemoglobin A1c blood test that is used to help determine how well a person is managing their blood glucose levels. This test measures how well the blood sugar has been controlled over about a 2 to 3 month time span. If the results show poor blood sugar control (high A1c levels), it suggests that the person's insulin therapy, dietary habits, and/or physical activity be modified to lower blood sugar levels into a more normal range.
Pancreatic Islet Cell Transplant
Some people with diabetes fail insulin therapy and may have reactions to the insulin that is injected. These people may be candidates for a procedure that some clinicians consider experimental. The procedure is a transfer of healthy insulin-producing cells from a donor into the pancreas of the patient with type I diabetes. Although there are benefits to this procedure, there are also drawbacks including medications with serious side effects that must be used to prevent rejection of the donor cells, and the probability that the transplanted cells may only function for a few years.
Type 1 Diabetes and Exercise
Most people benefit from exercise; people with type I diabetes also can benefit, but they need to take precautions to prevent sudden drops in blood glucose levels. People with type I diabetes should check their blood sugars before exercising, and may require eating a snack before or during exercise. In addition, they may need to adjust their insulin dosage before exercising to ensure they stay within normal ranges of blood glucose. People with type I diabetes also may need to check their urine for ketones – ketones suggest that your blood sugar is too high. Strenuous activity needs to be avoided if ketones are detected or if your blood sugar level is either high or low before exercise.
Type 1 Diabetes and Diet
People with type I diabetes, like everyone else, need to eat a well-balanced diet. This will help their insulin therapy and reduce the chance of diabetic complications. Even a person with type I diabetes can eat sweets as long as it is part of a well-balanced diet. That is not to say they can eat anything all the time – it means there are no foods people with diabetes should consider off-limits but they do need to consider how sweets (for example, a thin slice of pie) can fit into their well-balanced diet. Healthcare workers such as dietitians can help people with diabetes plan a well-balanced and varied diet.
Type 1 Diabetes and Pregnancy
Women with type I diabetes need to let their doctors know if they plan to become pregnant because if they are in poor control of their blood sugars, complications including birth defects may occur. Planning ahead, even before conception, to control blood sugar levels can lower the risk of miscarriage and birth defects. Good blood sugar control can reduce other complications during pregnancy such as high blood pressure or retinal damage in the mother.
Type 1 Diabetes in Children
Diagnosis of diabetes in children is a life-changing situation because it affects the whole family. Parents must help children monitor blood sugar and plan family meals that are appropriate for the child with diabetes and other family members. Insulin dosages must be monitored and blood sugar levels also need to be checked by child’s caregivers. Diabetes in children is a 24-hour-a-day problem that needs to be considered when a child is attending school and participating in extracurricular activities. Parents and their children need to make arrangements to follow through with insulin treatments even while the child is at school. These arrangements need to be planned in advance as not every state or school may participate in the child’s care the same way.
Hope for an Artificial Pancreas
Researchers are attempting to develop an artificial pancreas. This device is a combination of an insulin pump and continuous glucose monitoring system controlled by a computer program. The goal is for the system to release insulin in response to blood sugar levels and to reduce the release of insulin if blood sugar levels drop. The goal is to have a device that mimics the function of a normal pancreas. Some early trials of experimental devices suggest this device may be available in the future.