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Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus

Alternate Names

  • insulin-dependent diabetes mellitus
  • IDDM
  • type 1 diabetes mellitus
  • Pancreas
  • Diabetic foot ulcer
  • Corns and Calluses
  • Diabetic retinopathy

Definition

Diabetes mellitus (more simply, "diabetes") comes in two types (1 and 2) which really are very different diseases, called by the same name only because both feature abnormally high blood sugar and its consequences. Type 1 is the less common of the two diseases.

What is going on in the body?

Glucose is a key source of energy for the cells of the body. When a person eats, the pancreas makes extra insulin to move glucose from the bloodstream into the cells, where it is converted to energy. In type 1 diabetes, the body's immune system attacks the cells in the pancreas (a long, thin organ behind the stomach) responsible for producing insulin.
As a result, a person with type 1 diabetes does not make enough insulin to move the glucose into the cells. The amount of glucose in the blood rises to an abnormal level. This condition, known as hyperglycemia, causes damage to the body, if left untreated.

Risks

What are the causes and risks of the disease?

The underlying cause of type 1 diabetes is damage resulting because the person's immune system produces antibodies against the cells in the pancreas responsible for producing insulin. As a result, the pancreas can no longer make enough insulin to meet the body's needs. Why this occurs in some people and not others is not fully understood.. Experts believe that some people have a genetic predisposition to type 1 diabetes. In these people, a trigger, such as a virus, an environmental factor, or some type of toxin, occurs which sets off the antibody response.
Type 1 diabetes accounts for only 5% to 10% of cases of diabetes mellitus diagnosed in the United States. The condition is rare in most Asian, African, and American Indian populations but more common in Caucasians. It is also more common in children and in adults younger than 30 years old, although it can appear at any age. It is most often diagnosed in young, thin individuals.
Type 1 diabetes is rare in most Asian, African, and American Indian populations but more common in Caucasians. It is also more common in children and in adults younger than 30 years old, but it can appear at any age. It is most often diagnosed in young, thin individuals.

Prevention

What can be done to prevent the disease?

Recently, as risk factors for type 1 diabetes have become better understood, scientists have begun looking into promising new ways to prevent type the condition in people at highest risk.

Diagnosed

How is the disease diagnosed?

A medical history and physical exam often lead a doctor to suspect type 1 diabetes. Diabetes is diagnosed on the basis of a high glucose level in the blood.
A blood sample can be measured at a random time or after an 8-hour fast. After an 8-hour fast, the normal blood glucose level is less than 100 mg/dL, or milligrams per deciliter. A fasting blood sugar (FBS) level of 126 mg/dL or higher on two separate days usually indicates diabetes.
When blood is taken randomly or without fasting first, a blood glucose level of 200 mg/dL or higher on two separate days usually indicates diabetes.
Additional blood tests can help distinguish between type 1 diabetes and other types of diabetes. The level of ketones, for example, can be measured. Ketones are usually elevated only in type 1 diabetes.

Long Term Effects

What are the long-term effects of the disease?

Some of the long-term effects of type 1 diabetes include:
  • atherosclerosis, also known as hardening of the arteries, which can lead to heart attacks and strokes
  • autonomic neuropathy, which may cause digestion problems, erectile dysfunction in males, and low blood pressure
  • bacterial infections of the skin
  • diabetic retinopathy, damage to the retina of the eye that can cause blindness
  • increased risk of dying from coronary heart disease, known as CHD
  • diabetic nephropathy, damage to the kidneys that can lead to kidney failure
  • fungal infections like ringworm and athlete's foot
  • peripheral neuropathy, or damage to nerves in the limbs, which can cause serious infections that may require amputation
  • urinary tract infections
  • vaginal yeast infections, because high levels of blood glucose encourage the growth of yeast
Coma or death may occur as a result of diabetic ketoacidosis. In addition, smoking greatly increases the risk of getting many of these long-term effects. People with diabetes who smoke are a much higher risk for heart attacks, strokes, infections, and problems with circulation.

Other Risks

What are the risks to others?

Diabetes is not contagious and poses no risk to others. Type 1 diabetes can sometimes run in families.

Treatments

What are the treatments for the disease?

Treatment for type 1 diabetes is focused on controlling blood glucose levels using insulin given as a medication. It can be injected under the skin a certain number of times per day, or may be given with an insulin pump. Home blood glucose monitoring is also used to help guide dose adjustments. There are many types of insulin. The doctor can help decide what will work best for each person. Insulin levels must be balanced with meals, daily activities, stress, and illness, as all of these can affect the glucose level in the blood.
Treatment also includes following a proper diet for people with diabetes and getting the right amount of exercise. Less often, treatment may require a pancreas transplant, which may get rid of the symptoms of type 1 diabetes. Careful monitoring and management helps keep diabetes under control and can reduce long-term effects.
People who have type 1 diabetes can help manage it by following these steps:
  • Adjust for blood sugar levels when sick or stressed.
  • Have regular visits with a doctor.
  • Know the symptoms of hypoglycemia, which is also called low blood glucose, and how to treat it.
  • Monitor blood glucose levels at home.
  • Perform proper skin care and foot care and get regular eye examinations.
  • Plan meals and eat the right diet for a person with diabetes.
  • Take all medicines, including insulin, exactly as prescribed by the doctor.
Treating the complications of diabetes may involve several specialists. For example, eye, heart, foot, hormone, and circulation specialists may be needed. Dietitians can help people with diabetes set up an eating plan with suggestions for calorie intake and types of foods to eat.

Side Effects

What are the side effects of the treatments?

Too much insulin in the body means blood glucose levels can drop too low. This condition is known as hypoglycemia. It can cause nervousness, shakiness, and confusion. When these symptoms occur, the person needs to eat or drink something sweet right away to get his or her glucose level back up. If the individual passes out or has spasms or seizures, immediate medical attention is needed.
Side effects of other treatments depend on the treatment used. A pancreas transplant is a major operation. Like all major surgeries, it can be complicated by bleeding, infection, or an allergic reaction to the anesthetic. To prevent rejection of the new pancreas, powerful medicines with many side effects have to be taken for a long time.

After Treatment

What happens after treatment for the disease?

Treatment of diabetes lasts a lifetime. Type 1 diabetes cannot usually be cured, but it can be controlled with careful management and treatment. Any complications that do occur must be treated promptly.

Monitor

How is the disease monitored?

Monitoring type 1 diabetes is a lifelong process. People with type 1 diabetes should check their blood glucose at least 3 times a day at home with a finger-stick blood glucose test. There are portable devices on the market that can measure blood glucose at home. Blood tests, urine tests, foot and skin exams, eye exams, and visits with specialists are all part of routine monitoring for diabetes. Any new or worsening symptoms should be reported to the doctor.

Sources

[hyperLink url="http://www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover.htm/" linkTitle="www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover.htm"]www.niddk.nih.gov/health/diabetes/pubs/dmover/dmover.htm[/hyperLink]

[hyperLink url="http://www.diabetes.org/" linkTitle="www.diabetes.org"]www.diabetes.org[/hyperLink]

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