Type 1 Diabetes: Causes, Symptoms, and Management

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For people without a genetic risk, normal exposure to environmental factors will not trigger the development of T1D. However, for those with a genetic risk, it is possible that it will. Many countries in which children and teenagers have experienced an increasing risk of developing T1D have then seen a leveling off or reversal of the trend. This suggests that a change in an environmental factor is associated with a change in risk and the finding may help to identify the causal agents.

Type 1 diabetes is known to have a genetic element – it tends to run in families and although a specific gene putting a person at risk has not been identified, it is most likely that more than one gene is responsible. It is most probable that a predisposition to type 1 diabetes and a triggering event is required. This event could be a viral infection (mumps, rubella, chickenpox, or virus of the upper respiratory tract) or the development of an autoimmune disease other than diabetes. At this stage, research in mice has shown that type 1 diabetes can be prevented or cured by avoiding the introduction of diabetes proteins to the immune system with a special type of cell or a drug (designed to find, neutralize, or stimulate deactivation of harmful cells).

Type 1 diabetes (T1D) affects around 400,000 people in the UK, 29,000 of which are children. It is a lifelong condition that is often diagnosed in children, teenagers, or young adults and is usually associated with the insulin-producing cells which have been destroyed and the body’s own immune system which leads to a buildup of glucose in the blood. So how do you get type 1 diabetes?

What is Type 1 Diabetes?

When an individual is affected by diabetes, their body is unable to sustain a healthy blood glucose level. Glucose is vital to our health; it is an essential energy source for the cells that make up muscle and tissues, and it is the brain’s main source of fuel. The glucose comes from the food you eat; after food is digested, the glucose makes its way into your bloodstream. Insulin is a hormone made by the pancreas, and the job of insulin is to transport glucose from the bloodstream into the cells, where it then can be used as an energy source. However, in diabetics, glucose is unable to enter the cells due to the lack of insulin, or in some cases, the body may not produce any insulin at all. This results in high blood glucose levels, which can lead to symptoms such as fatigue, weight loss, and blurred vision. Over time, high levels of glucose in the blood can cause damage to the eyes, kidneys, heart, and blood vessels. Type 1 diabetes is an autoimmune disease and it is the least common form of diabetes, affecting 10% of people with the condition. It develops when the immune system destroys the insulin-producing beta cells in the pancreas. Why the immune system attacks the beta cells is not entirely understood, but it is thought to be a combination of genetic predisposition and environmental factors. This includes exposure to certain viruses and the consumption of food containing toxic chemicals. Type 1 diabetes can develop at any age, but most commonly emerges in children, teenagers, and young adults.

Causes of Type 1 Diabetes

Type 1 diabetes is a complex disease, which results from a combination of a genetic predisposition and some environmental factors. The exact cause of type 1 diabetes is still not known. However, it is widely believed that in type 1 diabetes, the immune system is activated inappropriately, which leads to the destruction of insulin-secreting beta cells in the pancreas. This could be triggered by a virus or other microorganism. If you have a close relative such as a parent, brother, or sister with diabetes, then you may have a higher risk of developing the disease. It is thought that the tendency to develop abnormal antibodies to the pancreas in response to a trigger that causes the disease is actually inherited. Each year, more and more people are diagnosed, but most people with type 1 diabetes do not have a family history of the disease. A very normal occurrence could have occurred which triggered the onset of type 1 diabetes, possibilities might include food poisoning or a chemical toxin. Living with a young child who has a long-term illness or the death of a close family member also seems to increase the risk of developing diabetes in some people. Some people wrongly believe that sugar and mental stress can cause diabetes. This is not true. Both sugar and stress can affect blood glucose control in people with diabetes, but they do not cause the disease.

Symptoms of Type 1 Diabetes

Type 1 diabetes occurs when the body’s immune system attacks and destroys certain cells in the pancreas, an organ in the digestive system. The pancreas produces insulin, a hormone that regulates blood sugar. Diabetes develops when the body doesn’t make enough insulin because the cells that produce insulin have been destroyed. The pancreas then no longer produces insulin. The onset of type 1 diabetes is abrupt and is a life-threatening disease. Nine in 10 people who have type 1 diabetes develop the disease before the age of 30. It is one of the most common chronic childhood diseases and the most prevalent childhood metabolic disorder. It is estimated that about 60,000 individuals under 18 in the US have type 1 diabetes. Diabetes is a serious and lifelong condition. Over time, the high sugar levels in the blood can seriously damage many parts of the body. It can lead to problems with the eyes, kidneys, nerves, heart, and blood vessels. High sugar levels in the blood can also damage the blood vessels and this may result in problems with sexual function, and a higher risk of strokes and heart attacks.

Diagnosis and Treatment

Often newly diagnosed with Type 1 diabetes, the patient will be confused about how to correctly manage the disease. They must be educated on meal planning that will consist of convenient meal times and a consistent diet with a suitable amount of fat, protein, and carbohydrates. This diet plan will coincide with the insulin therapy, which will be discussed later. If celiac disease is present, the patient will need to restrict the intake of gluten. Weight loss therapy is often applied to overweight patients with Type 1 diabetes and will effectively help lower blood sugar. Lastly, regular diabetes education will help the patient effectively manage the disease in discussion with a physician, diabetes educator, or other primary care provider.

The management of Type 1 diabetes is a complicated process that requires the patient to make several key considerations. The patient will obviously want to effectively manage the disease in a way that will not negatively affect their everyday life. The patient will need to take into account the amount of physical activity that they are involved in so that they can match their food intake with the insulin dosage. Since many patients with Type 1 diabetes are children or adolescents, the parents of the child patient are the ones who must be aware how food intake and activity level will affect blood sugar level. This is also crucial for the adolescent patient who may be concerned that managing the disease may inhibit their ability to participate in certain activities or even result in social stigmatization.

Because so many people suffer from diabetes, the various methods of testing and levels that can be tested make it a complicated disease to diagnose. There are no established diagnostic criteria for Type 1 diabetes in adults as there are in children. The onset of Type 1 diabetes may be more difficult to detect in adults due to the fact that the early symptoms including polyuria, polydipsia, weight loss, and fatigue are common in many other diseases. If one suspects that they have Type 1 diabetes, the best way to diagnose the disease is to have a physician test the islet cell antibodies in the blood.

Diagnosing Type 1 Diabetes

An oral glucose tolerance test is another common test used to diagnose type 1 diabetes. This test involves drawing blood to test glucose levels then drinking a high-glucose liquid and drawing blood again after two hours. A blood glucose level of 200 mg/dL or higher indicates diabetes. This is a reliable test for diagnosing type 1 diabetes, but it is more time-consuming than the blood glucose test.

Blood Glucose Test A blood glucose test is the most common test for diagnosing type 1 diabetes. This test measures the level of glucose in a person’s blood. A person is required to fast before this test is performed. Then a person is given a drink with a high level of glucose. Blood samples are taken at certain intervals to measure the blood glucose levels. A blood glucose level of 200 mg/dL or higher indicates diabetes. If one test is positive, a person can do the test again on a different day to confirm the results.

The Urine Test The urine test will involve using a urine sample to test for the presence of glucose and ketones. A high level of glucose or ketones in the urine is a clear sign of diabetes. This test will take time to confirm, as it requires finding a urine sample and sending it to a lab.

An individual might visit a doctor after experiencing symptoms of diabetes. The doctor might choose to test for diabetes if he or she suspects the individual has the disease. The blood tests used to diagnose type 1 diabetes are the same as those used to diagnose type 2 diabetes. A doctor may suspect diabetes if a patient is urinating frequently, drinking large amounts of liquids, losing weight, or having vision problems. Some doctors will order a urine test for diabetes.

Managing Type 1 Diabetes

There are also other types of injectable medications that help with blood sugar control. Some diabetics take pills, while others take medications that supplement insulin. The goal is to keep blood sugar levels as close to normal as possible, taking into consideration individual factors that can greatly affect blood sugar levels. High and low blood sugar levels each have immediate bad effects and with time, they can also cause long-term complications. Too much sugar in the blood can cause damage to the eyes, kidneys, and nerves. High levels of blood sugar can also cause ketoacidosis. Low blood sugar levels can cause shaking, sweating, and irritability. This is because the brain is dependent on sugar as its main source of energy. In the worst-case scenarios, seizures and insulin shock can occur.

It is important for a diabetic to find an appropriate balance between food, exercise and insulin in order to maintain health and avoid long-term complications. For example, if blood sugar levels are too high, a diabetic can take insulin to help correct this. If a meal is skipped or contains very little carbohydrate, they may not need to take insulin or they may take a smaller dose. Interviewees in the course of my research consistently reiterated the idea of waiting for perceived high blood sugar levels to restore to normal and to correct low blood sugar levels.

For diabetics, achieving and maintaining adequate blood glucose levels is an extremely important goal. This can be achieved through education and training on how to properly control blood sugar levels. Type 1 diabetes is usually treated with specific types of insulin and with a closely monitored diet. Learning how to manage this condition involves making some adjustments over time, and with the help of your doctor, a diabetic can learn how to best manage their diabetes.

Insulin Therapy

Insulin is essential for control of blood glucose in diabetes. Although first discovered and isolated from the pancreatic islets in 1921, it took more than 20 years before a method was developed to produce insulin for clinical use. This was achieved in 1946. Initial preparations had many impurities and a relatively short duration of action. This has been improved over the years and it is now possible to achieve insulin preparations that are virtually identical to that produced by the pancreas in a non-diabetic person. All insulin preparations should provide good glycemic control without increasing risk of adverse events. Factors taken into consideration when choosing the most suitable regimen include the type of diabetes, eating habits, lifestyle, age of the patient and any concomitant illness. This results in the need for an individualized approach to insulin therapy, which may be intensified (with multiple doses or continuous subcutaneous insulin infusion) at times and not others. Any changes to a regimen should aim to build on existing good control while striving to avoid hypoglycemia.

Blood Sugar Monitoring

Hyperglycemia occurs when there is too little insulin within the body. This can be caused by a recent diagnosis of diabetes when insulin production is decreasing. It can also be triggered by illness or incorrect administration of insulin. Monitoring blood glucose to detect high levels enables correction of insulin and evaluation of its effectiveness of treatment. High blood glucose over a prolonged period may result in increased thirst and frequency of passing urine. This can hinder quality of life, and so people have a tendency to accept high blood glucose symptoms as ‘normal’ and must monitor blood glucose to realize a change in blood glucose control. In extreme cases, Diabetic Ketoacidosis (DKA) can occur, and this is a medical emergency. Symptoms are abdominal pain, vomiting, rapid breathing, and loss of consciousness. DKA is determined by high levels of ketones in blood and urine. So monitoring of blood glucose is essential to determine high levels so precautionary measures can be taken to avoid ketones and more importantly to avoid DKA.

Type 1 diabetes fluctuates to a great extent. The major trials are too low blood glucose (hypoglycemia) and too high blood glucose (hyperglycemia). The former is accompanied by an abrupt reduction in insulin. This might be in response to exercise or delayed/missed meals. The symptoms are non-specific like mood change, fatigue, and hunger. Detecting hypoglycemia while sleeping can be determined by sweating, headache, or tiredness after waking or in extreme cases having a seizure. While hypoglycemia can be determined by symptoms, it’s ideal to monitor blood glucose. This way the severity of blood glucose can be determined and the effectiveness of treatment can be evaluated.

Complications and Prevention

High blood pressure and raised cholesterol levels are also seen as specific diabetes-related conditions. This is because they can pose a very high risk for people living with type-1 or type-2 diabetes to develop further cardiovascular diseases, including strokes and heart attacks. On a positive note, a recent study suggested tight blood glucose control may reduce the risk of cardiovascular disease by 57% in people with type-1 diabetes.

Other complications include sexual dysfunction in women and increased risk of urinary tract infections and potentially fatal damage to the kidneys. All of these conditions can be extremely distressing for a sufferer and often have a large impact on a person’s psychological well-being.

Cognitive dysfunction, the condition is frequently under-diagnosed and has been cited as the largest single cause of repeat hospital admissions for people living with type-1 diabetes. It is also the largest single cause of early retirement. Although it is prevalent amongst the diabetes community, there is often an absence of reported causal links between diabetes and depression or cognitive dysfunction.

Eye problems are another complication. Retinopathy occurs when diabetes damages the small blood vessels in the retina. It is a common complication for anyone who has had diabetes for a significant number of years. Up to 600 people are newly diagnosed with retinopathy each year. High blood pressure and kidney disease are two key factors which greatly increase the risk of retinopathy. Regular eye checks can identify any problems early and treatments can stop them getting worse. This is important as early retinopathy often does not have any symptoms.

Foot problems are common in people with diabetes. You should have a full foot examination at least once a year. Ask your doctor to check your feet as soon as you are diagnosed with diabetes, so any existing problems can be identified early. Even if you have no sign of any foot problems, you should have your feet checked at least once a year.

Complications Associated with Type 1 Diabetes

The effects of diabetes on the body and overall health are alarming. The disease speeds up the aging of the blood, affecting the blood vessels and increasing the risk of various diseases. It also hastens the development of hardening of the arteries (atherosclerosis), which can lead to heart and blood vessel disease. According to nationally representative data, diabetes accounts for over 60% of non-traumatic lower limb amputations. And when that happens, it has been known that the patient won’t live much longer – approximately 5 years after an amputation. It has been shown that diabetes is associated with an unacceptable degree of heart disease, and diabetics often have different outcomes following a heart attack than non-diabetics. The conditions brought on from heart disease can lead to kidney failure, which in turn makes the person more likely to require dialysis, which leads to several other complications and an early death. High blood pressure in diabetics can lead to eye problems, including a greater probability of going blind at some point in their lives due to the damage that diabetes does to the eyes. The less publicized conditions that diabetes contributes to are incontinence leading to an increased rate of infection, damage to sexual organs, the risk of Alzheimer’s disease, and the possibility of increased complications with menopause for diabetic women. All of these conditions are often painful, may require emergency care and even hospitalization, and contribute to a lower quality of life. In a recent year, the cost of diabetes was determined to be 132 billion dollars in the United States alone. This figure included a variety of indirect costs, such as hospital admissions, drugs, diagnostic and medical services, and medical provider treatment for identified problems. On average, medical expenses were $13,243 per year for a diabetic, with 60% of the costs being attributed to the diabetes, 20% attributed to chronic conditions and lastly 20% to other medical treatment. After reflecting on the information provided, the effects of diabetes are devastating, and the condition must be managed to prevent these complications from taking place.

Preventing Complications

People with diabetes can take steps to prevent the development of, and complications associated with, foot ulcers. First and foremost, people with diabetes should strive to maintain good glycemic control. A trial involving patients with diabetes and neuropathy found that those patients in the intensive treatment group were less likely to develop ulcers than the patients in the standard therapy group. One of the most important reasons for this difference was the intensive group’s lower HbA1c (a measure of glycemic control) values. Meta-analysis of trials of improved glycemic control in type 1 and type 2 diabetes has shown that intensive glycemic control significantly reduces the risk of development of microvascular complications. In addition to maintaining good glycemic control, people with diabetes and neuropathy should strive to avoid further nerve damage. Measures to prevent feet injury and leg amputations have to be involved and the patients should be informed and motivated to take an active part in their prevention. Identification of patients at high risk and treatment of risk factors for foot ulcers are essential to prevent foot ulcers. This can be achieved by screening the feet of patients with diabetes and neuropathy. Regular foot examinations, especially if abnormal findings are present, can identify the high-risk foot and patients with incentive to prevent problems are more likely to take heed of advice. In patients with diabetes and neuropathy, high-pressure areas under the sole are particularly at risk of developing ulcers. In-shoe orthoses have been shown to reduce the plantar pressures and the risk of foot ulcers in diabetic patients. By identifying pressure areas, the in-shoe orthoses can be designed specifically for the particular patient, thereby maximizing their effectiveness in preventing foot ulcers.

Lifestyle Changes for Better Diabetes Management

If a person is diagnosed with type 1 diabetes, it is likely that they will have to make significant lifestyle changes to better manage their condition and to avoid developing complications. Type 1 diabetics must carefully monitor their blood sugar levels and take insulin, which can be affected by an abundance of things. Because of this variability, planning ahead and regularity in everyday choices are key elements to successful management. It is important for diabetics to develop routine in their meal times, exercise, sleeping, and medication schedule. This will make it easier to keep blood sugar levels in the desired range. A diabetic diet is now recognized to hold major importance in overall management of the disease. It is a common misconception that diabetics must eat a strictly sugar-free diet. Instead, diabetics are encouraged to maintain a diet consistent in variety and high in nutrients from vegetables, whole grains and lean meats. Monitoring portion sizes and carbohydrate intake is also helpful in keeping blood sugar levels from fluctuating. Regular exercise also has a stabilizing effect on blood sugar levels, but if an exercise routine is going to be changed it is important to consult a doctor, as alterations in an exercise regimen may necessitate changes in insulin dosage. An ideal blood sugar level will help offset the development of various complications, many of which can be prevented with lasting lifestyle changes. High blood pressure and kidney disease can be prevented with close monitoring and medication when necessary. Both heart disease and eye damage can be avoided by not smoking. One of the main concerns for male diabetics is the increased risk and severity of impotence, which can be offset and maintained by tight blood sugar control.

Support and Resources for Type 1 Diabetes Patients

Financially, managing diabetes can be quite straining. The cost of supplies is high and medical aid is not always comprehensive. It is important that patients are aware of what they are entitled to. In Australia, the NDSS (National Diabetes Services Scheme) provides subsidized products to diabetes patients. Registration to the scheme is not automatic and there are certain requirements, but the NDSS is a useful resource for many.

People diagnosed with type 1 diabetes must undertake lifelong management of the disease. This may come as a shock, and patients will feel alone and overwhelmed at times. It is important that they know they are not alone, and that there are support systems in place to help them emotionally, physically, and financially. A major factor to be taken into account is support from family and friends. Knowing that people care can make an enormous difference. Many patients find it helpful to talk to others in the same position, and often support groups are formed. In some areas, camps are set up for children with diabetes. These prove to be a great experience and provide the children with a sense of normality. Professional help is also available. Psychologists are able to help people deal with the stress and demands of diabetes, and social workers can assist in locating information and financial support.