Type 1 Diabetes

1 What is Type 1 Diabetes?

Type 1 diabetes, previously known as juvenile or insulin-dependent diabetes, is a condition in which there is reduced or no secretion of insulin by the pancreas. This causes sugar (glucose) to accumulate in the blood, since insulin is needed for transporting sugar into the cells of the body. Insulin therefore, decreases the amount of sugar in the blood.

Various factors have been implicated in the development of type 1 diabetes. They include genetics and exposure to certain viruses and chemicals (certain medications) which lead to destruction of the insulin-secreting cells (beta cells) of the pancreas. Although it mostly occurs during childhood and adolescence, type 1 diabetes can also develop in adults.

There is currently no cure for type 1 diabetes. Treatments which usually consists of insulin replacement therapy, can help patients to manage the symptoms of this condition.

2 Symptoms

The onset of symptoms in type 1 diabetes is early.

Signs and symptoms include:

  • Increased thirst
  • Frequent urination and bed wetting in children who previously didn't wet the bed during the night
  • Extreme hunger
  • Unintended weight loss
  • Irritability and mood changes
  • Fatigue and weakness
  • Blurred vision
  • Vaginal yeast infections in females

3 Causes

The exact cause of type 1 diabetes is unknown.

However, it is associated with the destruction of the pancreatic islets. This can occur as a result of the body's immune system attacking the cells of the pancreas.

Genetics and exposure to certain environmental factors, such as viruses may play a role in the development of this disease.

4 Making a Diagnosis

The following tests can be used for the diagnosis of type 1 Diabetes:

  • Glycated hemoglobin (A1C) test - which can indicate the amount of sugar in the blood for the past two to three months. This tests works by measuring the amount of glucose attached to hemoglobin, the oxygen carrying protein of red blood cells. An A1C level of 6.5 percent or higher indicates diabetes.
  • Fasting blood sugar test - in which a person is asked to fast overnight and the level of sugar is measured on the next day, usually in the morning. A fasting blood sugar level of 100 mg/dL (5.6 mmole/L) is normal. A fasting blood sugar level of 100-125 mg/dL (5.6- 6.9 mmol/L) is considered as prediabetes and if it is higher than 126 mg/dL (7 mmol/L), it is considered as diabetes.
  • Random blood sugar test - which can be taken at any time. Regardless of when the patient last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) indicates diabetes.

5 Treatment

Several treatments for type 1 Diabetes are available. They include:

  • Insulin Therapy which is required for lifelong treatment. Types of insulin include, rapid-acting, long-acting and intermediate acting insulin. Examples are regular insulin (Humulin 70/30, Novolin 70/30), insulin isophane (Humulin N, Novolin N) insulin glulisine (Apidra), insulin lispro (Humalog) and insulin aspart (Novolog). Long-acting insulins include glargine (Lantus) and determir (Levemir). Because insulin is degraded by enzymes of the stomach, it should not be taken orally. It can be given through injections or an insulin pump. A fine needle or an insulin pen , which looks similar to ink pens can be used to inject insulin under the skin. Multiple daily injections usually consist of different types of insulin (Long-acting and regular insulin). An insulin pump is a small device about the size of a cellphone that can be worn outside the body. A tube connects the reservoir to a catheter that is inserted under the skin of the abdomen. It can be worn as a waistband, in a pocket or as a specially designed pump belt. Pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as the basal rate, and it replaces any long-acting insulin that a person was using.
  • Medications, such as high blood pressure medications, drugs like pramlintide, which reduce the rate of movement of food through the stomach to reduce the sharp rise in blood sugar that occurs after meals, aspirin to protect the heart and cholesterol-lowering drugs.
  • Artificial pancreas is an emerging treatment approach in which patients are given a closed-loop insulin delivery. The device automatically delivers the correct amount of insulin when a monitor indicates the need for it. There are a number of different versions of the artificial pancreas, and clinical trials have had encouraging results.
  • Healthy eating and monitoring carbohydrates.
  • Regular exercising, at least 30 minutes of aerobic exercise on most days of the week.

There is ongoing research for new treatments for type 1 Diabetes, such as pancreas, islet cell and stem cell transplant.

6 Prevention

There is no known prevention for type 1 diabetes. There is ongoing research on preventing further destruction of islets of the pancreas in people with newly diagnosed type 1 diabetes.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with type 1 diabetes.

Managing diabetes requires a lot of effort and time and this can prove to be very stressful, especially in the beginning.

If it is not managed properly, it can result in changes in behavior such as irritability. People with diabetes are at an increased risk of having depression and diabetes-related distress. It is for this reason that many diabetic specialists regularly include a psychologist or social worker as part of their diabetic team. Joining a support group can be very helpful for patients with type 1 diabetes.

It is very important for patients with diabetes to follow round-the-clock treatment to prevent the development of serious and life-threatening complications.

The following tips can be helpful:

  • Taking medications as recommended.
  • Wearing a tag that shows a person has diabetes.
  • Having yearly physical and regular eye exams.
  • Being up to date with immunizations since diabetes can weaken the immune system.
  • Paying special attention to the feet to check for sores, cracks, blisters or cuts.
  • Keeping blood pressure and blood cholesterol under control.
  • Quit smoking and avoiding excessive consumption of alcohol.
  • Avoiding prolonged exposure to stress, since stress can prevent insulin from functioning properly.

8 Risks and Complications

The risk factors for developing type 1 diabetes include:

  • A family history
  • Presence of genes which may indicate an increased risk of diabetes
  • Being between the ages of 4- 14 years
  • Exposure to certain viral infections, such as Epstein-Bar, Coxsackie, mumps and cytomegalovirus
  • Early exposure to cow's milk
  • Low levels of vitamin D
  • Having a mother mother with preeclampsia during pregnancy
  • Being born with jaundice

Complications can arise due to lack or improper treatment of diabetes. This usually leads to destruction of major organs, such as the heart, blood vessels, nerves, eyes and kidneys.

9 Related Clinical Trials