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Diabetes Type 1
Type 1 diabetes occurs when the body does not make enough insulin. Insulin is a hormone that helps your body convert food into energy. Without insulin, glucose (sugar) from the food you eat cannot enter cells and glucose builds up in the blood. Your body tissue becomes starved for energy.
Type 1 diabetes usually begins in children and young adults. Over the long-term, if type 1 diabetes is not adequately treated, high blood sugar levels can damage the blood vessels, heart, kidneys, eyes, nerves, and other tissues or organs.
Most cases of type 1 diabetes are caused by the body's immune system attacking and destroying the islet cells that make insulin. These cells are in the pancreas. The current theory is that some people have genes that make them prone to getting type 1 diabetes. For these people, certain things in the environment may trigger an immune system attack on the pancreas. The trigger or triggers have yet to be identified, but may be certain viruses, foods, or chemicals.
- Family history (parent, sibling) of type 1 diabetes
- Age: starts at age four with peak at ages 11-13
- Sex: more common in males than females
- Ethnicity: Northern European, Mediterranean, African American, Hispanic
- Bottle-feeding or short duration of breastfeeding
- Risk increases with increase in birth weight
- Obesity during childhood
If you have any of these symptoms, do not assume it is due to type 1 diabetes. The symptoms may be caused by other conditions. Tell your doctor if you have any of these:
- Weight loss
- Increased urination
- Extreme thirst
- Fatigue, weakness
- Blurry vision
Destruction of insulin-producing pancreatic cells may occur so quickly that ketoacidosis (commonly known as diabetic coma) is the first sign of a problem.
Symptoms of ketoacidosis include:
- Vomiting and nausea
- Abdominal pain
- Dehydration (not enough fluid in the body)
- Abnormally deep and fast breathing
- Dry skin and mouth
- Fruity breath odor
- Rapid pulse
- Low blood pressure
The doctor will ask about your symptoms, medical history, and family history, and do a physical exam.
Type 1 diabetes is diagnosed based on the results of blood tests and other criteria. These include:
- Symptoms consistent with diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 mg/dL* (11.1 mmol/L)
- Blood sugar tests after you have not eaten for eight or more hours (called fasting blood test) revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days
- Glucose tolerance test measuring blood sugar two hours after you consume glucose with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)
- HbA1c level of 6.5% or higher, indicating high blood sugar over the past 2-4 months
Diabetes treatment aims to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.
Insulin injection replaces the natural insulin the pancreas would normally produce. The dosage is adjusted based on results of blood sugar tests before and after meals and at bedtime. You will need to have insulin shots two, three, or more times daily. Or you may wear an insulin pump that continually gives you a small amount of insulin. The pump connects to tubing and a small needle or catheter under the skin.
Amylin is made in the pancreas along with insulin. In people with type 1 diabetes, like insulin, this hormone is lacking. Researchers think that the post-meal glucose rise in people with diabetes is somehow related to the amylin deficiency. The drug pramlintide (Symlin) may be used when insulin therapy is insufficient to adequately control blood sugar.
If you have type 1 diabetes, you should meet regularly with a registered dietician. Generally speaking, it is best to:
- Follow a well-balanced meal plan incorporating a variety of food groups
- Eat consistently at regular times each day, including a bedtime snack
- Avoid highly refined carbohydrates (sugar or high fructose products)
Exercise is encouraged when blood sugar levels are consistently under control and there are no complications. Follow your doctor's advice on activity levels and restrictions. You may need to adjust your insulin regimen or diet to compensate for low glucose levels linked to exercise.
Blood Sugar Testing
Checking blood sugar levels during the day helps you track the amount of glucose in your blood. Testing is easy with a blood glucose monitor. You can also ask your doctor about continuous glucose monitoring systems that you wear all day.
Keep a record of the results to show your doctor. Your treatment plan may change based on your test results. The HbA1c blood test is also used by your doctor to assess your overall diabetes control.
Pancreatic Islet Cell Transplant
This is an experimental procedure. It involves transplanting islet cells from a donor to a person with type 1 diabetes. After the transplant, these new cells are able to produce insulin. In some cases, people who receive these transplants may no longer need insulin injections.
Closed-Loop Artificial Pancreas
This device, which is still being studied, automatically checks glucose levels using a continuous glucose monitoring system (CGMS). Insulin is delivered as needed throughout the day and night. It will allow you to keep your blood sugar levels within the normal range without having to do daily blood sugar testing and injections. Scientists have also designed the device to deliver glucagon, a hormone that can work to prevent hypoglycemia.
Currently, there is no known way to prevent type 1 diabetes. Researchers are studying immunosuppressive treatments that may benefit high-risk people.
American Diabetes Association
National Diabetes Information Clearinghouse