Type 1 Diabetes
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What is type 1 diabetes?
Type 1 diabetes is when you have high levels of sugar (glucose) in the blood because the body can’t produce enough insulin, the hormone that controls blood sugar. Without insulin, your body can’t move sugar into your cells to be used as energy or stored as fat. This causes very high levels of sugar in your body, which can damage your organs.
Type 1 diabetes (also known as diabetes mellitus or juvenile diabetes) usually starts in childhood though it can occur at any age. Symptoms, like fatigue and frequent urination, often come on suddenly.
If it progresses quickly, the body can enter a life-threatening state called diabetic ketoacidosis (DKA). This is a medical emergency and you should call 911.
Despite the seriousness of the disease, it is a treatable condition. Currently there are 1.6 million Americans with type 1 diabetes, according to JDRF. Controlling your glucose levels will help prevent long-term complications.
Most common symptoms
Diabetes is a team sport: your endocrinologist, certified diabetes educator, dietician, and others on your care team are there to work with you to ensure you have optimal disease control and prevention of long-term complications. —Dr. Rachel Arakawa
With type 1 diabetes it is common to feel tired. This is because without insulin, your body can’t absorb enough sugar to get energy.
Too much sugar can harm your organs. The body compensates by peeing out the extra sugar. This loss of fluid can dehydrate you and make you thirsty.
Weight loss is also common with type 1 diabetes. Since your muscles cannot use the sugar as energy, it tries to gain energy by breaking down muscle and fat. That’s why you lose weight without trying.
Symptoms can be sudden and severe and usually include some of the following:
- Frequent urination
- Increased thirst
- Increased appetite
- Unintended weight loss
- Irritability and mood swings
- Blurred vision
- Bed-wetting in children who did not previously wet the bed
Other symptoms you may have
Type 1 diabetes is often diagnosed suddenly in a moment of crisis. Without insulin, you may experience DKA. Call 911 if you or a family member develops the following symptoms:
- Severe nausea and vomiting
- Decreased levels of consciousness
- Rapid breathing
- Flushed face
- Fruity-smelling breath
- Dry skin and mouth indicating dehydration
- Muscle stiffness or body aches
DKA may require staying in the intensive care unit for a few days. Untreated DKA can lead to cardiac arrest, kidney failure, coma, and death.
What is the difference between type 1 and type 2 diabetes?
There are two types of diabetes: type 1 and type 2. Type 1 occurs when the body can’t produce enough insulin. Type 2 occurs when the body’s response to insulin is impaired.
Type 1 diabetes is more dangerous than type 2. It often starts in childhood and requires insulin treatment.
Type 2 is associated with diet and obesity and can sometimes be treated with lifestyle changes. Over 90% of people with diabetes have type 2.
Is there anything I did to cause this? Is there anything in my lifestyle I can change to reverse this? The answer is no. It is not your fault. It has everything to do with your genetic predisposition. There are currently no diets, medications, or lifestyle modifications that can reverse the disease. Preventing type 1 diabetes with powerful immune-suppressing drugs is an area of research investigation that is still considered experimental. —Dr. Arakawa
It is extremely important to seek medical care immediately. Your doctor can run some blood tests to determine if you have diabetes. Type 1 diabetes is treated by a specialist known as an endocrinologist.
Causes of type 1 diabetes
Type 1 diabetes begins when the insulin-producing cells within the pancreas (known as “beta” or “islet” cells) are damaged by the body’s own immune system. This is why type 1 diabetes is considered an autoimmune disease, meaning the body’s defense mechanisms mistakenly attack its own cells.
We do not know what triggers the immune system to attack insulin-producing cells. This process can go on for months or years before any symptoms appear.
By the time most people are diagnosed, the condition has already become severe with little to no insulin production left.
A few factors are associated with developing type 1 diabetes:
- Family history: a parent or sibling with type 1 diabetes
- Genetics: certain genetic variations
- Ethnicity: European descent
Treatment for type 1 diabetes
A common misconception is that type 1 diabetes is a limitation. This couldn’t be further from the truth. With the right preparation, you can conduct all daily activities, exercise, hobbies, pregnancy, and travel with ease. Activities include but are not limited to: swimming, scuba diving, marathons & elite sporting events, airline piloting—and the list continues. —Dr. Arakawa
As of now, there is no cure for type 1 diabetes, but your blood sugar levels can be managed. Treatments include:
People with type 1 diabetes need to take insulin for the rest of their lives. This is usually done with injections under the skin multiple times per day, always with meals.
There are two common ways for delivering insulin. Both are designed to mimic the body’s natural insulin patterns with a constant low-level (basal) insulin and additional peaks (boluses) as needed.
- A traditional “basal-bolus” regimen consists of a long-acting insulin (basal) injected once or twice daily, and a shorter-acting insulin (bolus) injected at mealtime or when sugars go too high.
- An insulin pump can be used. This allows the long-acting insulin to be replaced with a constant low-dose infusion. Larger “bolus” doses of insulin are still given at mealtime or when sugars run high.
Either way, it is important to check your blood sugar multiple times throughout the day so you know how much insulin your body needs, especially around mealtimes.
You can check your blood sugar two ways:
- A glucose meter: Prick your finger and add a drop of blood to a testing strip.
- Continuous glucose monitor (CGM). This is implanted beneath the skin. It has a small catheter that reads blood sugar values from the fluid in your skin.
Doctors may prescribe other medications in addition to insulin. These help protect your organs that can be damaged by diabetes, such as your heart, blood vessels, and kidneys.
- Baby aspirin
- High blood pressure medications
- Cholesterol-lowering drugs
- Hormones like glucagon
- Glucose tablets (or gels) to quickly correct low blood sugar
You can help control your type 1 diabetes with a healthy diet that includes plenty of fruits and vegetables and regular physical activity.
If diagnosed, an endocrinologist and diabetes educator can help you understand:
- How to check your own (or child's) blood sugar and record the results.
- How to use an insulin syringe/pump/pen.
- Recognize signs and symptoms of high and low blood sugar and what to do.
- Choose heart-healthy foods low in saturated fat, trans-fats, sugar, and salt.
- Eat at regular times and do not skip meals. Monitor your feet, skin, and eyes regularly, as these can all be affected by diabetes.
- Drink water instead of sugary beverages like juice or soda.
- Limit alcoholic drinks.
- Exercise regularly.
- Track your meals, drinks, and physical activity.
- Manage physical stressors, such as when you’re sick or have hormonal fluctuations, which can affect blood sugar levels.
- Use an over-the-counter ketone test to check for DKA.
Type 1 diabetes is a condition you will have to manage for the rest of your life.
- It’s important to follow up with your doctor regularly.
- You will have to check your blood sugar levels throughout the day. Home blood sugar targets are 80 to 130 mg/dL before a meal and less than 180mg/dL two hours after the start of a meal, according to the Centers for Disease Control and Prevention.
- You may have some episodes of hypoglycemia—when your blood sugar drops too low (70 mg/dL or lower). Some symptoms of this are shaking, sweating, nervousness, irritability, confusion, dizziness, and hunger. Have glucose tablets or candies with you at all times to prevent severe hypoglycemia.
- If you find you are having increased episodes of weight loss, thirst, urination or frequent episodes of hyperglycemia (when blood sugar is too high), you are likely not controlling your sugar level well.
- Frequent episodes of hyperglycemia or hypoglycemia require a follow-up with your doctor. They can better assess how your condition needs to be treated.
Dr. Kelly is a graduate of the University of Pennsylvania Perelman School of Medicine, specializing in internal medicine and bioethics. He received his undergraduate degree from Emory University with a BA in Spanish. Dr. Kelly has formal training in medical interpretation and translation, along with several years of professional experience in medical communication and editing work for publication.