Type 1 diabetes

Endocrine glands Insulin pump Glucose test Insulin pump Type I diabetes
Monitor blood
glucose -
series
Definition:
Type 1 diabetes is a chronic (lifelong) disease that occurs hen the pancreas produces too little
insulin to regulate blood sugar le!els appropriately"
Alternative Names:
Insulin-dependent diabetes mellitus; #u!enile onset diabetes; $iabetes - Type 1
Causes, incidence, and risk factors:
$iabetes is a life-long disease for hich there is not yet a cure" There are se!eral forms of
diabetes% including&
Type 1 diabetes% often called 'u!enile or insulin-dependent diabetes
Type ( diabetes% often called adult or non-insulin-dependent diabetes
Gestational diabetes% hich occurs during pregnancy"
)or all types of diabetes% the metabolism of carbohydrates (including sugars such as glucose)%
proteins% and fats is altered"
In type 1 diabetes% the beta cells of the pancreas produce little or no insulin% the hormone that
allos glucose to enter body cells" *nce glucose enters a cell% it is used as fuel"
+ithout ade,uate insulin% glucose builds up in the bloodstream instead of going into the cells"
The body is unable to use this glucose for energy despite high le!els in the bloodstream% leading
to increased hunger"
In addition% the high le!els of glucose in the blood causes the patient to urinate more% hich in
turn causes e-cessi!e thirst" +ithin . to 1/ years after diagnosis% the insulin-producing beta cells
of the pancreas are completely destroyed% and no more insulin is produced"
Type 1 diabetes can occur at any age% but it usually starts in people younger than 0/" 1ymptoms
are usually se!ere and occur rapidly"
The e-act cause of type 1 diabetes is not 2non" Type 1 diabetes accounts for 03 of all ne
cases of diabetes each year" There is 1 ne case per e!ery 4%/// children per year" 5e cases are
less common among adults older than (/"
Symptoms:
increased thirst
increased urination
eight loss despite increased appetite
nausea
!omiting
abdominal pain
fatigue
absence of menstruation
Signs and tests:
The folloing tests can be used to diagnose diabetes&
urinalysis shos glucose and 2etone bodies in the urine% but a blood test is re,uired for
diagnosis
fasting blood glucose is 1(6 mg7d8 or higher
random (nonfasting) blood glucose e-ceeds (// mg7d8 (this must be confimed ith a
fasting test)
insulin test (lo or undetectable le!el of insulin)
9-peptide test (lo or undetectable le!el of the protein 9-peptide% a by-product of insulin
production)
Treatment:
:t diagnosis% the immediate goals of treatment are to treat diabetic 2etoacidosis (also called
$;:) and high blood glucose le!els" <ecause of the sudden onset and se!erity of symptoms in
type 1 diabetes% treatment for nely diagnosed people may in!ol!e hospitali=ation"
The long-term goals of treatment are to prolong life% reduce symptoms% and pre!ent diabetes-
related complications such as blindness% 2idney failure% and amputation of limbs"
These goals are accomplished through education% insulin use% meal planning and eight control%
e-ercise% foot care% and careful self-testing of blood glucose le!els"
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Insulin loers blood sugar by alloing it to lea!e the blood stream and enter cells" E!eryone
needs insulin" ?eople ith type I diabetes can@t ma2e their on insulin% and they must ta2e
insulin e!ery day"
Insulin is in'ected under the s2in using a syringe% or in some cases% an infusion pump deli!ers the
insulin continuously" It is not a!ailable in an oral form"
Insulin preparations differ in ho fast they start to or2 and ho long they last" The health care
professional re!ies blood glucose le!els to determine the appropriate type of insulin the person
should use" More than one type of insulin may be mi-ed together in an in'ection to achie!e the
best control of blood glucose"
The in'ections are needed% in general% from 1 to A times a day" ?eople are taught ho to gi!e
insulin in'ections by their health care pro!ider or a diabetes nurse educator" Initially% a child@s
in'ections may be gi!en by a parent or other adult" <y age 1A% most children can be e-pected (but
should not be re,uired) to gi!e their on in'ections"
$IET
Meal planning for type 1 diabetes re,uires consistency to allo food and insulin to or2
together to regulate blood glucose le!els" If meals and insulin are out of balance% e-treme
!ariations in blood glucose can occur"
The :merican $iabetes :ssociation and the :merican $ietetic :ssociation has information for
planning healthy% balanced meals" 9onsultation ith a registered dietitian or nutrition counselor
is an in!aluable tool for meal planning and dietary control for diabetics"
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Eegular e-ercise is especially important for the person ith diabetes% as it helps control the
amount of sugar in the blood and helps burn e-cess calories and fat to achie!e optimal eight"
<efore people ith diabetes begin any e-ercise program% they should obtain medical appro!al"
Type 1 diabetics must ta2e special precautions before% during and after participation in intense
physical acti!ity or e-ercise"
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<lood glucose monitoring is done by chec2ing the glucose content of a small drop of blood" The
testing is done on a regular basis and ill inform the person ith diabetes ho ell diet%
medication% and e-ercise are or2ing together to control diabetes"
The results can be used to ad'ust meals% acti!ity% or medications to 2eep blood-sugar le!els
ithin an appropriate range" It ill pro!ide !aluable information for the health care pro!ider to
suggest changes to impro!e care and treatment" Testing ill identify high and lo blood-sugar
le!els before serious problems de!elop"
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?eople ith diabetes are prone to foot problems because of complications related to the illness"
$iabetes causes damage to the blood !essels and ner!es% hich can result in a decreased ability
to sense trauma or pressure on the foot" : foot in'ury could go unnoticed until se!ere infection
de!elops"
:dditionally% diabetes alters the bodies immune system% decreasing the body@s ability to fight
infection" 1mall infections can rapidly progress to death of the s2in and other tissues%
necessitating amputation of the affected limb"
To pre!ent in'ury to the feet% diabetics should adopt a daily foot care routine"
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8o blood sugar% 2non as hypoglycemia% can occur in diabetics hen they use too much
insulin% e-ercise too much% or ha!e not eaten enough food" Bypoglycemia can de!elop ,uic2ly in
people ith diabetes" 1ymptoms of lo blood sugar typically appear hen the sugar le!el falls
belo 4/" +atch for ea2ness% sha2ing% seating% headache% ner!ousness% and hunger"
If these symptoms occur and you ha!e a blood sugar test 2it a!ailable% do a blood sugar chec2" If
the le!el is lo% the person ith diabetes should eat something ith sugar& fruit 'uice% se!eral
teaspoons of sugar% a cup of s2im mil2% or regular soda" If you don@t ha!e a test 2it handy% sugar
should be eaten anyay - it can@t hurt" 1ymptoms should subside ithin 1. minutes" If the
symptoms don@t subside% more sugar should be eaten and the sugar le!el tested again"
:)TEE the symptoms subside% more substantial food can be eaten" Eat simple sugar )IE1T to
get the situation under control" E!en if you or your child is hungry% FrealF food should not be
eaten until the sugar le!el comes up - real food on@t produce enough sugar and ta2es too long to
digest"
If you are a parent% relati!e% or friend of someone e-periencing these symptoms% monitor the
person closely" If symptoms become orse -- confusion% sei=ures% or unconsciousness -- gi!e the
person a shot of glucagon" If you don@t ha!e glucagon% call G11 immediately"
Cou should ha!e some glucagon stored for emergencies" Ma2e sure e!eryone in your home% as
ell as babysitters and caregi!ers% 2nos ho to use it" ?eriodically remind e!eryone ho to use
it% and chec2 the e-piration date"
$on@t panic" Glucagon or2s !ery fast -- usually ithin 1. minutes" +hile you are aiting for
the person to re!i!e% 2eep him on his side to pre!ent cho2ing" If the person is not better in 1.
minutes% call G11"
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+hen there is not enough insulin to mo!e glucose into cells% glucose can build up in the blood"
The body then loo2s for other forms of energy and uses fat as a fuel source" :s fats are bro2en
don% acids called 2etones build up in the blood and urine" In high le!els% 2etones are poisonous
to body tissue" This condition is 2non as 2etoacidosis"
Cou can chec2 for 2etones using a simple urine test a!ailable at pharmacies" This test should be
performed e!ery A-6 hours anytime a person ith diabetes is registering blood sugar abo!e (A/;
sic2; unusually thirsty or has a dry mouth; urinating fre,uently; or !omited
The arning signs that 2etoacidosis is getting serious might include flushed face% dry s2in and
mouth% nausea or !omiting% stomach pain% deep% rapid breathing% or fruity breath odor"
If these symptoms occur% call the doctor or go to the emergency room right aay" If left
untreated% this condition ill lead to coma and e!en death"
M*5IT*EI5G
Disit your physician and7or diabetes educator at least A times a year"
Ba!e your glycosylated hemoglobin (Bb:1c) measured (-A times a year to e!aluate your
o!erall glucose control" (:s2 your doctor ho often you should be tested")
Ba!e your cholesterol and triglyceride le!els and 2idney function e!aluated yearly"
Disit your ophthalmologist (preferably one that speciali=es in diabetic retinopathy) at
least once a year% more fre,uently if signs of diabetic retinopathy de!elop"
E!ery 6 months ha!e a thorough dental cleaning and e-amination" Inform your dentist
and hygienist that you ha!e diabetes"
Monitor your feet e!ery day for early signs of in'ury or infection" Ma2e sure your health
care pro!ider inspects your feet at each !isit"
1tay up-to-date ith all of your !accinations (including pneumococcal)% and get a flu
shot e!ery year in the fall"
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Cou are the most important person in managing your diabetes" $iabetes education is a crucial
part of the treatment plan" $iabetes education basically in!ol!es learning ho to li!e ith your
diabetes"
;noledge of disease management is imperati!e to a!oid de!eloping short-term complications
such as hypoglycemia and hyperglycemia and to delay or slo the onset of long-term
complications of the disease such as diabetic retinopathy (eye disease) or nephropathy (2idney
disease)"
Cou should be 2noledgeable about the basic principles of diabetes management" <asic
Fsur!i!al s2illsF include&
ho to recogni=e and treat lo blood sugar(hypoglycemia)
ho to recogni=e and treat high blood sugar (hyperglycemia)
diabetes meal planning
ho to administer insulin
ho to monitor blood glucose and urine 2etones
ho to ad'ust insulin and7or food inta2e during e-ercise
ho to handle sic2 days
here to buy diabetic supplies and ho to store them
Support Groups:
)or additional information and resources% see diabetes support group"
!pectations "prognosis#:
The outcome for people ith diabetes !aries" Eecent studies sho that tight control of blood
glucose can pre!ent or delay the progression of eye disease% 2idney disease and ner!ous system
disease that is caused by diabetes" Boe!er% complications may occur e!en hen good diabetes
control is achie!ed ith insulin and diet"
Complications:
EMEEGE59C 9*M?8I9:TI*51&
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In a person ith type 1 diabetes% the body ill use fat as a fuel if insulin is not present"
The by-products of fat metabolism are 2etones" ;etones build up in the blood and FspillF
o!er into the urine"
: condition called 2etoacidosis de!elops hen the blood is made acidic by the 2etones"
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Bypoglycemia (lo blood glucose) occurs hen the balance beteen insulin% food
inta2e% and e-ercise is disturbed" 1ymptoms of mild hypoglycemia include hunger%
ner!ousness% and fast heart rate" More serious hypoglycemia can lead to confusion and
e!en loss of consciousness" 8oss of consciousness due to lo blood sugar is called
hypoglycemic coma"
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?eople ho ha!e had diabetes for se!eral years are li2ely to de!elop long-term complications%
hich can be minimi=ed but not entirely eliminated by proper diabetic management&
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<y age ..% about 0.3 of men and omen ith type 1 diabetes ha!e died from a heart
attac2 compared to H3 of nondiabetic men and A3 of nondiabetic omen"
?eople ith type 1 diabetes are also at higher ris2 to de!elop bloc2ages in the ma'or
arteries of the legs than nondiabetics" 8oer the ris2 of !ascular disease by aggressi!ely
treating cholesterol and blood pressure% e-ercising regularly% and a!oiding or ,uitting
tobacco products"
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Micro!ascular (small !essel) changes occur in capillaries of e!ery organ of the body"
There is a thic2ening of the all of the small blood !essels" These changes are
responsible for many of the diabetes complications"
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9hanges in the small blood !essels of the retina (also 2non as diabetic retinopathy)
predispose the diabetic to se!eral eye disorders" :fter 1. years of diabetes% H/3 of
diabetics ill ha!e some diabetic retinopathy"
If bleeding and scarring has de!eloped% a retinal detachment may occur% causing
blindness" Dascular changes in the iris may cause obstruction of the flo of ocular fluid
and cause glaucoma" $iabetics are also more li2ely than nondiabetics to de!elop
cataracts"
$I:<ETI9 5E?BE*?:TBC (2idney disease)
;idney abnormalities may be noted early in the disease" ?oorly controlled diabetes may
accelerate the de!elopment of 2idney failure" >rinary tract infections in diabetics tend to
be more se!ere and may result in 2idney damage"
$iabetics are more !ulnerable to 2idney damage from high blood pressure than
nondiabetics"
$I:<ETI9 5E>E*?:TBC(ner!e damage)
?eople ith diabetes may de!elop temporary or permanent damage to ner!e tissue"
$iabetic neuropathy is more li2ely to de!elop if blood glucose is poorly controlled"
1ome diabetics ill not de!elop neuropathy% hile others may de!elop this condition
relati!ely early"
*n a!erage% symptoms such as numbness and tingling occur 1/ to (/ years after diabetes
has been diagnosed"
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The feet of people ith diabetes are !ery susceptible to infection and in'ury" Many
diabetes-related hospital admissions are for foot problems% and a significant number of
non-accident-related leg amputations are performed on diabetics"
1e!eral foot problems are common in people ith diabetes% including s2in changes (loss
of hair; loss of ability to seat; and dry% crac2ed s2in)% arterial insufficiency (impaired
blood supply to feet)% neuropathy% and specific foot deformities (hallu- !algus% bunion%
hammertoe% and calluses)"
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?eople ith diabetes are more li2ely than nondiabetics to de!elop infections"
Byperglycemia (high blood sugar) predisposes diabetics to fungal infections of the s2in%
nails% and female genital tract and to urinary tract infection"
Calling your $ealt$ care provider:
Medical follo-up for a person nely diagnosed ith type 1 diabetes should probably occur
ee2ly until good control of blood glucose is achie!ed" The health care pro!ider ill ant to
re!ie results of home glucose monitoring and urine testing% and a diary of meals% snac2s% and
insulin in'ections"
:s the disease becomes more stable% follo-up !isits ill be less fre,uent" ?eriodic e!aluation is
!ery important for the e!aluation of long-term complications associated ith diabetes"
9all your health care pro!ider or go to the emergency room if symptoms of 2etoacidosis are
present&
increased thirst and urination
nausea
deep and rapid breathing
abdominal pain
seet-smelling breath
loss of consciousness (This may occur in insulin dependent diabetics hen a dose of
insulin is missed% or if illness or infection is present")
Go to the emergency room or call the local emergency number (such as G11) if symptoms of
se!ere hypoglycemia or insulin reaction are present&
trembling
ea2ness
drosiness
headache
confusion
di==iness
double !ision
lac2 of coordination
con!ulsions or unconsciousness
Early signs of hypoglycemia may be treated at home by eating sugar or candy or in'ecting
glucagon" If the signs of hypoglycemia are not relie!ed by the abo!e action or if blood glucose
le!els remain belo 6/ mg7d8 go to the emergency room"
Ee!ie $ate& (7G7(//.
Ee!ieed <y& ;e!in ?ho% M"$"% :ttending% Internal Medicine% <oston D: Medical 9enter%
<oston% M:" Ee!ie pro!ided by DeriMed Bealthcare 5etor2"