ALL ABOUT DIABETES

Type 1 Diabetes Overview

What Is Type 1 Diabetes?

Type 1 diabetes is all about insulina lack of the hormone insulin. If you have type 1 diabetes, then your body doesnt produce enough insulin to handle the glucose in your body. Glucose is a sugar that your body uses for instant energy, but in order for your body to use it properly, you have to have insulin. Having too much glucose in your body can cause serious complications. In order to avoid those, people with type 1 diabetes must take insulin to help their bodies use glucose effectively. Learn more about the hormone insulin and how it works. Type 1 diabetes used to be called juvenile diabetes because so many cases were noticed when patients were children. Children and young people account for many of the type 1 diabetes diagnoses today, which is why we created a Patients' Guide to Managing Your Child's Type 1 Diabetes. However, it is possible to develop type 1 diabetes later in life. Jay Cutler, quarterback for the Chicago Bears, is just one example of someone who began his journey with type 1 diabetes as an adult. Heres another reason juvenile diabetes isnt exactly accurate anymore: type 1 diabetes isnt the only type of diabetes that can affect children and young adults. Type 2 diabetes is becoming more prevalent in younger people, and the treatments and causes of type 1 and type 2 are very different. It can be misleading and confusing to talk about juvenile diabetes when there are two distinct types that can affect children and young adults.

Type 1 Diabetes Symptoms

How to tell if you or your child has type 1 diabetes Type 1 diabetes develops gradually, but the symptoms may seem to come on suddenly. If you notice that you or your child have several of the symptoms listed below, make an appointment to see the doctor. Heres why symptoms seem to develop suddenly: something triggers the development of type 1 diabetes (researchers think its a viral infectionread this article on what causes type 1 diabetes, and the body loses its ability to make insulin. However, at that point, theres still insulin in the body so glucose levels are still normal. Over time, a decreasing amount of insulin is made in the body, but that can take years. When theres no more insulin in the body, blood glucose levels rise quickly, and these symptoms can rapidly develop: Extreme weakness and/or tiredness Extreme thirstdehydration Increased urination Abdominal pain

Nausea and/or vomiting Blurry vision Wounds that dont heal well Irritability or quick mood changes Changes to (or loss of) menstruation

There are also signs of type 1 diabetes. Signs are different from symptoms in that they can be measured objectively; symptoms are experienced and reported by the patient. Signs of type 1 diabetes include: Weight lossdespite eating more Rapid heart rate Reduced blood pressure (falling below 90/60) Low body temperature (below 97 F) There is an overall lack of public awareness of the signs and symptoms of type 1 diabetes. But there are people working to promote knowledge of type 1 diabetes. And Jay Cutler, quarterback for the Chicago Bears, is one of them. To learn more about his type 1 diabetes awareness efforts, read EndocrineWeb's interview with Jay Cutler. Making yourself aware of the signs and symptoms of type 1 diabetes is a great way to be proactive about your health and the health of your family members. If you notice any of these signs or symptoms, its possible that you have (or your child has) type 1 diabetes. A doctor can make that diagnosis by checking blood glucose levels.

Type 1 Diabetes Causes

What leads to the development of type 1 diabetes? It isnt entirely clear what triggers the development of type 1 diabetes. Researchers do know that genes play a role; there is an inherited susceptibility. However, something must set off the immune system, causing it to turn against itself and leading to the development of type 1 diabetes Genes Play a Role in Type 1 Diabetes Some people cannot develop type 1 diabetes; thats because they dont have the genetic coding that researchers have linked to type 1 diabetes. Scientists have figured out that type 1 diabetes can develop in people who have a particular HLA complex. HLA stands for human leukocyte antigen, and antigens function is to trigger an immune response in the body. There are several HLA complexes that are associated with type 1 diabetes, and all of them are on chromosome 6 Different HLA complexes can lead to the development of other autoimmune disorders, such as rheumatoid arthritis, ankylosing spondylitis, or juvenile rheumatoid arthritis. Like those conditions, type 1 diabetes has to be triggered by somethingusually a viral infection. What Can Trigger Type 1 Diabetes Heres the whole process of what happens with a viral infection: When a virus invades the body, the immune system starts to produce antibodies that fight the infection. T cells are in charge of making the antibodies, and then they also help in fighting the virus. However, if the virus has some of the same antigens as the beta cellsthe cells that make insulin in the pancreasthen the T cells can actually turn against the beta cells. The T cell products (antibodies) can destroy the beta cells, and once all the beta cells in your body have been destroyed, you cant produce enough insulin.

It takes a long time (usually several years) for the T cells to destroy the majority of the beta cells, but that original viral infection is what is thought to trigger the development of type 1 diabetes. Not every virus can trigger the T cells to turn against the beta cells. The virus must have antigens that are similar enough to the antigens in beta cells, and those viruses include: B4 strain of the coxsackie B virus (which can cause a range of illnesses from gastrointestinal problems to myocarditisinflammation of the muscle part of the heart) German measles Mumps Rotavirus (which generally causes diarrhea) There have also been some controversial studies into the connection between drinking cows milk as an infant and the development of type 1 diabetes. Researchers dont all agree on this, but some believe that the proteins in cows milk are similar to a protein that controls T cell production called glycodelin1. The babys body attacks the foreign proteinthe cows milk proteinbut then also attacks glycodelin, leading to an overproduction of T cells. And too many T cells in the body can lead to those T cells destroying the beta cells. Researchers have made significant progress in understanding the cause of type 1 diabetes, and theyre still hard at work to figure out why certain viruses trigger it and why T cells turn against beta cells. The medical community wants to better understand the cases of diabetes in order to prevent it.

Type 1 Diabetes Risk Factors

Genes, ethnicity, and geography may all play a role There are several risk factors that may make it more likely that youll develop type 1 diabetesif you have the genetic marker that makes you susceptible to diabetes. That genetic marker is located on chromosome 6, and its an HLA (human leukocyte antigen) complex. Several HLA complexes have been connected to type 1 diabetes, and if you have one or more of those, you may develop type 1. (However, having the necessary HLA complex is not a guarantee that you will develop diabetes; in fact, less than 10% of people with the right complex(es) actually develop type 1.) Other risk factors for type 1 diabetes include: Viral infections: Researchers have found that certain viruses may trigger the development of type 1 diabetes by causing the immune system to turn against the bodyinstead of helping it fight infection and sickness. Viruses that are believed to trigger type 1 include: German measles, coxsackie, and mumps. For more details on how viral infections increase your risk of diabetes, read this article on the causes of type 1 diabetes. Race/ethnicity: Certain ethnicities have a higher rate of type 1 diabetes. In the United States, Caucasians seem to be more susceptible to type 1 than African-Americans and Hispanic-Americans. Chinese people have a lower risk of developing type 1, as do people in South America. Geography: It seems that people who live in northern climates are at a higher risk for developing type 1 diabetes. Its been suggested that people who live in northern countries are indoors more (especially in the winter), and that means that theyre in closer proximity to each otherpotentially leading to more viral infections.

Conversely, people who live in southern climatessuch as South Americaare less likely to develop type 1. And along the same lines, researchers have noticed that more cases are diagnosed in the winter in northern countries; the diagnosis rate goes down in the summer. Family history: Since type 1 diabetes involves an inherited susceptibility to developing the disease, if a family member has (or had) type 1, you are at a higher risk. If both parents have (or had) type 1, the likelihood of their child developing type 1 is higher than if just one parent has (or had) diabetes. Researchers have noticed that if the father has type 1, the risk of a child developing it as well is slightly higher than if the mother or sibling has type 1 diabetes. Early diet: Researchers have suggested a slightly higher rate of type 1 diabetes in children who were given cows milk at a very young age. You can read more about the possible connection between cows milk and type 1 diabetes in this article on type 1 diabetes causes. Other autoimmune conditions: As explained above, type 1 diabetes is an autoimmune condition because it causes the bodys immune system to turn against itself. There are other autoimmune conditions that may share a similar HLA complex, and therefore, having one of those disorders may make you more likely to develop type 1. Other autoimmune conditions that may increase your risk for type 1 include: Graves' disease, multiple sclerosis, and pernicious anemia.

Diagnosing Diabetes
The two primary tests and their results, which combine to make the diagnosis of diabetes Fasting Blood Glucose (Blood Sugar) Level The gold standard for diagnosing diabetes is an elevated blood sugar level after an overnight fast (not eating anything after midnight). A value above 140 mg/dl on at least 2 occasions typically means a person has diabetes. Normal people have fasting sugar levels that generally run between 70 to 110 mg/dL. The Oral Glucose Tolerance Test An oral glucose tolerance test is one that can be performed in a doctor's office or a lab. The person being tested starts the test in a fasting state (having no food or drink except water for at least 10 hours but not greater than 16 hours). An initial blood sugar is drawn and then the person is given a "glucola" bottle with a high amount of sugar in it (75 grams of glucose or 100 grams for pregnant women). The person then has their blood tested again 30 minutes, 1 hour, 2 hours, and 3 hours after drinking the high glucose drink. For the test to give reliable results, you must be in good health (not have any other illnesses, not even a cold). Also, you should be normally active (for example, not lying down or confined to a bed like a patient in a hospital), and you should not be taking any medicines

that could affect your blood glucose. The morning of the test, you should not smoke or drink coffee. During the test, you need to lie or sit quietly. The oral glucose tolerance test is conducted by measuring blood glucose levels 5 times over a period of 3 hours. In a person without diabetes, the glucose levels in the blood rise following drinking the glucose drink, but then they fall quickly back to normal (because insulin is produced in response to the glucose, and the insulin has a normal effect of lowing blood glucose). In a diabetic, glucose levels rise higher than normal after drinking the glucose drink and come down to normal levels much slower (insulin is either not produced, or it is produced but the cells of the body do not respond to it). As with fasting or random blood glucose tests, a markedly abnormal oral glucose tolerance test is diagnostic of diabetes. However, blood glucose measurements during the oral glucose tolerance test can vary somewhat. For this reason, if the test shows that you have mildly elevated blood glucose levels, the doctor may run the test again to make sure the diagnosis is correct. Glucose tolerance tests may lead to one of the following diagnoses: Normal Response A person is said to have a normal response when the 2-hour glucose level is less than or equal to 110 mg/dL. Impaired Fasting Glucose When a person has a fasting glucose equal to or greater than 110 and less than 126 mg/dL, they are said to have impaired fasting glucose. This is considered a risk factor for future diabetes and will likely trigger another test in the future, but by itself, does not make the diagnosis of diabetes. Impaired Glucose Tolerance A person is said to have impaired glucose tolerance when the 2-hour glucose results from the oral glucose tolerance test are greater than or equal to 140 but less than 200 mg/dL. This is also considered a risk factor for future diabetes. There has recently been discussion about lowering the upper value to 180 mg/dL to diagnose more mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications. Diabetes A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dL. This must be confirmed by a second test (either one) on another day. There has recently been discussion about lowering the upper value to 180 mg/dL to diagnose more people with mild diabetes to allow earlier intervention and hopefully prevention of diabetic complications. Gestational Diabetes A woman has gestational diabetes when she is pregnant and has any 2 of the following: a fasting plasma glucose of more than 105 mg/dL, a 1-hour glucose level of more than 190 mg/dL, a 2-hour glucose level of more than 165 mg/dL, or a 3-hour glucose level of more than 145 mg/dL.

Type 1 Diabetes Complications

You Can Prevent Short- and Long-term Complications

Type 1 diabetes is complicatedand if you dont manage it properly, there are complications, both short-term and long-term. If you dont manage it properly is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if youve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Short-term Diabetes Complications Hypoglycemia Hypoglycemia is low blood glucose (blood sugar). It develops when theres too much insulinmeaning that youve taken (or given your child) too much insulin or that you havent properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when its in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech
Diabetic Ketoacidosis Diabetic ketoacidosis (sometimes abbreviated to DKA) is sometimes the first indication that a person has type 1 diabetes, and can be a serious complication of lack of insulin. As you can read in the article on type 1 symptoms, diabetes develops gradually and so people may not realize that they have ituntil it becomes very serious very quickly and they have diabetic ketoacidosis. However, its also possible to develop diabetic ketoacidosis after youve been diagnosed with diabetesif you arent taking care of your blood glucose levels as you should. Heres how diabetes ketoacidosis develops: When the body runs out of insulinand that will happen as the effects of diabetes take their tollyou cant use glucose properly or effectively. Without glucose to fuel your body, it starts to use fat to get its energy. When fat is broken down by the body, ketones are released. When too many ketones build up in the blood, it makes the blood acidic, leading to diabetic ketoacidosis if the situation isnt dealt with. The signs and symptoms of DKA are: Frequent urination Extreme thirstiness Abdominal pain

Weight loss Fruity smell on breath (thats the smell of ketones being released from your body) Cold skin Confusion Weakness

If you think you (or your child) has DKA, you can quickly confirm it with two at-home tests: Check the blood glucose level: If its above 250mg/dl, you have very high blood sugar (blood glucose), and its quite possible that you have diabetic ketoacidosis. Use a ketone strip to test urine for ketones: Keep these handy at home so that if you suspect DKA, you can immediately test. You can get ketone strips at your local pharmacy; you dont need a prescription for them. The strip will turn a deep purple if too many ketones are in the body. (If you cant urinate, drink 8oz and wait 10 to 20 minutes. You should then be able to urinate.) Diabetic ketoacidosis must be treated, so as soon as you confirm DKA, call your doctor. If you dont have any ketone strips available but still suspect DKA, go to the nearest hospital emergency room immediately to be evaluated. Long-term Diabetes Complications By tightly controlling your blood glucose level (or your childs blood glucose level), you can avoid long-term complications of type 1 diabetes. Basically, if you work to avoid the short-term complications, youll also be doing some long-range planning and avoiding the complications listed in this section. These complications develop over many yearsusually at least 10 yearsand they all relate to how blood glucose levels can affect blood vessels. Uncontrolled blood glucose can, over time, damage the bodys tiny and large blood vessels. Damage to your tiny blood vessels causes microvascular complications; damage to your large vessels causes macrovascular complications. Microvascular Complications: Eye, Kidney, and Nerve Disease You have small blood vessels that can be damaged by poor blood glucose control. Damaged blood vessels dont deliver blood as well as they should, so that leads to other problems, specifically with the eyes, kidneys, and nerves.

Eyes: Because of type 1 diabetes, you can develop cataracts and/or retinopathy in your eyes. Retinopathy, or damage to the retina, is much more common than cataracts in type 1 diabetes, but both can cause loss of vision. To avoid eye problems associated with type 1 diabetes, keep your blood glucose under control and have yearly dilated eye check-ups to monitor your eye health. Kidneys: If untreated, kidney disease (also called diabetic nephropathy) leads to dialysis and/or kidney transplant. Uncontrolled (or poorly controlled) diabetes will likely eventually cause the kidneys to fail; theyll be unable to clean the blood like they should. To prevent diabetic nephropathy, you (or your child) should be tested every year for microalbuminuria, which is a condition thats an early sign of kidney problems. The test measures how much protein is in the urine. When the kidneys begin to have problems, they start to release too much protein.

Nerves: Nerve damage caused by diabetes is also known as diabetic neuropathy. The tiny blood vessels feed your nerves, so if the blood vessels are damaged, then the nerves will eventually be damaged as well. There are various types of diabetic neuropathy: peripheral, autonomic, proximal, and focal. Diabetic peripheral neuropathy is the most common form of nerve damage, and it most often affects the nerves going to the feet. People who have had type 1 diabetes for a very long time and who havent done well managing their blood glucose may lose sensation in their feet. They may also experience pain, weakness, or tingling. The most serious complication of diabetic peripheral neuropathy in the feet is that people may not realize when they have a sore on their foot. The sore can become infected, the infection can spread, and left untreated, the foot may need to have surgery to keep the infection from spreading more.

Macrovascular Complications: The Heart Type 1 diabetes can also affect the large blood vessels, causing plaque to eventually build up and potentially leading to a heart attack. To prevent heart disease as a result of diabetes, you should manage your diabetes well. However, you should also make heart-healthy choices in other areas of your life: dont smoke, keep your blood pressure under control, and pay attention to your cholesterol. These are the main complications, both short-term and long-term, that are associated with type 1 diabetes. By carefully controlling your blood glucose, you can prevent these complications.