Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.
Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1
There are several forms of diabetes. Type 1 diabetes used to be called juvenile or insulin-dependent diabetes. Type 1 diabetes can occur at any age, but it is most often diagnosed in children, adolescents, or young adults.
Insulin is a hormone produced by special cells, called beta cells, in the pancreas, an organ located in the area behind your stomach. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used for energy. In type 1 diabetes, these cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy. This leads to the symptoms of type 1 diabetes.
Within 5 - 10 years, the insulin-producing beta cells of the pancreas are completely destroyed and the body can no longer produce insulin.
The exact cause is unknown, but most likely there is a viral or environmental trigger in genetically susceptible people that causes an immune reaction. The body's white blood cells mistakenly attack the insulin-producing pancreatic beta cells.
Some people will have no symptoms before they are diagnosed with diabetes.
Others may notice these symptoms as the first signs of type 1 diabetes, or when the blood sugar is high:
For others, warning symptoms that they are becoming very sick may be the first signs of type 1 diabetes, or may happen when the blood sugar is very high (see: diabetic ketoacidosis):
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms typically appear when the blood sugar level falls below 70 mg/dL. Watch for:
Diabetes is diagnosed with the following blood tests:
Ketone testing is also used in type 1 diabetes. Ketones are produced by the breakdown of fat and muscle. They are harmful at high levels. The ketone test is done using a urine sample. Ketone testing is usually done at the following times:
The following tests will help you and your doctor monitor your diabetes and prevent complications of diabetes:
The immediate goals of treatment are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can come on suddenly and the symptoms can be severe, newly diagnosed people may need to stay in the hospital.
The long-term goals of treatment are to:
You are the most important person in managing your diabetes. You should know the basic steps to diabetes management:
Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone needs insulin. People with type 1 diabetes can't make their own insulin. They must take insulin every day.
Insulin is usually injected under the skin. In some cases, a pump delivers the insulin continuously. Insulin does not come in pill form.
Insulin preparations differ in how fast they start to work and how long they last. The health care professional will review your blood glucose levels to determine the appropriate type of insulin you should use. More than one type of insulin may be mixed together in an injection to achieve the best blood glucose control.
The injections are needed, in general, from one to four times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator. At first, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.
People with diabetes need to know how to adjust the amount of insulin they are taking in the following situations:
People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. (See: Diabetes diet)
The American Diabetes Association and the American Dietetic Association have information for planning healthy, balanced meals. It can help to talk with a registered dietitian or nutrition counselor.
Regular exercise helps control the amount of sugar in the blood. It also helps burn excess calories and fat to achieve a healthy weight.
Ask your health care provider before starting any exercise program. Those with type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.
Self-testing refers to being able to check your blood sugar at home yourself. Regular self-testing of your blood sugar tells you and your health care provider how well your diet, exercise, and diabetes medications are working. This is also called self-monitoring of blood glucose, or SMBG.
A health care provider or diabetes educator will help set up a testing schedule for you at home.
Testing will provide valuable information so the health care provider can suggest improvements to your care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.
A device called a glucometer can provide a blood sugar reading. There are different types of devices. Usually, you prick your finger with a small needle called a lancet to get a tiny drop of blood. You place the blood on a test strip and put the strip into the device. You should have results within 30 - 45 seconds.
Keeping accurate records of your test results will help you and your health care provider plan how to best control your diabetes.
The American Diabetes Association recommends keeping blood sugar levels in a range that is based on your age. Discuss these goals with your physician and diabetes educator.
Diabetes causes damage to the blood vessels and nerves. This can reduce your ability to feel injury to or pressure on the foot. You may not notice a foot injury until severe infection develops. Diabetes can also damage blood vessels. Small sores or breaks in the skin may progress to deeper skin ulcers. Amputation of the affected limb may be needed when these skin ulcers do not improve or become larger or deeper.
To prevent problems with your feet, you should:
See: Diabetes foot care.
TREATING LOW BLOOD SUGAR
Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70 mg/dL. If you have symptoms:
Ask your doctor if you need a glucagon injection kit to raise blood sugar quickly in an emergency.
MEDICATIONS TO PREVENT COMPLICATIONS
Your doctor may prescribe medications to reduce your chances of developing eye disease, kidney disease, and other conditions that are more common in people with diabetes.
An ACE inhibitor (or ARB) is often recommended as the first choice for those with high blood pressure and those with signs of kidney disease. ACE inhibitors include:
Statin drugs are usually the first choice to treat an abnormal cholesterol level. Aim for an LDL cholesterol level of less than 100 mg/dL (less than 70 mg/dL in high-risk patients).
Aspirin to prevent heart disease is most often recommended for people with diabetes who:
TREATING HIGH KETONES
For additional information and resources, see diabetes support group.
Diabetes is a lifelong disease for which there is not yet a cure. However, the outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, nervous system, and heart in type 1 diabetes. However, complications may occur even in those with good diabetes control.
After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, and other areas in your body.
If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
In general, complications include:
Other complications include:
If you are newly diagnosed with type 1 diabetes, you should probably have medical follow-up weekly until you have good control of blood glucose. Your health care provider will review the results of home glucose monitoring and urine testing. The provider will also look at your diary of meals, snacks, and insulin injections.
As the disease becomes more stable, follow-up visits will be less often. Visiting your health care provider is very important for monitoring possible long-term complications from diabetes.
Call 911 if you have:
Call your health care provider or go to the emergency room if you have these symptoms of ketoacidosis:
Also call your doctor if you have:
You can treat early signs of hypoglycemia at home by eating sugar or candy or taking glucose tablets. If your signs of hypoglycemia continue or your blood glucose levels stay below 60 mg/dL, go to the emergency room.
Currently, there is no way to prevent type 1 diabetes. There is no effective screening test for type 1 diabetes in people with no symptoms.
To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having.
Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.
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American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010. 33 Suppl 1:S62-S69.
American Diabetes Association. Standards of medical care in diabetes -- 2010. Diabetes Care. 2010. 33 Suppl 1:S11-S61.
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 31.