Overview Of Type 1 Diabetes
Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood. In this form of diabetes, specialized cells in the pancreas called beta cells stop producing insulin. Insulin controls how much glucose (a type of sugar) is passed from the blood into cells for conversion to energy. Lack of insulin results in the inability to use glucose for energy or to control the amount of sugar in the blood.
Type 1 diabetes can occur at any age, from early childhood to late adulthood. The first signs and symptoms of the disorder are caused by high blood sugar and may include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet, and weight loss. These symptoms may recur during the course of the disorder if blood sugar is not well controlled by insulin replacement therapy. Improper control can also cause blood sugar levels to become too low (hypoglycemia). This may occur when the body’s needs change, such as during exercise or if eating is delayed. Hypoglycemia can cause headaches, dizziness, hunger, shaking, sweating, weakness, and agitation.
Uncontrolled type 1 diabetes can lead to a life-threatening complication called diabetic ketoacidosis. Without insulin, cells cannot take in glucose. A lack of glucose in cells prompts the liver to try to compensate by releasing more glucose into the blood, and blood sugar can become extremely high. The cells, unable to use the glucose in the blood for energy, respond by using fats instead. Breaking down fats to obtain energy produces waste products called ketones, which can build up to toxic levels in people with type 1 diabetes, resulting in diabetic ketoacidosis. Affected individuals may begin breathing rapidly; develop a fruity odor in the breath; and experience nausea, vomiting, facial flushing, stomach pain, and dryness of the mouth (xerostomia). In severe cases, diabetic ketoacidosis can lead to coma and death.
Over many years, the chronic high blood sugar associated with diabetes may cause damage to blood vessels and nerves, leading to complications affecting many organs and tissues. The retina, which is the light-sensitive tissue at the back of the eye, can be damaged (diabetic retinopathy), leading to vision loss and eventual blindness. Kidney damage (diabetic nephropathy) may also occur and can lead to kidney failure and end-stage renal disease (ESRD). Pain, tingling, and loss of normal sensation (diabetic neuropathy) often occur, especially in the feet. Impaired circulation and absence of the normal sensations that prompt reaction to an injury can result in permanent damage to the feet; in severe cases, the damage can lead to amputation. People with type 1 diabetes are also at increased risk of heart attacks, strokes, and problems with urinary and sexual function.
Commonly Associated With
Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes – type 1; High blood sugar – type 1 diabetes; T1D; autoimmune diabetes; diabetes mellitus type 1; type 1 diabetes mellitus
Causes Of Type 1 Diabetes
Type 1 diabetes can occur at any age. It is most often diagnosed in children, adolescents, or young adults.
Insulin is a hormone produced in the pancreas by special cells, called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. With type 1 diabetes, beta cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. This buildup of glucose in the blood is called hyperglycemia. The body is unable to use glucose for energy. This leads to the symptoms of type 1 diabetes.
The exact cause of type 1 diabetes is unknown. Most likely, it is an autoimmune disorder. This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1 diabetes, an infection or another trigger causes the body to mistakenly attack the beta cells in the pancreas that make insulin. The tendency to develop autoimmune diseases, including type 1 diabetes, can be inherited from your parents.
The causes of type 1 diabetes are unknown, although several risk factors have been identified. The risk of developing type 1 diabetes is increased by certain variants of the HLA-DQA1, HLA-DQB1, and HLA-DRB1 genes. These genes provide instructions for making proteins that play a critical role in the immune system. The HLA-DQA1, HLA-DQB1, and HLA-DRB1 genes belong to a family of genes called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body’s own proteins from proteins made by foreign invaders such as viruses and bacteria.
Type 1 diabetes is generally considered to be an autoimmune disorder. Autoimmune disorders occur when the immune system attacks the body’s own tissues and organs. For unknown reasons, in people with type 1 diabetes, the immune system damages the insulin-producing beta cells in the pancreas. Damage to these cells impairs insulin production and leads to the signs and symptoms of type 1 diabetes.
HLA genes, including HLA-DQA1, HLA-DQB1, and HLA-DRB1, have many variations, and individuals have a certain combination of these variations, called haplotype. Certain HLA haplotypes are associated with a higher risk of developing type 1 diabetes, with particular combinations of HLA-DQA1, HLA-DQB1, and HLA-DRB1 gene variations resulting in the highest risk. These haplotypes seem to increase the risk of an inappropriate immune response to beta cells. However, these variants are also found in the general population, and only about 5 percent of individuals with the gene variants develop type 1 diabetes. HLA variations account for approximately 40 percent of the genetic risk for the condition. Other HLA variations appear to be protective against the disease. Additional contributors, such as environmental factors and variations in other genes, are also thought to influence the development of this complex disorder.
Symptoms Of Type 1 Diabetes
HIGH BLOOD SUGAR
The following symptoms may be the first signs of type 1 diabetes. Or, they may occur when blood sugar is high.
- Being very thirsty
- Feeling hungry
- Feeling tired all the time
- Having blurry eyesight
- Feeling numbness or tingling in your feet
- Losing weight despite an increased appetite
- Urinating more often (including urinating at night or bedwetting in children who were dry overnight before)
For other people, these serious warning symptoms may be the first signs of type 1 diabetes. Or, they may happen when blood sugar is very high (diabetic ketoacidosis):
- Deep, rapid breathing
- Dry skin and mouth
- Flushed face
- Fruity breath odor
- Nausea and vomiting; inability to keep down fluids
- Stomach pain
LOW BLOOD SUGAR
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms usually appear when a person’s blood sugar level falls below 70 milligrams per deciliter (mg/dL), or 3.9 mmol/L.
- Nervousness, irritability
- Rapid heartbeat (palpitations)
After many years, diabetes can lead to serious health problems, and as a result, many other symptoms.
Exams & Tests
Diabetes is diagnosed with the following blood tests:
- Fasting blood glucose level — Diabetes is diagnosed if it is 126 mg/dL (7 mmol/L) or higher two different times.
- Random (non-fasting) blood glucose level — You may have diabetes if it is 200 mg/dL (11.1 mmol/L) or higher, and you have symptoms such as increased thirst, urination, and fatigue. (This must be confirmed with a fasting test.)
- Oral glucose tolerance test — Diabetes is diagnosed if the glucose level is 200 mg/dL (11.1 mmol/L) or higher 2 hours after you drink a special sugar drink.
- Hemoglobin A1C (A1C) test — Diabetes is diagnosed if the result of the test is 6.5% or higher.
Ketone testing is also used sometimes. The ketone test is done using a urine sample or blood sample. Ketone testing may be done to determine if someone with type 1 diabetes has had ketoacidosis.
Testing is usually done:
- When the blood sugar is higher than 240 mg/dL (13.3 mmol/L)
- During an illness such as pneumonia, heart attack, or stroke
- When nausea and vomiting occur
- During pregnancy
The following exams and tests will help you and your health care provider monitor your diabetes and prevent problems caused by diabetes:
- Check the skin and bones on your feet and legs.
- Check if your feet are getting numb (diabetic nerve disease).
- Have your blood pressure checked at least once a year. The goal should be 140/90 mmHg or lower.
- Have an A1C test done every 6 months if your diabetes is well controlled? Have the test done every 3 months if your diabetes is not well controlled?
- Have your cholesterol and triglyceride levels checked once a year.
- Get tests once a year to make sure your kidneys are working well. These tests include checking levels of microalbuminuria and serum creatinine.
- Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease.
- See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Treatment Of Type 1 Diabetes
Because type 1 diabetes can start quickly and the symptoms can be severe, people who have just been diagnosed may need to stay in the hospital.
If you have just been diagnosed with type 1 diabetes, you may need to have a checkup each week until you have good control over your blood sugar. Your provider will review the results of your home blood sugar monitoring and urine testing. Your doctor will also look at your diary of meals, snacks, and insulin injections. It may take a few weeks to match the insulin doses to your meal and activity schedules.
As your diabetes becomes more stable, you will have fewer follow-up visits. Visiting your provider is very important so you can monitor any longterm problems from diabetes.
Your provider will likely ask you to meet with a dietitian, clinical pharmacist, and certified diabetes care and education specialist (CDCES). These providers will also help you manage your diabetes.
But, you are the most important person in managing your diabetes. You should know the basic steps of diabetes management, including:
- How to recognize and treat low blood sugar (hypoglycemia)
- How to recognize and treat high blood sugar (hyperglycemia)
- How to plan meals, including carbohydrate (carb) counting
- How to give insulin
- How to check blood glucose and urine ketones
- How to adjust insulin and food when you exercise
- How to handle sick days
- Where to buy diabetes supplies and how to store them
Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone with type 1 diabetes must take insulin every day.
Most commonly, insulin is injected under the skin using a syringe, insulin pen, or insulin pump. Another form of insulin is the inhaled type. Insulin cannot be taken by mouth because the acid in the stomach destroys insulin.
Insulin types differ in how fast they start to work and how long they last. Your provider will choose the best type of insulin for you and will tell you at what time of day to use it. Some types of insulin may be mixed together in an injection to get the best blood glucose control. Other types of insulin should never be mixed.
Most people with type 1 diabetes need to take two kinds of insulin. Basal insulin is long-lasting and controls how much sugar your own body makes when you are not eating. Meal-time (nutritional) insulin is rapid-acting and is taken with every meal. It lasts only long enough to help move the sugar absorbed from a meal into muscle and fat cells for storage.
Your provider or diabetes educator will teach you how to give insulin injections. At first, a child’s injections may be given by a parent or another adult. By age 14, most children can give themselves their own injections.
Inhaled insulin comes as a powder that is breathed in (inhaled). It is rapid-acting and used just before each meal. Your provider can tell you if this type of insulin is right for you.
People with diabetes need to know how to adjust the amount of insulin they are taking:
- When they exercise
- When they are sick
- When they will be eating more or less food and calories
- When they are traveling
HEALTHY EATING AND EXERCISE
By testing your blood sugar level, you can learn which foods and activities raise or lower your blood sugar level the most. This helps you adjust your insulin doses to specific meals or activities to prevent blood sugar from becoming too high or too low.
The American Diabetes Association and the Academy of Nutrition and Dietetics have information for planning healthy, balanced meals. It also helps to talk to a registered dietitian or nutrition counselor.
Regular exercise helps control the amount of sugar in the blood. It also helps burn extra calories and fat to reach and maintain a healthy weight.
Talk to your provider before starting any exercise program. People with type 1 diabetes must take special steps before, during, and after physical activity or exercise.
MANAGING YOUR BLOOD SUGAR
Checking your blood sugar level yourself and writing down the results tells you how well you are managing your diabetes. Talk to your provider and diabetes educator about how often to check.
To check your blood sugar level, you use a device called a glucose meter. 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 meter. The meter gives you a reading that tells you the level of your blood sugar.
Continuous glucose monitors measure your blood sugar level from fluid under your skin. These monitors are used mostly by people who are on insulin pumps to control their diabetes. Some monitors do not require a finger prick.
Keep a record of your blood sugar for yourself and your health care team. These numbers will help if you have problems managing your diabetes. You and your provider should set a target goal for your blood sugar level at different times during the day. You should also plan what to do when your blood sugar is too low or high.
Talk to your provider about your target for the A1C test. This lab test shows your average blood sugar level over the past 3 months. It shows how well you are controlling your diabetes. For most people with type 1 diabetes, the A1C target should be 7% or lower.
Low blood sugar is called hypoglycemia. A blood sugar level below 70 mg/dL (3.9 mmol/L) is too low and can harm you. A blood sugar level below 54 mg/dL (3.0 mmol/L) is cause for immediate action. Keeping good control of your blood sugar can help prevent low blood sugar. Talk to your provider if you’re not sure about the causes and symptoms of low blood sugar.
People with diabetes are more likely than those without diabetes to have foot problems. Diabetes damages the nerves. This can make your feet less able to feel pressure, pain, heat, or cold. You may not notice a foot injury until you have severe damage to the skin and tissue below, or you get a severe infection.
Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal, or become larger, deeper, or infected.
To prevent problems with your feet:
- Stop smoking, if you smoke.
- Improve control of your blood sugar.
- Get a foot exam at least twice a year from your provider, and learn whether you have nerve damage.
- Ask your provider to check your feet for problems such as calluses, a bunion or hammertoe. These need to be treated to prevent skin breakdown and ulcers.
- Check and care for your feet every day. This is very important when you already have nerve or blood vessel damage or foot problems.
- Treat minor infections, such as athlete’s foot, right away.
- Good nail care is important. If your nails are very thick and hard, you should have your nails trimmed by a podiatrist or other provider who knows you have diabetes.
- Use moisturizing lotion on dry skin.
- Make sure you wear the right kind of shoes. Ask your provider what kind is right for you.
Your provider may prescribe medicines or other treatments to reduce your chances of developing common complications of diabetes, including:
- Eye disease
- Kidney disease
- Peripheral nerve damage
- Heart disease and stroke
- With type 1 diabetes, you are also at risk of developing conditions such as hearing loss, gum disease, bone disease, or yeast infections (in women). Keeping your blood sugar under good control can help prevent these conditions.
Talk with your health care team about other things you can do to lower your chances of developing diabetes complications.
People with diabetes should make sure to keep up on their vaccination schedule.
Living with diabetes can be stressful. You may feel overwhelmed by everything you need to do to manage your diabetes. But taking care of your emotional health is just as important as your physical health.
Ways to relieve stress include:
- Listening to relaxing music
- Meditating to take your mind off your worries
- Deep breathing to help relieve physical tension
- Doing yoga, taichi, or progressive relaxation
- Feeling sad or down (depressed) or anxious sometimes is normal. But if you have these feelings often and they’re getting in the way of managing your diabetes, talk with your health care team. They can find ways to help you feel better.
Type 1 diabetes occurs in 10 to 20 per 100,000 people per year in the United States. By age 18, approximately 1 in 300 people in the United States develop type 1 diabetes. The disorder occurs with similar frequencies in Europe, the United Kingdom, Canada, and New Zealand. Type 1 diabetes occurs much less frequently in Asia and South America, with reported incidences as low as 1 in 1 million per year. For unknown reasons, during the past 20 years, the worldwide incidence of type 1 diabetes has been increasing by 2 to 5 percent each year.
Type 1 diabetes accounts for 5 to 10 percent of cases of diabetes worldwide. Most people with diabetes have type 2 diabetes, in which the body continues to produce insulin but becomes less able to use it.