Type 1 Diabetes

Diabetes mellitus (DM or, simply, diabetes) refers to a group of diseases that affect how your body uses sugar (glucose). Glucose comes from the foods you eat. Glucose is essential to health because it is an important source of energy for the cells that make up your muscles and tissues and it is the brain's main source of fuel. If you have diabetes, no matter what type, it means you have too much glucose in your blood. Too much glucose can lead to serious health problems, including damage to your eyes, kidneys, and nerves, heart disease, and stroke.

Insulin is a hormone that helps the glucose get into your cells to give them energy. With type 1 diabetes, your body does not make insulin. With type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood.

Type 1 diabetes can develop at any age, but it typically appears during childhood or adolescence. For this reason, type 1 diabetes was previously called “juvenile diabetes.”

A blood test can show if you have diabetes. The only treatment for type 1 diabetes is to take insulin for the rest of your life.

Diabetes symptoms vary depending on how much your blood sugar is elevated. Symptoms of type 1 diabetes include:

• being very thirsty
• urinating often
• feeling very hungry or tired
• losing weight without trying
• having sores that heal slowly
• having dry, itchy skin
• losing feeling in your feet or having tingling in your feet
• having blurry eyesight

The exact cause of type 1 diabetes is unknown. There is an autoimmune component to the disease and your immune system, which normally fights harmful bacteria or viruses, attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no insulin.

Type 1 is thought to be caused by a combination of genetic susceptibility and environmental factors, though exactly what many of those factors are is still unclear.

Several blood tests are used to screen for and diagnosis diabetes including:

• glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past 2 to 3 months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal.
• random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.
• fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
• oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes.

If type 1 diabetes is suspected, your urine will also be tested to look for the presence of a byproduct (ketones) that is produced when muscle and fat tissue are used for energy when the body does not have enough insulin to use the available glucose.

Type 1 diabetes is a serious disease. Proper type 1 diabetes management is composed of a handful of elements: blood glucose control and insulin management, exercise, nutrition, and support.

• Make a commitment to managing your diabetes. Learn all you can about diabetes. Establish a relationship with a diabetes educator, and ask your diabetes treatment team for help when you need it.
• Choose healthy foods and maintain a healthy weight. A healthy diet is one with plenty of fruits, vegetables, whole grains and legumes, with a limited amount of saturated fat.
• Make physical activity part of your daily routine. Regular exercise can help maintain better blood sugar control.

You should also:

• identify yourself. Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency and make sure your friends and loved ones know how to use it.
• schedule a yearly physical and regular eye exams. Your regular diabetes checkups are not meant to replace yearly physicals or routine eye exams. During the physical, your doctor will look for any diabetes-related complications and screen for other medical problems. Your eye care specialist will check for signs of retinal damage, cataracts and glaucoma.
• keep your vaccinations up to date. High blood sugar can weaken your immune system. Get a flu shot every year, and your doctor may recommend the pneumonia vaccine, as well. The Centers for Disease Control and Prevention (CDC) also currently recommends hepatitis B vaccination if you have not previously been vaccinated against hepatitis B and you are an adult ages 19 to 59 with type 1 or type 2 diabetes. The most recent CDC guidelines advise vaccination as soon as possible after diagnosis with type 1 or type 2 diabetes.
• pay attention to your feet. Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize with lotion, but not between the toes. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that does not heal promptly on its own.
• keep your blood pressure and cholesterol under control. Eating healthy foods and exercising regularly can go a long way toward controlling high blood pressure and cholesterol. Medication may be needed, too.
• take care of your teeth. Diabetes may leave you prone to serious gum infections. Brush and floss your teeth at least twice a day. Schedule regular dental exams. Consult your dentist right away if your gums bleed or look red or swollen.
• stop using tobacco products. If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications. Smokers who have diabetes are more likely to die of cardiovascular disease than are nonsmokers who have diabetes.
• drink alcohol in moderation. If you drink alcohol, do so responsibly. Alcohol can cause either high or low blood sugar, depending on how much you drink and if you eat at the same time. If you choose to drink, do so only in moderation and always with food. Remember to include the carbohydrates from any alcohol you drink in your daily carbohydrate count. And check your blood sugar levels before going to bed.
• take stress seriously. The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which will raise your blood sugar and stress you even more. Set limits for yourself and prioritize your tasks. Learn relaxation techniques and get plenty of sleep.

Long-term complications of diabetes develop gradually. The longer you have diabetes and the less controlled your blood sugar the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening. Possible complications include:

• cardiovascular disease. Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, and narrowing of arteries (atherosclerosis). If you have diabetes, you are more likely to have heart disease or stroke.
• nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in your legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves related to digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, it may lead to erectile dysfunction.
• kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters (glomeruli) that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which may require dialysis or a kidney transplant.
• eye damage (retinopathy). Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can develop serious infections, which often heal poorly. These infections may ultimately require toe, foot or leg amputation.
• skin conditions. Diabetes may leave you more susceptible to skin problems, including bacterial and fungal infections.
• hearing impairment. Hearing problems are more common in people with diabetes.

Treatment for type 1 diabetes involves insulin injections or the use of an insulin pump, frequent blood sugar checks, and carbohydrate counting.

Depending on your treatment plan, you may check and record your blood sugar as often as several times a week to as many as four to eight times a day. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. People who receive insulin therapy also may choose to monitor their blood sugar levels with a continuous glucose monitor. Although this technology does not yet replace the glucose meter, it can provide important information about trends in blood sugar levels.

Even with careful management, blood sugar levels can sometimes change unpredictably. With help from your diabetes treatment team, you will learn how your blood sugar level changes in response to food, physical activity, medications, illness, alcohol, stress, and, especially for women, fluctuations in hormone levels.

In addition to daily blood sugar monitoring, your doctor will likely recommend regular A1C testing to measure your average blood sugar level for the past two to three months. Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working overall. An elevated A1C level may signal the need for a change in your insulin regimen or meal plan. Your target A1C goal may vary depending on your age and various other factors. However, for most people with diabetes, the American Diabetes Association recommends an A1C of below 7 percent. Ask your doctor what your A1C target is.

Many types of insulin are available, including:

• rapid-acting insulin such as lispro (Humalog), aspart (Novolog), glulisine (Apidra)
• short-acting insulin such as Regular humulin or novolin, or Velosulin
• long-acting insulin such as insulin glargine (Lantus), insulin detemir (Levemir), and insulin degludec (Tresiba)
• intermediate-acting insulin such as NPH

Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night.

Several pre-mixes of insulin are available including:

• Humulin 70/30
• Novolin 70/30
• Novolog 70/30
• Humulin 50/50
• Humalog mix 75/25

Insulin is usually injected using a fine needle and syringe or an insulin pen — a device that looks like a large ink pen. An insulin pump may also be an option. The pump is a device about the size of a cellphone worn on the outside of your body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of your abdomen. A tubeless pump that works wirelessly is also now available. You program an insulin pump to dispense specific amounts of insulin. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.