Type 1 Diabetes

Type 1 diabetes, formerly called insulin-dependent diabetes mellitus or "juvenile" diabetes, is an autoimmune disorder. The body's immune system mistakenly attacks and destroys the insulin-producing cells (beta cells) in the pancreas. As a result, the body does not produce insulin, cells don't get the glucose they need, causing a build-up of glucose in the blood (high blood sugar). A complication of this is diabetic ketoacidosis, a condition in which the glucose level is very high and acid builds up in the body.

Type 1 diabetes affects about 5% of people with diabetes. Type 1 diabetes usually develops in children and teenagers which is why it used to be called juvenile-onset diabetes, though adults can also be diagnosed.

Type 1 diabetes is caused by the body's immune system attacking and destroying certain cells in the pancreas that produce insulin (beta cells) which means people with type 1 diabetes cannot make their own insulin.

Genetics are a major cause for developing type 1 diabetes. In most cases, both parents need to pass on certain genes in order for a child to develop type 1 diabetes. A type of gene variant called a human leukocyte antigen (HLA) is the major gene linked to a higher risk for developing type 1 diabetes, specifically the variants HLA-DQA1, HLA-DQB1, and HLA-DRB1.

Environmental factors combined with a genetic predisposition seem to affect whether a person could develop type 1 diabetes, such as:

• Cold weather: Type 1 diabetes is diagnosed more often in winter, and is more common in colder climates.
• Viruses: Certain viruses may trigger type 1 diabetes in those susceptible.
• Breastfeeding: Infants who are breastfed are less likely to develop type 1 diabetes.
• Early diet of solid foods: Children who eat solid foods at earlier ages may be at higher risk.

Symptoms of type 1 diabetes are similar in men, in women, and in children. Common symptoms and signs of type 1 diabetes include:

• Frequent urination
• Extreme thirst or hunger
• Extreme fatigue
• Blurred vision
• Slow wound healing
• Nausea, vomiting, abdominal pain
• Weight loss (even if you are eating more)
• Mood changes
• Fast heart rate
• Headache
• Sleepiness
• Sweating
• Changes in menstruation
• Blood pressure drops below 90/60
• Low body temperature (below 97F)

People with type 1 diabetes also need to be careful of abnormally low blood sugar (hypoglycemia), which can be a medical emergency. Symptoms of hypoglycemia may come about rapidly and include:

• Shaking
• Anxiety
• Chills
• Irritability or mood changes
• Confusion
• Lightheadedness or dizziness
• Tingling or numbness in the lips or tongue
• Nausea
• Slurred speech
• Weakness
• Lack of coordination
• Seizures
• Unconsciousness

Type 1 diabetes (formerly called juvenile-onset or insulin-dependent diabetes) is an autoimmune disorder in which the body cannot produce insulin on its own, while type 2 diabetes (formerly called adult-onset or non-insulin-dependent diabetes) the body produces insulin but is unable to use it properly (a condition called insulin resistance).

In type 1 diabetes symptoms can be serious, and the disease starts in childhood or in young adulthood. In type 2 diabetes there may be no symptoms and the disease is usually diagnosed in adults age 35 and older, though children can also develop it.

In type 1 diabetes, low blood sugar episodes (hypoglycemia) occur frequently. In type 2 diabetes episodes of low blood sugar levels (hypoglycemia) are very rare, unless a person is taking insulin or other anti-diabetic medications.

Type 1 diabetes cannot be prevented. Type 2 diabetes is preventable with a healthy lifestyle that includes a balanced diet, maintaining a healthy weight, and getting regular exercise.

Type 1 diabetes treatment requires insulin along with lifestyle changes. Insulin may be taken in several injections each day, or via an insulin pump. Different types of insulin vary in how they are made, how quickly they work in the body, when they peak, how long they last, and how much they cost. The most common strength in the U.S. is U-100, which means it has 100 units of insulin per milliliter of fluid.

• Rapid-acting insulin: Taken before a meal, works in about 15 minutes, lasts 2-4 hours, Helps cover the rise in blood glucose from eating. Usually used along with longer-acting insulin. Examples: insulin glulisine (Apidra), insulin lispro (Humalog), insulin aspart (NovoLog)
• Short-acting insulin (or regular insulin): Taken before a meal, works in about 30 minutes, peaks around 2 to 3 hours, effective for 3 to 6 hours. Usually used along with longer-acting insulin. Examples: Humulin R, Novolin R
• Intermediate acting insulin: Reaches the bloodstream about 2 to 4 hours after injection, peaks 4 to 12 hours afterwards, effective for 12 to 18 hours. Normally taken twice daily, intermediate-acting insulin is usually taken in combination with rapid-acting insulin or short-acting insulin. Examples: NPH (Humulin N, Novolin N)
• Long-acting insulin: Usually taken once or twice daily, reaches the bloodstream in several hours, evenly lowers blood glucose levels over a 24-hour period. Often combined with rapid-acting insulin or short-acting insulin. Examples: insulin detemir (Levemir), insulin glargine (Lantus)

Some patients use an insulin pump, which is a small computerized device that delivers insulin to the body either in a programmed and continuous dose ("basal" insulin), or in a surge dose ("bolus") taken as needed, usually around meals. A catheter is inserted through the skin into fatty tissue, and taped in place and the insulin is pumped through it.

• Monitor blood sugar levels
• Eat a healthy diet
• Regular exercise
• Avoid alcohol
• Don't smoke
• Have regular medical checkups

There is no cure for type 1 diabetes and it cannot be reversed. However, it can be managed. Patients need to control their blood sugar with insulin, other diabetes medication if needed, weight loss (or maintaining a healthy weight), healthy eating, and exercise. These lifestyle changes will help control blood sugar levels and reduce the risk of developing complications from the disease.

The diet for type 1 diabetes is one that includes a variety of fruits, vegetables, whole grains, beans and legumes, poultry, fish, and non-fat dairy. Avoid processed, sugary, and fatty foods. Monitor portion sizes so you don't overeat.

Meal planning is important for people with type 1 diabetes so they can manage blood sugar levels between the foods they eat and insulin they take.

Some meal planning tools the American Diabetes Association recommends include:

• The plate method: Include larger portions of non-starchy veggies and smaller portions of starchy foods and protein on your plate.
• Carbohydrate (or carb) counting: You and your doctor figure out the amount of carbs you can have each day, and set a maximum limit of carbohydrates for each meal, taking into account physical activity and any medications.
• Glycemic index (GI): GI measures how carbohydrate-containing foods can raise blood glucose. Choose foods with low to medium GI.

Type 1 diabetes cannot be prevented. However, managing blood sugar levels can help prevent complications.

When left unchecked or poorly managed for long periods of time, type 1 diabetes can lead to serious complications such as heart disease, stroke, high blood pressure, kidney disease, diabetic retinopathy (which can lead to blindness), and Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). Other complications include nerve damage (neuropathy), diabetic ketoacidosis, gastroparesis, skin infection, glaucoma, and cataracts.

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