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Type 1 Diabetes




Type 1 diabetes

General Overview

Diabetes is a disorder in which the body does not produce or properly use insulin (hormone produced by pancreas that regulates glucose in your blood) due to unknown cause. There are three main types of diabetes such as type 1 diabetes, type 2 diabetes, and gestational diabetes. India has approximately 20% of diabetics in the world, with studies showing that more than 40 million people suffering from diabetes in 2007. This number may increase by another 60% in the year 2025, reaching 69.9 million.
Type 1 diabetes is very rare, when compared to type 2 diabetes. Studies have estimated that in India, type 1 diabetes affects around 1% of all those suffering from diabetes. Studies have also shown that type 1 diabetes in India is not mainly due to obesity. In India, one-third of the people with type 1 diabetes are obese, while 10% to 15% are underweight, and the remaining are in the borderline range of normal weight.

Introduction

What is type 1 diabetes?
Type 1 diabetes occurs because the insulin-producing cells (called beta cells) of the pancreas are damaged. People with type 1 diabetes produce little or no insulin, so sugar cannot get into the body's cells for use as energy. This causes blood sugar levels to rise. People with type 1 diabetes must use insulin injections to control their blood sugar.
The damage to the insulin-producing cells in type 1 diabetes occurs over a period of years. However, the symptoms of type 1 diabetes might occur over a period of days to weeks. Type 1 diabetes is the most common form of diabetes in people younger than 20 years of age, but it can occur at any age.
Type 1 diabetes is a type of diabetes, which was initially known as juvenile diabetes or insulin-dependent diabetes. This is a lifelong condition and is commonly diagnosed in children, teens, and younger adults. Type 1 diabetes develops, if your pancreas (abdominal organ that produces digestive enzymes to breakdown the food you eat) is unable to produce sufficient insulin to regulate the blood sugar level. Insulin acts by helping your body to use the glucose for energy and nourishment. You can develop conditions such as hyperglycemia (high blood sugar level), hypoglycemia (low blood sugar level), ketoacidosis (serious medical condition, due to the presence of high levels of ketones [acidic substances] in the blood), and celiac disease (disease of the intestine), if you have type 1 diabetes.
You can also develop serious complications such as:
  • cardiovascular disease (heart disease).
  • retinopathy (blindness).
  • neuropathy (nerve damage).
  • nephropathy (kidney damage).
Type 1 diabetes cannot be cured, but proper and timely treatment can help you to lead a healthy life.

Signs and Symptoms

What are the symptoms of type 1 diabetes?
The symptoms of type 1 diabetes usually develop suddenly and progress quickly. They include:
  • polyuria (increased frequency of urination, especially at night).
  • polydipsia (increased thirst).
  • polyphagia (increased hunger).
  • fatigue or lethargy.
  • weight loss.
  • nausea and vomiting.
  • irritability.
  • eye problems like blurred vision.
  • frequent infections (urinary tract infection or skin infection).

Causes

What causes type 1 diabetes?
The reason why you develop type 1 diabetes is not known. It is generally considered that genetic (family link) and environmental factors (viruses or chemicals) could upset the normal function of your immune system. This causes your immune system to attack and destroy the beta cells of the pancreas (cells that produce insulin). This results in the glucose level in your blood to rise, causing diabetes.

Risk Factors

Find out if you are at risk of developing type 1 diabetes
Type 1 diabetes can occur at any age, but you can develop it before 30 years of age, usually during adolescence. It can equally affect both the sexes. Other risk factors include:
  • Family history of diabetes. Having a parent, sibling with diabetes can increase your risk.
  • Obesity. Being overweight increases your chance of developing type 1 diabetes.
  • Ethnicity. Your risk can increase, if you belong to certain races like northern European and in specific Mediterranean groups (Sardinians) than blacks, Asian, or Hispanic.
  • Other diseases. Your risk can increase, if you have certain autoimmune diseases (a condition where your immune system attacks the body's own tissues) like Grave's disease, Addison's disease, and multiple sclerosis.

Diagnosis and Screening

How is type 1 diabetes diagnosed?
Your doctor will record your medical history and perform a physical examination to check for the presence of any signs of diabetes and high blood sugar. You may also have to undertake some tests to measure the level of glucose in your blood and urine.
Fasting plasma glucose:
This simple blood test is the standard test for diagnosing diabetes. This test is performed to measure the levels of glucose (sugar) in your blood before eating. You should fast for 8 hours before the test to check the sugar level. The sample of blood to be tested will be drawn from a vein in your arm, or a drop is taken from a skin prick, if you are performing a self-check. The normal fasting blood glucose level ranges from 70 mg/dL to 99 mg/dL (3.9 mmol/L to 5.5 mmol/L). The levels ranging between 100 mg/dL to 125 mg/dL (5.6 mmol/L to 6.9 mmol/L), are considered as impaired fasting glucose (prediabetes). You will be diagnosed with diabetes, if your levels measure 126 mg/dL (7.0 mmol/L) and more after two or more testing.
Postprandial blood sugar test:
This simple blood test is the standard test for diagnosing diabetes. The sample of blood to be tested will be drawn from a vein in your arm, or a drop is taken from a skin prick, if you are performing a self-check. This test measures the blood glucose level after eating. You should undertake this test in exactly 2 hours after your last meal. The normal value of blood glucose 2 hours after eating ranges between 70 mg/dL to 145 mg/dL (< 7.9 mmol/L), and values higher than that will indicate diabetes.
Oral glucose tolerance test:
Oral glucose tolerance test (OGTT) is used to diagnose prediabetes and diabetes. This test shows the rate at which the glucose is metabolized from your blood. You should eat a balanced diet for 3 days before OGTT. You should not eat or drink for 8 hours before taking this test. During the test, a solution containing 75 g of glucose is administered.
First, a fasting blood sugar sample is taken. Then, you are asked to quickly drink the glucose solution. The blood is taken at regular intervals of 30 minutes for the next 2 hours. The normal blood glucose values after 2 hours should be less than 140 mg/dL. The value between 140 mg/dL to 200 mg/dL indicates that you have impaired glucose tolerance. This range implies that you have a prediabetic condition, which means you have an increased risk of developing diabetes. Values that are more than 200 mg/dL will indicate that you have diabetes.
Glycosylated hemoglobin or hemoglobin A1c:
This test measures the levels of glycosylated hemoglobin in the blood and helps to monitor your diabetic status. Hemoglobin is a protein, which carries oxygen, is found in the red blood cells. Glucose in the blood binds with hemoglobin to form glycosylated hemoglobin. This test measures the amount of glycosylated hemoglobin, which if present in a higher amount indicates increased levels of glucose in your blood. This test is used to monitor your glucose control, as it can indicate the levels of glucose over the past 120 days on an average. The blood sample is taken from the vein in your arm or from a pinprick on your finger. You do not need any special preparation before the test. The normal range for a person without diabetes is 4% to 6%. Levels higher than normal will indicate that your diabetes control is not sufficient.
Urine glucose test:
This is a commonly used test for screening diabetes. This test measures the amount of glucose in your urine sample. Glucose is usually not found in the urine, and if present in the urine, it is known as glycosuria. The sample of urine is collected in a clean or sterile container. You should collect 1 to 2 ounces of urine for the test.
You may be advised by the doctor not to take certain medicines before the test, as they might interfere with the results. Absence of glucose and very small or non-traceable amount of glucose can be considered normal. Any significant increase of glucose will warrant further diabetic testing.

Treatment

The goal of treatment for type 1 diabetes is to reduce the symptoms, prevent any complications, and to lead a healthy life. This goal can be achieved by medicines (insulin), proper planned diet and weight control, exercise, and regularly monitoring your blood glucose levels.
Insulin:
As your body no longer produces insulin, the first-line of treatment will be to take insulin. Insulin can be taken in different ways and your doctor will advise on the best mode of delivery.
  • Injections. You can take insulin shots using a syringe and needle. Insulin pen can also be used, which looks like a pen having a cartridge of insulin and a needle for its point. This helps in easy carrying of the shots, when compared to traditional syringe and needle.
  • Insulin pump. An insulin pump, which is about the size of a deck of cards, is a device for delivering insulin. You can wear it on a belt or carry it in a pouch or pocket. This device is connected to a catheter (thin, flexible, plastic tube) placed under your skin for delivering insulin 24 hours a day.
  • Insulin jet injector. The jet injector is a device, which looks like a large pen. The injector uses a mechanism to release a tiny stream of insulin, which is forced through your skin under high pressure.
There are also premixed combinations of intermediate- and rapid-acting insulins. Insulin will stay in your body for different lengths of time, depending on the type of insulin you use. Your healthcare provider will prescribe the insulin that is best for you. You may need to take different types of insulin.
What are the different types of insulin?
There are many forms of insulin. The types are differentiated based on the speed, with which they act.
  • Rapid-acting insulin is the fastest acting insulin. It begins to act within 15 minutes of injection and works for around an hour. It is fully used up by 4 to 5 hours. It appears as a clear liquid in a bottle.
  • Short-acting insulin is also called as regular insulin. It takes longer time to start working than rapid-acting insulin and works for 6 hours. So, the person should take these 30 to 45 minutes before taking food. It appears as a clear liquid in a bottle.
  • Intermediate-acting insulin takes longer time to start working in the body but lasting for a longer time. It usually starts acting by around 2 to 4 hours after injection, and will keep working for around 10 to 16 hours. This type of insulin is mixed with a substance, which will help the body absorb the insulin much slower. This insulin has a cloudy appearance due to this mixture, and must be well shaken before use.
  • Long-acting insulin starts to act after 6 to 10 hours and can stay in the body for 20 hours or more. This type of insulin is usually taken in the morning or before bedtime.

Self Care and Lifestyle Change

Your treatment plan should also include controlling your risk factors. These can be done by:
  • Maintaining and regulating your blood glucose, blood pressure, and lipid levels regularly.
  • Following a healthy diet to control your condition. You will be advised to reduce your intake of proteins, salts, fats, and carbohydrate in your diet.
  • Maintaining an active lifestyle, and undertaking exercises. If you are overweight, you will be advised to control and lose weight.
  • Stop smoking.
  • Consult your doctor regularly for screening tests to monitor any complications that might arise.

References

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