Dr. Subodh Banzal

MD (Med), DM (Endo),
MRCP (UK), FRCP (Glasgow), MAMS

Type I Diabetes

Overview

Type 1 diabetes is also known as juvenile diabetes or insulin-dependent diabetes. It is a chronic condition where pancreas secretes little or no insulin, a hormone required to allow sugar (glucose) to enter cells to produce energy. On the other hand type 2 diabetes results when the body becomes resistant to the effects of insulin or it secretes less of insulin.

Type 1 diabetes may occur due to various factors, which may include genetics and contact to certain viruses. Generally type 1 diabetes typically appears during childhood or adolescence, but it can also develop in adults. There is no cure for type 1 diabetes but still it can be managed. People who have type 1 diabetes can expect to live longer and healthier lives with proper treatment.

Causes

The exact cause for type 1 diabetes is still not known. Type 1 diabetes may occur due to dysfunctioning of the body's own immune system which mistakenly destroys the insulin-producing (islet) cells in the pancreas. This process may be because of genetics or exposure to certain viruses.

The role of insulin

Insulin is one of the hormones that is secreted from the islets cells of pancreas, a gland to be found behind and below the stomach. When the islet cells are destroyed, there will be little or no insulin.

  • Insulin is secreted from pancreas into the bloodstream.
  • The circulating insulin helps sugar enter into cells
  • Amount of sugar in ones bloodstream is lowered by insulin.
  • Whenever blood sugar level drops, the secretion of insulin from pancreas also reduces.
The role of glucose

Glucose is a sugar which is one of the main sources of energy for the body cells that build up muscles and other tissues.

  • Food and our liver are two main sources of glucose.
  • Sugar from bloodstream enters inside the cells with the help of insulin.
  • Glucose is stored as glycogen in our liver.

Whenever insulin levels drops, the stored glycogen is converted into glucose by liver to keep the glucose level within a normal range. Since there is no insulin or reduced levels of insulin in type 1 diabetes, the levels of sugar increases in bloodstream. This can result in life-threatening complications.

Symptoms

Various signs and symptoms associated with type 1 diabetes are:

  • Increased thirst
  • Recurrent urination
  • Excessive hunger
  • Loss of weight
  • Exhaustion or tiredness
  • Hazy vision
Risk Factors

Some of the known risk factors for type 1 diabetes include:

  • Positive family history- Those with history of type 1 diabetes in a parent or sibling have higher chance of developing the disease
  • Heredity- There is increased risk of developing type 1 diabetes in the presence of certain genes in body.
  • Topography-The incidence of type 1 diabetes is two to three times higher in people living in certain geographical areas. Trend of disease is increased when we move away from equator.
  • Contact with Virus- The autoimmune destruction of the islet cells can be triggered after exposure to epstein-barr virus, coxsackievirus, mumps virus or cytomegalovirus
  • Having early exposure to vitamin D- Early drinking of cow's milk (common source of vitamin D) can lead to increased risk of type 1 diabetes.
  • Other dietary factors- It has been found that drinking water which contains nitrates can also increase the risk of developing the disease.
  • Becoming mother before 25 yrs of age
  • Children of mother who had preeclampsia during pregnancy
  • Children born with hyperbilirubinemia
  • Children having respiratory distress or infection after birth

Diagnosis

It has been recommended by experts from international committee like the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation that type 1 diabetes testing include the:

  • Glycated hemoglobin (A1C) test. Patients average blood sugar level for the past two to three months can be detected by this test. If A1C level comes out to be of 6.5 percent or higher on two different tests ,this indicates that patient has diabetes.
  • Random blood sugar test. In this test blood sample will be taken at a random time, regardless of time when you last ate. Blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, particularly when any of the signs and symptoms of diabetes are present.
  • Fasting blood sugar test. Here blood sample is taken after an overnight fast. Fasting blood sugar value less than 100 mg/dL (5.6 mmol/L) is considered to be normal, while value from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. Fasting blood sugar value of 126 mg/dL (7 mmol /L) or higher on two separate tests is considered as having diabetes. When patient is diagnosed to have diabetes, doctor will do blood tests to check for auto antibodies that are common in type 1 diabetes. By these test doctor will be able to differentiate between type 1 and type 2 diabetes. The presence of byproducts from the breakdown of fat , ketones — in urine also rule out type 1 diabetes, rather than type 2.

Complications

Major organs of body like heart, blood vessels, nerves, eyes and kidneys are affected by type 1 diabetes. By keeping blood sugar levels under control one can considerably reduce the risk of developing the complications.

Type 1 diabetic patients develop long-term complications steadily over the years. Earlier the patient develops diabetes and the lesser the control of blood sugar levels, higher are chances of developing complications. Complications of diabetes can be disabling or even life-threatening. ।

  • Heart and blood vessel disease. Diabetes increases risk of various cardiovascular diseases like chest pain (angina), heart attack, stroke, atherosclerosis-narrowing of arteries and high blood pressure.
  • Damage to nerves (neuropathy). Diabetes can injure the walls of the tiny blood vessels (capillaries), especially in the legs. Symptoms of this are tingling, numbness, burning or pain that is first felt at the tips of the toes or fingers and slowly spreads upward. Uncontrolled blood sugar levels lead to lose all sense of feeling in the affected limbs. Damage to gastrointestinal tract nerves cause problems like sickness, vomiting, diarrhea or constipation. Erectile dysfunction can occur in males.
  • Damage to kidneys (nephropathy). Diabetes can damage filtering system of kidneys. Extensive injury can lead to kidney failure or irreversible end-stage kidney disease, which may lead to need for dialysis or a kidney transplant.
  • Eye damage. Diabetes harm the blood vessels of the retina (diabetic retinopathy), leading to blindness. Diabetes can also result in other serious conditions, such as cataracts and glaucoma.
  • Foot damage. Foot complications occur due to nerve damage in the feet or poor blood flow to the feet Cuts and blisters in foot if left untreated can become serious infections. Sometimes toe, foot or even leg amputation may be required in severe damage.
  • Skin and mouth conditions. Patients with diabetes become prone to skin problems, including bacterial and fungal infections. Poor dental hygiene may lead to gum infections.
  • Osteoporosis. Diabetes results in osteoporosis by lowering bone mineral density.
  • Complications in pregnancy. Diabetes can increase risk of miscarriage, pregnancy-induced high blood pressure, preeclampsia stillbirth and birth defects.
  • Difficulty in hearing. Diabetes results in hearing impairments in patients.

Treatment

Management of type 1 diabetes involves :

  • Insulin
  • Regular exercise
  • Healthy food habits
  • Blood sugar monitoring

Treatment aim is to keep blood sugar level as close to normal as possible to delay or prevent complications. Generally, the goal is to keep your daytime blood sugar levels before meals between 80 and 120 mg/dL (4.4 to 6.7 mmol/L) and your bedtime numbers between 100 and 140 mg/dL (5.6 to 7.8 mmol/L).

Insulin and other medications

Insulin is required by anyone who has type 1 diabetes. There are many types of insulin and include:

  • Rapid-acting insulin
  • Long-acting insulin
  • Intermediate options

There is no method of taking Insulin orally and it has to be taken subcutaneously because stomach enzymes interfere with insulin's action. Sometimes other medications are prescribed and include:

  • Medications for high blood pressure.
  • Blood thinners like aspirin.
  • Cholesterol-lowering drugs.
Monitoring carbohydrates and healthy eating

There's no such thing as a diabetes diet, contrary to popular perception. There is no need to restrict you to a lifetime of boring, bland foods. Eat nutritious, low-fat, high-fiber foods such as:

  • Fruits
  • Vegetables
  • Whole grains

Eat less animal products and refined carbohydrates, such as white bread and sweets. Even for people without diabetes, this is the best overall eating plan.

Physical activity

Regular aerobic exercise is needed by everyone, and people who have type 1 diabetes are no exception. Take approval from your doctor to exercise. Find out activities that you enjoy, such as walking, swimming or biking. Do exercise routinely and aim for at least 30 minutes of aerobic exercise most days of the week. It is also important to do flexibility and strength training exercises.

Blood sugar monitoring

You may need to check and record your blood sugar level at least four times a day, and possibly more often depending on what type of insulin therapy you select or require — twice daily injections, multiple daily injections or insulin pump. The only way to make sure that your blood sugar level remains within your target range is by careful monitoring. Wash your hands positively before checking your blood sugar levels.

The amount of sugar in your blood can change unpredictably in many situations. Learn how your blood sugar level changes in response to:

  • Food
  • Physical activity
  • Medication
  • Illness
  • Alcohol
  • Stress
  • For women, fluctuations in hormone levels
Prevention

It is serious to suffer from type 1 diabetes. Improved management of type 1 diabetes can prevent complications. The ways to prevent complications are:

  • Manage diabetes effectively
  • Schedule regular check up by doctor
  • Maintain oral hygiene
  • Take care of your feet
  • Control blood pressure and cholesterol
  • Stop smoking
  • Minimize alcohol intake
  • Retain a healthy weight
  • Avoid stress
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