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by Wood D

Type 1 Diabetes

(Insulin Dependent Diabetes Mellitus; Juvenile-Onset Diabetes; Ketosis-Prone Diabetes; "Brittle" Diabetes; Diabetes Mellitus Type 1; Diabetes, Type 1)

Definition

Diabetes is a higher level of glucose in the blood than is normal. Glucose travels through the body in the blood. A hormone called insulin then helps glucose move from the blood to the cells. Once glucose is in the cells it can be used for energy. A problem making or using insulin means glucose cannot move into cells. Insulin also helps glucose to move into the liver for storage if there is too much to use. Without enough insulin, glucose will build up in the blood.
In type 1 diabetes, the body does not make insulin. This will lead to the build up of glucose in the blood, also called hyperglycemia. At the same time, cells are not getting glucose they need to function well. Over a long period of time high blood glucose levels can also damage vital organs. The blood vessels, heart, kidneys, eyes, and nerves are most commonly affected organs.
Type 1 diabetes is often found during childhood and young adulthood.

Causes

Our immune system keeps us well by fighting off and destroying viruses and bacteria. Unfortunately, sometimes the immune system attacks healthy tissue. Most type 1 diabetes develop because the immune system attacks and destroys the cells that make insulin. These cells are in the pancreas.
It is not yet clear why the immune system attacks these cells. It is believed that some people have genes that make them prone to getting diabetes. For these people, certain triggers in the environment may make the immune system attack the pancreas. The triggers are not known but may be certain viruses, foods, or chemicals.
Type 1 diabetes may also develop as a complication of other medical conditions. It may develop in:
The Pancreas
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Risk Factors

Type 1 diabetes is more common in males. It can start at any age but most commonly children and adolescents. Other factors that may increase your chance of type 1 diabetes include:

Symptoms

Type 1 diabetes may cause:
  • Increased urination
  • Extreme thirst
  • Hunger
  • Weight loss
  • Fatigue, weakness
  • Blurry vision
  • Irritability
  • Headaches
Without insulin, the body will need to find new forms of energy. This will cause an imbalance in the body called ketoacidosis. It is a severe state that can lead to coma or death. Ketoacidosis may cause:
  • Dry skin and mouth
  • Dehydration
  • Rapid pulse
  • Low blood pressure
  • Fruity breath odor
  • Vomiting and nausea
  • Abdominal pain
  • Drowsiness
  • Abnormally deep and fast breathing
  • Coma

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Type 1 diabetes is diagnosed based on the results of blood tests and other criteria. These include:
  • Symptoms common with diabetes and a random blood test showing a blood sugar level greater than or equal to 200 mg/dL* (11.1 mmol/L)
  • Fasting blood test showing blood glucose levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days—test is done after you have not eaten for eight or more hours
  • Glucose tolerance test results with blood glucose greater than or equal to 200 mg/dL (11.1 mmol/L)—test is done after you eat glucose
  • HbA1c level of 6.5% or higher—measure of blood sugar over the past 2-4 months
*mg/dL = milligrams per deciliter of blood, mmol/L = millimole per liter of blood
You may also need blood tests to confirm diabetes is type 1 and not type 2. These may include:
  • Insulin level or C-peptide tests—to see how much insulin is being made by the pancreas
  • Tests that look for antibodies that are working against your pancreas
You may also need other blood tests, including.

Treatment

Diabetes treatment goal is to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.
While diabetes makes blood glucose levels too high, treatment can make blood glucose levels go too low. This is called hypoglycemia. It can cause confusion, shakiness, anxiety, heart palpitations and more. If the levels fall too low it can cause seizures and loss of consciousness.
Medication and diet will be adjusted to prevent hyperglycemia and keep the risk of hypoglycemia low.

Insulin

Insulin injections replace the insulin that is missing. The amount given is based on individual need and a blood glucose test that is taken before and after meals and at bedtime. Insulin shots will be needed 2 or more times daily. There is one short-acting inhaled insulin which may be available for select persons.
An insulin pump can automatically deliver small amounts of insulin through the day.
Insulin may be available in inhaled forms.

Pramlintide

Amylin is made in the pancreas along with insulin. In people with type 1 diabetes, this hormone, like insulin, is missing. The missing amylin may be responsible for the blood glucose rise after a meal in people with diabetes. The drug pramlintide may be used in adults when insulin therapy is not enough to control blood sugar.

Glucagon

Glucagon can be injected to quickly increase blood glucose level. People with type 1 diabetes should always have an emergency supply available in case of hypoglycemia.
A medical alert ID can let others know of the condition if communication is impacted.

Other Medications

If not controlled by diet and exercise, medications may be needed to control blood pressure and cholesterol.
Vaccinations will be needed. Some may be needed earlier in children with diabetes.

Diet

Meet often with a registered dietitian. Generally speaking, it is best to:
  • Follow a well-balanced meal plan with a variety of food groups.
  • Eat at regular times each day. Include a bedtime snack. Do not skip meals
  • Avoid highly refined carbohydrates. This includes sugar or high fructose products like soda.

Exercise

Exercise is encouraged as long as blood glucose levels are under control. The doctor will advise activity levels and changes that may need to be made.
The insulin dose or diet may need to be adjusted if glucose levels are low after exercise.

Blood Sugar Testing

Regular blood glucose checks throughout the day will help manage diabetes. Testing is often done with a blood glucose monitor. Continuous monitoring systems that are worn all day are also available.
Keep a record of the results to show the doctor. The treatment plan may change based on test results. The HbA1c blood test is also used by the doctor to assess overall glucose control.

Pancreatic Islet Cell Transplant

This is a procedure that is still being investigated. It involves transplanting islet cells from a donor to a person with type 1 diabetes. After the transplant, these new cells are able to produce insulin. In some cases, people who receive these transplants may no longer need insulin injections.

Closed-Loop Artificial Pancreas

This device is still being studied and developed. It is a continuous glucose monitoring system (CGMS). This system can automatically checks glucose levels through the day. Insulin is then delivered as needed through the day and night. The monitoring system will help keep blood sugar levels within the normal range without daily testing or injections.

Pancreatic Transplant

A pancreatic transplant may be advised if:
  • Severe kidney disease requires a kidney transplant
  • Acute diabetic complications or emergencies can not be prevented by insulin
  • Severe problems occur due to injecting large amounts of insulin
  • Severe and frequent complications related to diabetes occur, such as severe recurrent hypoglycemia

Counseling

Depression can undermine recovery and increase the risk of other complications. Feelings of sadness, hopelessness, and loss of interest in activities that last for at least 2 weeks should prompt a call to the doctor. Depression is treatable. Counseling can help better manage depression and diabetes.

Complications

Over a long period of time, high blood glucose levels can damage vital organs. The risk of complications increases with increasingly poor control

Common complications

Diabetes can also increase the risk of heart disease.

Decreasing Risk of Complications

Maintaining goal blood glucose and HbA1c levels according to the doctors recommendations is the first step to lowering the risk of these complications. Other steps:
  • Practice good footcare. Be on the lookout for any sores or irritated areas. Keep the feet dry and clean.
  • Get yearly eye exams.
  • Don't smoke. If you do, look for programs or products that can help you quit.
  • Keep track of moods and be alert for persistent depressive symptoms.
  • Plan medical visits as recommended.

Prevention

There are no current guidelines to prevent type 1 diabetes.
Some research is looking at the effectiveness of suppressing the immune system. This may be helpful in people who are at high risk of developing type 1 diabetes.

RESOURCES

American Diabetes Association
http://www.diabetes.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov

CANADIAN RESOURCES

Canadian Diabetes Association
http://www.diabetes.ca
Public Health Agency of Canada
http://www.phac-aspc.gc.ca

References

Type 1 Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-1-diabetes. Updated July 2017. Accessed August 25, 2017.
Diabetes. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/diabetes/home/index.html. Updated July 23, 2017. Accessed August 25, 2017.
Diabetes type 1. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116244/Diabetes-mellitus-type-1. Updated August 29, 2016. Accessed August 25, 2017.
Traina AN, Kane MP. Primer on pramlintide, an amylin analog. Diabetes Educ. 2011;37(3):426-431.
Type 1 diabetes. American Diabetes Association website. Available at: http://www.diabetes.org/diabetes-basics/type-1/?loc=DropDownDB-type1. Accessed September 19, 2017.
9/23/2008 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116244/Diabetes-mellitus-type-1: The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359(14):1464-1476.
3/12/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116244/Diabetes-mellitus-type-1: Cardwell CR, Stene LC, Joner G, et al. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia. 2010;53(4):641-651.
4/1/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116244/Diabetes-mellitus-type-1: Verbeeten KC, Elks CE, Daneman D, Ong KK. Association between childhood obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis. Diabet Med. 2011;28(1):10-18.
9/11/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116244/Diabetes-mellitus-type-1: Tovote KA, Fleer J, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37(9):2427-2434.

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