Type 1 diabetes is a chronic condition where your body doesn’t produce enough insulin to regulate blood sugar levels properly. Without enough insulin, sugar builds up in the bloodstream, leading to various health issues. Let’s dive deeper into what Type 1 diabetes is all about, including its causes, symptoms, diagnosis, treatments, medications, surgeries, preventions, and when to seek medical help.
Type 1 diabetes is a lifelong condition where your body’s immune system attacks and destroys the cells in the pancreas responsible for producing insulin. Insulin is crucial for regulating blood sugar levels. Without enough insulin, sugar can’t enter your cells, causing high blood sugar levels, which can lead to serious health complications.
Type 1 diabetes mellitus (T1DM) is an autoimmune disease that leads to the destruction of the insulin-producing pancreatic beta cells. Insulin is an essential anabolic hormone that exerts multiple effects on glucose, lipid, protein and mineral metabolism, as well as growth. Importantly, insulin allows glucose to enter muscle and adipose cells, stimulates the liver to store glucose as glycogen and synthesize fatty acids, stimulates the uptake of amino acids, inhibits the breakdown of fat in adipose tissue, and stimulates the uptake of potassium into cells. People with T1DM require life-long insulin replacement therapy. Without insulin, diabetic ketoacidosis (DKA) develops and is life-threatening.[rx][rx]
Types of Diabetes
There are mainly two types of diabetes: Type 1 and Type 2. Type 1 diabetes typically develops during childhood or adolescence, whereas Type 2 diabetes is more common in adults and is often associated with lifestyle factors like diet and exercise.
Causes of Type 1 Diabetes
The exact cause of Type 1 diabetes isn’t fully understood, but it’s believed to involve a combination of genetic and environmental factors. Some possible causes include:
- Genetics: You may have a higher risk of developing Type 1 diabetes if you have a family history of the condition.
- Autoimmune Response: Your immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas.
- Environmental Triggers: Certain viruses or environmental factors may trigger the autoimmune response in susceptible individuals.
In the islets of Langerhans in the pancreas, there are two main subclasses of endocrine cells: insulin-producing beta cells and glucagon secreting alpha cells. Beta and alpha cells are continually changing their levels of hormone secretions based on the glucose environment. Without the balance between insulin and glucagon, the glucose levels become inappropriately skewed. In the case of DM, insulin is either absent and/or has impaired action (insulin resistance), and thus leads to hyperglycemia.
T1DM is characterized by the destruction of beta cells in the pancreas, typically secondary to an autoimmune process. The result is the absolute destruction of beta cells, and consequentially, insulin is absent or extremely low.
T2DM involves a more insidious onset where an imbalance between insulin levels and insulin sensitivity causes a functional deficit of insulin. Insulin resistance is multifactorial but commonly develops from obesity and aging.
The genetic background for both types is critical as a risk factor. As the human genome gets further explored, there are different loci found that confer risk for DM. Polymorphisms have been known to influence the risk for T1DM, including major histocompatibility complex (MHC) and human leukocyte antigen (HLA).[1]
T2DM involves a more complex interplay between genetics and lifestyle. There is clear evidence suggesting that T2DM is has a stronger hereditary profile as compared to T1DM. The majority of patients with the disease have at least one parent with T2DM.[2]
Monozygotic twins with one affected twin have a 90% likelihood of the other twin developing T2DM in his/her lifetime.[3] Approximately 50 polymorphisms to date have been described to contribute to the risk or protection for T2DM. These genes encode for proteins involved in various pathways leading to DM, including pancreatic development, insulin synthesis, secretion, and development, amyloid deposition in beta cells, insulin resistance, and impaired gluconeogenesis regulation. A genome-wide association study (GWAS) found genetic loci for transcription factor 7-like 2 gene (TCF7L2), which increases the risk for T2DM.[4][5] Other loci that have implications in the development of T2DM include NOTCH2, JAZF1, KCNQ1, and WFS1.[6][7]
MODY is a heterogeneous disorder identified by non-insulin-dependent diabetes diagnosed at a young age (usually under 25 years). It carries an autosomal dominant transmission and does not involve autoantibodies as in T1DM. Several genes have implications in this disease, including mutations to hepatocyte nuclear factor-1-alpha (HNF1A) and the glucokinase (GCK) gene, which occurs in 52 to 65 and 15 to 32 percent of MODY cases, respectively.[8][9] The genetics of this disease are still unclear as some patients have mutations but never develop the disease, and others will develop clinical symptoms of MODY but have no identifiable mutation.
Gestational diabetes is essentially diabetes that manifests during pregnancy. It is still unknown why it develops; however, some speculate that HLA antigens may play a role, specifically HLA DR2, 3, and 4. Excessive proinsulin is also thought to play a role in gestational diabetes, and some suggest that proinsulin may induce beta-cell stress. Others believe that high concentrations of hormones such as progesterone, cortisol, prolactin, human placental lactogen, and estrogen may affect beta-cell function and peripheral insulin sensitivity.[10]
Several endocrinopathies, including acromegaly, Cushing syndrome, glucagonoma, hyperthyroidism, hyperaldosteronism, and somatostatinomas, have been associated with glucose intolerance and diabetes mellitus, due to the inherent glucogenic action of the endogenous hormones excessively secreted in these conditions. Conditions like idiopathic hemochromatosis are associated with diabetes mellitus due to excessive iron deposition in the pancreas and the destruction of the beta cells.
Symptoms of Type 1 Diabetes
Recognizing the symptoms of Type 1 diabetes is crucial for early diagnosis and treatment. Common symptoms include:
- Frequent Urination: You may need to urinate more often than usual, especially at night.
- Increased Thirst: Excessive thirst is a common symptom as your body tries to compensate for fluid loss from frequent urination.
- Unexplained Weight Loss: Despite eating more, you may experience unexplained weight loss due to the body’s inability to utilize sugar for energy.
- Fatigue: Feeling tired or lethargic is common as your body struggles to convert sugar into usable energy.
- Blurred Vision: High blood sugar levels can affect the fluid levels in your eyes, leading to blurred vision.
Diagnostic Tests for Type 1 Diabetes
Diagnosing Type 1 diabetes typically involves a combination of medical history, physical examinations, and laboratory tests. Common diagnostic tests include:
- Blood Glucose Test: Measures your blood sugar levels at a given time.
- Glycated Hemoglobin (A1C) Test: Provides an average blood sugar level over the past two to three months.
- Autoantibody Test: Detects antibodies that attack insulin-producing cells in the pancreas.
Treatments for Type 1 Diabetes
Managing Type 1 diabetes involves maintaining blood sugar levels within a target range to prevent complications. Treatment options include:
- Insulin Therapy: The mainstay of treatment involves injecting insulin to replace the hormone your body can’t produce.
- Healthy Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can help regulate blood sugar levels.
- Regular Exercise: Physical activity can improve insulin sensitivity and help control blood sugar levels.
- Continuous Glucose Monitoring (CGM): CGM devices track blood sugar levels throughout the day, providing real-time data to adjust insulin doses.
Current Guidelines
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When glycosuria/hyperglycemia is noted, consult with an endocrinologist
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Differentiate between type 1 and type 2 disease
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Children usually require intense insulin regimens, with multiple daily injections
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Assess A1c every 3 months
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The blood glucose should be monitored 5-10 times every day
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Continuous blood glucose monitors should be recommended for children
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Monitor for ketones when the child is ill or has an infection
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Optimize nutrition
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Daily exercise for 60 mins is recommended; check blood glucose before and after exercise to detect hypoglycemia and hyperglycemia
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Remain compliant with medication; insulin omission is a leading cause of DKA
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Screen for albuminuria after age 10
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Ensure the child has annual eye exams at age 10 and annually thereafter
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Monitor BP; of high use ACE inhibitors
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Monitor LDL cholesterol and if abnormal, treat with diet; if that fails, use a statin.
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Maintain A1C to less than 7.5%
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Carry sugar snacks in case of hypoglycemia
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Monitor thyroid function if there is growth variability
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Screen for celiac disease
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Educate about harms of smoking
Medications for Type 1 Diabetes
In addition to insulin therapy, some medications may help manage Type 1 diabetes, including:
- Glucagon: Used to treat severe hypoglycemia (low blood sugar) episodes.
- Amylin Analogues: Mimic the hormone amylin, which helps control blood sugar levels.
- SGLT2 Inhibitors: Help lower blood sugar levels by increasing glucose excretion in the urine.
Surgeries for Type 1 Diabetes
While surgery isn’t a primary treatment for Type 1 diabetes, some procedures may be beneficial in certain cases, including:
- Pancreas Transplant: Involves replacing a diseased pancreas with a healthy one from a donor.
- Islet Cell Transplant: Transplants insulin-producing cells into the pancreas from a deceased donor.
Preventions for Type 1 Diabetes
Unfortunately, there’s no known way to prevent Type 1 diabetes since it’s largely an autoimmune condition. However, maintaining a healthy lifestyle may reduce your risk of complications.
When to See a Doctor
If you experience any symptoms of Type 1 diabetes, it’s essential to see a doctor promptly for evaluation and diagnosis. Early detection and treatment can help prevent complications and improve long-term outcomes.
In conclusion, Type 1 diabetes is a chronic condition that requires lifelong management. By understanding its causes, symptoms, diagnosis, and treatment options, individuals with Type 1 diabetes can effectively manage their condition and lead healthy, fulfilling lives. If you suspect you or someone you know may have Type 1 diabetes, don’t hesitate to seek medical advice for proper evaluation and care.