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Diabetes

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Type 1 Diabetes

Type 1 diabetes, which used to be called insulin dependent or juvenile diabetes, makes up about 5% of the diabetes cases in the United States. Most cases of type 1 diabetes are diagnosed in those under the age of 30. Type 1 diabetics make very little or no insulin. Any insulin-producing beta cells they do have at the time of diagnosis are usually completely destroyed within 5 to 10 years, leaving them entirely reliant on insulin injections to live.

The exact cause of type 1 diabetes is unknown, but a family history of diabetes, viruses that injure the pancreas, and autoimmune processes, in which the body's own immune system destroys the beta cells, are all thought to play a role. Type 1 diabetics may have more severe medical complications sooner than other diabetics. About 40% of those with type 1 diabetes will develop serious kidney problems leading to kidney failure by the age of 50.

Signs and Symptoms

Signs and symptoms in type 1 diabetes often develop abruptly and the diagnosis is often made in an emergency room setting. The affected person may be seriously ill, even comatose, with very high glucose levels and high levels of ketones (ketoacidosis) and may require hospitalization. See the section on Signs and Symptoms for more detailed information.

Laboratory Tests

In addition to diabetes tests, used for screening, diagnosing and monitoring, a few other tests may be used in the evaluation of type 1 diabetes:

  • Diabetes autoantibodies – this test may help distinguish between type 1 and type 2 diabetes if the diagnosis is unclear. The presence of one or more of these antibodies indicates type 1 diabetes.
  • Insulin, C-peptide – to monitor insulin production
  • Urine and/or blood ketone tests may be ordered to monitor people who present at the emergency room with symptoms suggesting acute hyperglycemia and to monitor those who are being treated for ketoacidosis. A build up of ketones can occur whenever there is a decrease in the amount or effectiveness of insulin in the body.

Treatment

There is currently no cure for type 1 diabetes, although there has been some limited success with islet (beta) cell transplantations as a way to potentially restore insulin production.

Diabetic treatment at the time of diagnosis is somewhat different than ongoing treatment. Type 1 diabetics are sometimes diagnosed when symptoms are acute, with very high blood glucose levels, electrolytes out of balance, and in a state of diabetic ketoacidosis with some degree of dehydration affecting the function of the kidneys. In a worst case scenario, a person may have become unconscious and comatose. This is a life-threatening condition requiring immediate hospitalization and expert care to get the person's body back to its normal balance.

Ongoing treatment of type 1 diabetes revolves around daily glucose monitoring and control, eating a healthy planned diet, and exercising regularly. Regular exercise lowers blood glucose, increases the body's sensitivity to insulin, and increases circulation.

Type 1 diabetics must self-check their glucose levels and inject themselves with insulin several times a day. As an alternative, a number of type 1 diabetics have turned to wearing insulin pumps, programmable devices that are carried at the waist and provide small amounts of insulin (through a needle under the skin) throughout the day to more closely match normal insulin secretion The amount and type of insulin administered must be adjusted to take into account what the person is eating, the size of their meals, and the amount of activity they are getting. There are several types of insulin available; some are fast-acting and short-lived while others take longer to act but have a longer duration.

Most type 1 diabetics use a combination of insulins to meet their needs, and maintaining control can sometimes be a challenge. Stress, illnesses, and infections can alter the amount of insulin necessary, and some type 1 diabetics have "brittle" control: their glucose levels make rapid swings during the day. As another complicating factor, type 1 diabetics may develop antibodies to insulin over time; their body begins to identify the injections as an "intruder" and works to destroy the insulin, resulting in the necessity of higher doses of insulin or of switching to a different kind.

Type 1 diabetics may also "overshoot," running into trouble with low glucose levels if they inject too much insulin, go extended periods of time without eating, or if their needs change unexpectedly. They must carry glucose with them, in the form of tablets or candy, and be ready to take some at the first signs of low blood sugar (hypoglycemia). Carrying glucagon injections (which stimulate the liver to release glucose) is also recommended for times when a person's hypoglycemia is not responding to oral glucose or for someone else to give them if the person has become unconscious. Acute conditions, such as diabetic ketoacidosis or kidney failure, may require hospitalization to resolve.

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