Filed under: Diabetes
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesn't make enough insulin.
Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age.
Despite active research, type 1 diabetes has no cure, although it can be managed. With proper treatment, people who have type 1 diabetes can expect to live longer, healthier lives than in the past.
Type 1 diabetes signs and symptoms can come on quickly and may include:
When to see a doctor
Consult your doctor if you're concerned about diabetes or if you notice any type 1 diabetes signs and symptoms.
The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes, their body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.
Whatever the cause, once the islet cells are destroyed, you'll produce little or no insulin. Normally, the hormone insulin helps glucose enter your cells to provide energy to your muscles and tissues. Insulin comes from the pancreas, a gland located just behind the stomach. When everything is working properly, once you eat, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter the body's cells. Insulin lowers the amount of sugar in the bloodstream, and as the blood sugar level drops, so does the secretion of insulin from the pancreas.
The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver converts stored glycogen back to glucose to keep your blood glucose level within a normal range.
In type 1 diabetes, none of this occurs because there's no insulin to let glucose into the cells. So instead of being transported into your cells, sugar builds up in your bloodstream, where it can cause life-threatening complications.
The cause of type 1 diabetes is different from the cause of the more familiar type 2 diabetes. In type 2 diabetes, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin or both.
There aren't many known risk factors for type 1 diabetes, though researchers continue to find new possibilities. Some known risk factors include:
Possible risk factors for type 1 diabetes include:
Some other possible risk factors include if your mother was younger than age 25 when she gave birth to you or if your mother had preeclampsia during pregnancy. Being born with jaundice is a potential risk factor, as is experiencing a respiratory infection just after you were born.
Type 1 diabetes can affect many major organs in your body, including your heart, blood vessels, nerves, eyes and kidneys. Keeping your blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.
Long-term complications of type 1 diabetes develop gradually, over years. The earlier you develop diabetes — and the less controlled your blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.
After you've been diagnosed with type 1 diabetes, you'll need close medical follow-up until your blood sugar level stabilizes and your doctor determines the proper insulin program and appropriate doses of insulin for you. Diabetes care is generally coordinated by a doctor who specializes in hormonal disorders (endocrinologist), but your health care team likely also will include a certified diabetes educator, a nutritionist, a social worker, a doctor who specializes in eye care (ophthalmologist) and a doctor who specializes in foot health (podiatrist).
Once your blood sugar is under control, your endocrinologist likely will recommend checkups every few months. A thorough yearly exam and regular foot and eye exams also are important — especially if your diabetes isn't well controlled, if you have high blood pressure or kidney disease, or if you're pregnant.
Because appointments can be brief and there's often a lot of ground to cover, it's a good idea to be well prepared. Additionally, your appointment may include visits with several members of your health care team as well as your doctor. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor and the rest of your health care team. For type 1 diabetes, topics you want to clarify with your doctor, dietitian or diabetes educator include:
Don't hesitate to ask any other questions that occur to you.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
What you can do in the meantime
If your blood sugar isn't well controlled, or if you're not sure about what to do in a certain situation, don't hesitate to contact your doctor or diabetes educator in between appointments for advice and guidance.
In June 2009, an international committee of experts from the American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation recommended that type 1 diabetes testing include the:
If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes:
If you're diagnosed with diabetes, your doctor will also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help your doctor distinguish between type 1 and type 2 diabetes. The presence of ketones - byproducts from the breakdown of fat — in your urine also suggests type 1 diabetes, rather than type 2.
After the diagnosis
Once you've been diagnosed with type 1 diabetes, you'll regularly visit your doctor to ensure good diabetes management. During these visits, the doctor will check your A1C levels. Your target A1C goal may vary depending on your age and various other factors, but the American Diabetes Association generally recommends that A1C levels be below 7 percent, which translates to an estimated average glucose of 154 mg/dL (8.5 mmol/L).
Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan.
In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function and to test for celiac disease. The doctor will also examine you to assess your blood pressure, and he or she will check the sites where you test your blood sugar and deliver insulin.
Treatment for type 1 diabetes is a lifelong commitment to:
The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. Although there are exceptions, generally, the goal is to keep your daytime blood sugar levels between 80 and 120 mg/dL (4.4 to 6.7 mmol/L) and your bedtime numbers between 100 and 140 mg/dL (5.6 to 7.8 mmol/L).
If managing your diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your blood sugar level as close to normal as possible.
Insulin and other medications
Anyone who has type 1 diabetes needs insulin therapy to survive.
Types of insulin are many and include:
Examples are regular insulin (Humulin R, Novolin R, others), insulin isophane (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog), insulin glargine (Lantus) and insulin detemir (Levemir).
Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.
An inhaled insulin (Exubera) was previously available, but the manufacturer stopped selling the drug because too few people were using it. Since it was taken off the market, this drug has been linked to an increased number of lung cancers in people with a history of smoking. However, because the additional number of lung cancer cases is so small, it's not clear if there's a link to the medication. If you used Exubera and have a history of smoking, discuss these concerns with your doctor.
Injection options to get insulin into your body currently include injection and insulin pump infusion. Insulin can't be taken orally to lower blood sugar because stomach enzymes interfere with insulin's action.
Insulin injections can be done using:
An insulin pump — a device about the size of a cell phone worn on the outside of your body. A tube connects a reservoir of insulin to a catheter that's inserted under the skin of your abdomen. There's also a wireless pump option that's available in most areas. You wear a pod filled with insulin on your body that has a tiny catheter that's inserted under your skin. The insulin pod can be worn on your abdomen, lower back, or on a leg or an arm. The programming is done with a wireless device that communicates with the pod.
Whichever pump you use, it's programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as your basal rate, and it replaces whatever long-acting insulin you were using. When you eat, you program the pump with the amount of carbohydrates you're eating and your current blood sugar, and it will give you what's called a "bolus" dose of insulin to cover your meal and to correct your blood sugar if it's elevated. Some research has found an insulin pump to be more effective at controlling blood sugar levels than injections are.
Oral medications are sometimes prescribed as well, such as:
Healthy eating and counting carbohydrates
Contrary to popular perception, there's no such thing as a diabetes diet. You won't be restricted to a lifetime of boring, bland foods. Instead, you'll need plenty of:
These foods are high in nutrition and low in fat and calories. And they mean fewer animal products and sweets. This is actually the best eating plan, even for people without diabetes.
You'll need to learn how to count the carbohydrates in the foods you eat so that you can give yourself enough insulin to properly metabolize those carbohydrates. A registered dietitian can help you create a meal plan that fits your health goals, food preferences and lifestyle.
Everyone needs regular aerobic exercise, and people who have type 1 diabetes are no exception. Get your doctor's OK to exercise. Then choose activities you enjoy, such as walking, swimming or biking. What's most important is making physical activity part of your daily routine. Aim for at least 30 minutes of aerobic exercise most days of the week. Stretching and strength training exercises are important, too. If you haven't been active for a while, start slowly and build up gradually.
Remember that physical activity lowers blood sugar, often for long after you're done working out. If you begin a new activity, check your blood sugar level more often than usual until you know how that activity affects your blood sugar levels. You might need to adjust your meal plan or insulin doses to compensate for the increased activity. If you use an insulin pump, you can set a temporary basal rate to keep your blood sugar from dropping. Ask your doctor or diabetes educator to show you how.
Blood sugar monitoring
Depending on what type of insulin therapy you select or require — single-dose injections, multiple-dose injections or insulin pump — you may need to check and record your blood sugar level at least four times a day, and probably more. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Be sure to wash your hands before checking your blood sugar levels to get the most accurate reading.
Even if you take insulin and eat on a rigid schedule, the amount of sugar in your blood can change unpredictably. With help from your diabetes treatment team, you'll learn how your blood sugar level changes in response to:
Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar levels, and may be most helpful for people who have developed hypoglycemia unawareness. Continuous glucose monitors attach to the body using a fine needle just under the skin that checks blood glucose level every few minutes. CGM isn't yet considered as accurate as standard blood sugar monitoring, so it's not considered a replacement method for keeping track of blood sugar, but an additional measure.
Certain life circumstances call for different considerations.
Signs of trouble
Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).
Low blood sugar (hypoglycemia). This occurs when your blood sugar level drops below your target range. Ask your doctor what's considered a low blood sugar level for you. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin.
Learn the symptoms of low blood sugar, and test your blood sugar if you think your blood sugar levels are dropping. When in doubt, always do a blood sugar test. Early signs and symptoms of low blood sugar include:
Later signs and symptoms of low blood sugar, which can sometimes be mistaken for alcohol intoxication in teens and adults include:
If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.
If you have a low blood sugar reading, have some fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Then retest your blood sugar in about 15 minutes to make sure it has gone up into the normal range. If it's not in the normal range, re-treat with more sugar (juice, candy, glucose tablets or another source of sugar) and then retest in another 15 minutes. Keep doing this until you get a normal reading. It's a good idea to eat a meal or snack once you've gotten a normal reading. A mixed food source, such as peanut butter and crackers, can help stabilize the blood sugar.
If a blood glucose meter isn't readily available, treat for low blood sugar anyway if you have symptoms of hypoglycemia, and then test as soon as possible.
Always carry a source of fast-acting sugar with you. Left untreated, low blood sugar will cause you to lose consciousness. If this occurs, you may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. Be sure you always have a glucagon emergency kit available — at home, at work, when you're out — and make sure it hasn't expired.
Hypoglycemia unawareness. Some people may lose the ability to sense that their blood sugar levels are coming down, because they've developed a condition known as hypoglycemia unawareness. With hypoglycemia unawareness, the body no longer reacts to a low blood sugar with symptoms such as lightheadedness or headaches. The more you experience low blood sugars, the more likely you are to develop hypoglycemia unawareness. The good news is that if you can avoid having a hypoglycemic episode for several weeks, you may start to become more aware of impending lows.
High blood sugar (hyperglycemia). Your blood sugar can rise for many reasons, including eating too much, eating the wrong types of foods, not taking enough insulin, or illness.
If you suspect hyperglycemia, check your blood sugar. You might need to adjust your meal plan or medications. If your blood sugar is higher than your target range, you'll likely need to administer a "correction" using an insulin shot or through an insulin pump. A correction is an additional dose of insulin that should bring your blood sugar back into the normal range. High blood sugar levels don't come down as quickly as they go up. Ask your doctor how long to wait until you recheck. If you use an insulin pump, random high blood sugar readings may mean you need to change the pump site.
If you have two consecutive blood sugar readings above 250 mg/dL (13.9 mmol/L), test for ketones using a urine test stick. Don't exercise if your blood sugar level is high or if ketones are present. If only a trace or small amounts of ketones are present, drink extra fluids to flush out the ketones.
If your blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your doctor or seek emergency care.
Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat — producing toxic acids known as ketones.
Signs and symptoms of this serious condition include:
If you suspect ketoacidosis, check your urine for excess ketones with an over-the-counter ketones test kit. If you have large amounts of ketones in your urine, call your doctor right away or seek emergency care. Also, call your doctor if you have vomited more than once and you have ketones in your urine.
Type 1 diabetes is a serious disease. Following your diabetes treatment plan takes round-the-clock commitment, which can be frustrating at times. But realize that your efforts are worthwhile. Careful management of type 1 diabetes can reduce your risk of serious — even life-threatening — complications. Consider these tips:
Above all, stay positive. The good habits you adopt today can help you enjoy an active, healthy life with type 1 diabetes.
Living with type 1 diabetes isn't easy. Good diabetes management requires a lot of time and effort, especially in the beginning.
Diabetes can affect your emotions both directly and indirectly. Poorly controlled blood sugar can directly affect your emotions by causing behavior changes, such as irritability. Diabetes may also make you feel different from other people, and there may be times you feel resentful that you always have to incorporate diabetes planning in everything you do.
People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team.
You may find that talking to other people with type 1 diabetes is helpful. There are support groups available both online and in person. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.
Or you can visit the websites of the American Diabetes Association (ADA) or the Juvenile Diabetes Research Foundation (JDRF) for support group information and to check out local activities for people with type 1 diabetes. You can also reach the ADA at 800-DIABETES (800-342-2383) or JDRF at 800-533-CURE (800-533-2873).
There's nothing you could have done to prevent type 1 diabetes; there is currently no known way to prevent the disease.
But researchers are working on preventing type 1 diabetes in people who have a high risk of developing the disease, and others are working on preventing further destruction of the islet cells in people who are newly diagnosed. Ask your doctor if you might be eligible for one of these trials, but carefully weigh the risks and benefits of any treatment available in a clinical trial. You can find more information on the types of research being done from TrialNet, a collaboration of diabetes researchers. TrialNet is also conducting a natural history study to check for diabetes genes in parents, children and siblings of people with type 1 diabetes.
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