Diabetes Type 1

Diabetes Type1

Definition

Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas that help regulate blood glucose levels.

Type 1 diabetes typically occurs in children and young adults, although it can appear at any age. Having a parent or sibling with the disease may increase your chance of developing type 1 diabetes. In the United States, about 5 percent of people with diabetes have type 1.

Diabetes occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes mainly from the food you eat. Insulin, a hormone made by the pancreas, helps the glucose in your blood get into your cells to be used for energy. Another hormone, glucagon, works with insulin to control blood glucose levels.

In most people with type 1 diabetes, the body’s immune system, which normally fights infection, attacks and destroys the cells in the pancreas that make insulin. As a result, your pancreas stops making insulin. Without insulin, glucose can’t get into your cells and your blood glucose rises above normal. People with type 1 diabetes need to take insulin every day to stay alive.

The American Diabetes Association said across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese.

Alternative Names

Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes – type 1

Causes

The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes, their body’s own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Symptoms

The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and develop over a short period of time.

Early symptoms, which are mainly due to hyperglycemia, include:

• increased thirst and urination
• constant hunger
• weight loss
• blurred vision
• exhaustion

For other people, these warning symptoms may be the first signs of type 1 diabetes, or they may happen when the blood sugar is very high:

• Deep, rapid breathing
• Dry skin and mouth
• Flushed face
• Fruity breath odor
• Nausea or vomiting, inability to keep down fluids
• Stomach pain

Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms usually appear when the blood sugar level falls below 70 mg/dL.

Watch for:

• Headache
• Hunger
• Nervousness
• Rapid heartbeat (palpitations)
• Shaking
• Sweating
• Weakness

Exams and Tests

It is recommended that type 1 diabetes testing include the:

• Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months.
• If the A1C test isn’t available, or if you have certain conditions that can make the A1C test inaccurate — such as if you’re pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:
• Random blood sugar test. A blood sample will be taken at a random time. You may have diabetes if it is higher than 200 mg/dL, and you have symptoms such as increased thirst, urination, and fatigue
• Fasting blood sugar test. A blood sample will be taken after an overnight fast. Diabetes is diagnosed if it is higher than 126 mg/dL two times
• Oral glucose tolerance test. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL after 2 hours

Treatments

Treatment for type 1 diabetes is a lifelong commitment to:

• Taking insulin
• Exercising regularly and maintaining a healthy weight
• Eating healthy foods
• Monitoring blood sugar

The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. Although there are exceptions, generally, the goal is to keep your daytime blood sugar levels 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).

If managing your diabetes seems overwhelming, take it one day at a time. And remember that you’re not in it alone. You’ll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.

Insulin and other medications

Anyone who has type 1 diabetes needs insulin therapy to survive.

Types of insulin are many and include:

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

Examples are regular insulin (Humulin R, Novolin R, others), insulin isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).

Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

An inhaled insulin (Exubera) was previously available, but the manufacturer stopped selling the drug because too few people were using it. Since it was taken off the market, this drug has been linked to an increased number of lung cancers in people with a history of smoking. However, because the additional number of lung cancer cases is so small, it’s not clear if there’s a link to the medication. If you used Exubera and have a history of smoking, discuss these concerns with your doctor.

Injection options to get insulin into your body currently include injection and insulin pump infusion. Insulin can’t be taken orally to lower blood sugar because stomach enzymes interfere with insulin’s action.

Insulin injections can be done using:

• A fine needle and syringe
• An insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin
• An insulin pump — a device about the size of a cell phone worn on the outside of your body. A tube connects a reservoir of insulin to a catheter that’s inserted under the skin of your abdomen. There’s also a wireless pump option that’s available in most areas. You wear a pod filled with insulin on your body that has a tiny catheter that’s inserted under your skin. The insulin pod can be worn on your abdomen, lower back, or on a leg or an arm. The programming is done with a wireless device that communicates with the pod.
• Whichever pump you use, it’s programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as your basal rate, and it replaces whatever long-acting insulin you were using. When you eat, you program the pump with the amount of carbohydrates you’re eating and your current blood sugar, and it will give you what’s called a “bolus” dose of insulin to cover your meal and to correct your blood sugar if it’s elevated. Some research has found an insulin pump to be more effective at controlling blood sugar levels than injections are.

Oral medications are sometimes prescribed as well, such as:

• Pramlintide (Symlin). An injection of this medication before you eat can slow the movement of food through your stomach to curb the sharp increase in blood sugar that occurs after meals.
• High blood pressure medications. Even if you don’t have high blood pressure, your doctor may prescribe medications known as angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), because these medications can help keep your kidneys healthy in addition to lowering blood pressure. It’s recommended that people with diabetes have blood pressures less than 130/80 millimeters of mercury (mm Hg).
• Cholesterol-lowering drugs. As with high blood pressure drugs, your doctor may not wait until your cholesterol is elevated before he or she prescribes cholesterol-lowering agents known as statins. Cholesterol guidelines are more aggressive for people with diabetes because of the elevated heart disease risk. The American Diabetes Association recommends that low-density lipoprotein (LDL, or “bad”) cholesterol be below 100 mg/dL (2.6 mmol/L) and that high-density lipoprotein (HDL, or “good”) cholesterol be over 50 mg/dL (1.3 mmol/L). Triglycerides, another type of blood fat, are ideal when they’re less than 150 mg/dL (1.7 mmol/L).
• Healthy eating and counting carbohydrates. Contrary to popular perception, there’s no such thing as a diabetes diet. You won’t be restricted to a lifetime of boring, bland foods. Instead, you’ll need plenty of:

• Fruits
• Vegetables
• Whole grains

These foods are high in nutrition and low in fat and calories. And they mean fewer animal products and sweets. This is actually the best eating plan, even for people without diabetes.

You’ll need to learn how to count the carbohydrates in the foods you eat so that you can give yourself enough insulin to properly metabolize those carbohydrates. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle.

Everyone needs regular aerobic exercise, and people who have type 1 diabetes are no exception. Get your doctor’s OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What’s most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven’t been active for a while, start slowly and build up gradually.

Remember that physical activity lowers blood sugar, often for long after you’re done working out. If you begin a new activity, check your blood sugar level more often than usual until you know how that activity affects your blood sugar levels. You might need to adjust your meal plan or insulin doses to compensate for the increased activity. If you use an insulin pump, you can set a temporary basal rate to keep your blood sugar from dropping. Ask your doctor or diabetes educator to show you how.

Depending on what type of insulin therapy you select or require — single-dose injections, multiple-dose injections or insulin pump — you may need to check and record your blood sugar level at least four times a day, and probably more. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Be sure to wash your hands before checking your blood sugar levels to get the most accurate reading.

Even if you take insulin and eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you’ll learn how your blood sugar level changes in response to:

• Food. What and how much you eat will affect your blood sugar level. Blood sugar is typically highest one to two hours after a meal.
• Physical activity. Physical activity moves sugar from your blood into your cells. The more active you are, the lower your blood sugar level. To compensate, you might need to lower your insulin dose before unusual physical activity.
• Medication. You need insulin to lower your blood sugar level. But other medications you take may affect your blood sugar level as well, sometimes requiring changes in your diabetes treatment plan.
• Illness. During a cold or other illness, your body will produce hormones that raise your blood sugar level. This might require changes in your diabetes treatment plan.
• Alcohol. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so in moderation, which means no more than one drink a day for women and two drinks or fewer daily for men.
• Stress. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly.

For women, fluctuations in hormone levels. As your hormone levels fluctuate during your menstrual cycle, so can your blood sugar level — particularly in the week before your period. Menopause may trigger fluctuations in your blood sugar level as well.

Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar levels, and may be most helpful for people who have developed hypoglycemia unawareness. Continuous glucose monitors attach to the body using a fine needle just under the skin that checks blood glucose level every few minutes. CGM isn’t yet considered as accurate as standard blood sugar monitoring, so it’s not considered a replacement method for keeping track of blood sugar, but an additional measure.

Possible Complications

Type 1 diabetes can affect many major organs in your body, including your heart, blood vessels, nerves, eyes and kidneys.

• Long-term complications include:
• heart and blood vessel disease
• nerve damage (neuropathy)
• kidney damage (nephropathy)
• eye damage
• foot damage
• skin and mouth conditions
• osteoporosis
• pregnancy complications
• hearing problems

When to Contact a Medical Professional

Call 911 if you have:

• Chest pain or pressure, shortness of breath, or other signs of angina
• Loss of consciousness
• Seizures

Call your healthcare provider or go to the emergency room if you have symptoms of diabetic ketoacidosis. Also, call your doctor if you have:

• Blood sugar levels that are higher than the goals you and your doctor have set
• Numbness, tingling, or pain in your feet or legs
• Problems with your eyesight
• Sores or infections on your feet
• Symptoms that your blood sugar is getting too low (feeling weak or tired, trembling, sweating, feeling irritable, having trouble thinking clearly, fast heartbeat, double or blurry vision, feeling uneasy)
• Symptoms that your blood