Detailed information on conditions: Type 1 diabetes
Type 1 diabetes is a disorder normally caused by the autoimmune destruction of insulin-secreting pancreatic cells, making the body unable to produce enough insulin to meet their needs. Insulin is a hormone produced by the pancreas that allows the body to use sugar (glucose) as energy. Without insulin, the glucose in the food you eat can not enter the cells. This causes the accumulation of glucose in the blood, whereby the cells and tissues of the body do not receive energy. While several transplant techniques are being developed and some genetic treatments have been proposed, at this time, the only treatments widely available for type 1 diabetes are insulin injections and insulin inhalation.
The American Diabetes Association estimates that 500,000 to 1 million people in the United States have type 1 diabetes. Usually, diabetes Type 1 begins in childhood and youth, between 8 and 12 years of age. Before it was called juvenile diabetes, but the name was changed to diabetes mellitus type 1, since both children and adults can suffer from this disease. The latter is called adult latent autoimmune diabetes (DALA).
In the United States, type 1 diabetes is one of the most diagnosed chronic diseases in children. According to the International Juvenile Diabetes Research Foundation in the United States, approximately 30,000 cases of type 1 diabetes are diagnosed each year, of which more than 13,000 correspond to children (35 children per day).
Type 1 diabetes is caused by the immune system that attacks and destroys the cells that produce insulin (beta cells) in the pancreas. Among people with a genetic predisposition to this disease, exposure to environmental factors can trigger the response of the immune system. The exact cause is unknown. The trigger can be a virus, a food, a chemical or a medicine.
Type 1 diabetes can also manifest itself due to other medical conditions. It can manifest in:
- People with type 2 diabetes, who no longer produce insulin.
- Some people with chronic pancreatitis or undergoing pancreatic surgery. They can lose the cells that produce insulin.
- People cystic confibrosis.
The key to controlling diabetes is maintaining the blood sugar level (fasting and after meals) within the normal range. This is achieved through the combination of insulin treatment, diet and exercise. When blood sugar levels are not within the ideal range, diabetes can cause the following problems:
- High blood sugar (hyperglycemia)
- Low blood sugar (hypoglycaemia), as a result of excess insulin
- Diabetic retinopathy, one of the leading causes of blindness
- Diabetic nephropathy, which can lead to kidney failure
- Heart disease
- Diabetic neuropathy, which can lead to amputations
- Erectile dysfunction
- Peripheral arterial disease of the lower extremities
- Early death
Risk factors for type 1 diabetes
A risk factor is something that increases your chances of getting a disease or condition. Type 1 diabetes may occur with or without the risk factors listed below. No defined risk factors are known. However, the more risk factors you have, the more likely you are to have type 1 diabetes. The main risk factors are:
If one of your parents or one of your siblings has type 1 diabetes, you (or your child) are at higher risk of suffering from it. Scientists continue to believe that genetic factors influence the onset of type 1 diabetes, but it is unclear what the genes involved are.
Type 1 diabetes is an autoimmune disease that appears because the body's immune system attacks and destroys the cells of the pancreas that produce insulin. You may have a higher risk of getting type 1 diabetes if you have another condition that affects the immune system, such as:
- Hashimoto's disease
- Graves' disease
- Addison's disease
- Pernicious anemia
- Celiac disease
- systemic lupus erythematosus
- Rheumatoid arthritis
- Crohn's Disease
- Virus: mumps, hepatitis, cytomegalovirus
- Ethnic origin
You have a higher risk of type 1 diabetes if you belong to the following ethnic groups:
- North of Europe
- African American
- Native peoples of the States United
Other risk factors
Other factors that may increase the risk of type 1 diabetes in your child include:
- Cystic fibrosis
- Bottle feeding or short breastfeeding
- High birth weight
- Obesity during childhood
- Mother's age at the time of delivery (more than 35 years)
Diabetes Diagnosis Type 1
The doctor will ask about your symptoms, medical and family history, and perform a physical exam. He will also perform some laboratory tests. There are three main tests used to diagnose diabetes. A diagnosis is made based on the symptoms, combined with a positive result in one or more of these three tests and a second positive test on a different day.
The exams are:
Random Plasma Glucose Test – This is taken at any time of the day, regardless of when you have eaten for the last time. A sample of your blood is taken and the blood glucose level is measured. A measure of 200 milligrams per deciliter (mg / dl) is considered a positive result.
Fasting Plasma Glucose Test – This is considered a more accurate test. You will need to fast for eight hours before performing this test. A sample of your blood is taken and the blood glucose level is measured. In this test, a measurement of 126 mg / dl is a positive result.
Two Hour Glucose Tolerance Test (OGTT) – After 3 days of consuming a diet consisting of at least 150 grams of carbohydrates, you will be asked to fast overnight (between 8 and 16 hours) . Usually, this test is done in the morning, in your doctor's office.
A sample of your blood will be obtained to measure the blood sugar level. Next, you will consume a beverage that contains 75 grams of glucose dissolved in water. Two hours later, another blood sample will be obtained to measure blood sugar. If you have diabetes, your blood sugar level will rise above normal and remain elevated for much longer than normal. A measure of 200 milligrams per deciliter (mg / dl) or above at two hours is considered a positive test. Because this test is uncomfortable, some experts recommend that it not be used routinely.
Other Commonly Ordered Exams – After the diagnosis of diabetes is confirmed, your doctor will most likely order the following tests:
- glycosylated hemoglobin (HbA1c) – a test that measures how well your blood sugar is controlled in 2-3 Previous months
- Microalbumin in urine – to see if there is any damage to your kidneys
- Thyroid function tests
- Blood lipid levels (total cholesterol, LDL and HDL cholesterol, triglycerides)
- Kidney function tests including serum creatinine and potassium
- Others Less frequently ordered tests – These tests may include: plasma insulin levels, islet cell antibodies, and plasma C-peptide.
Treatments for Type 1 Diabetes
Type 1 diabetes is a chronic disease that has no cure; at least for now. However, it can be controlled with proper treatment. The goal of treatment for diabetes is to maintain blood sugar levels before and after food within a healthy range. By doing this, you will feel better daily and help prevent or delay the complications of diabetes. Talk to your doctor about what is a healthy range of blood sugar for you.
The four main components of the treatment are:
- Blood glucose monitoring
Review for Type 1 Diabetes
The purpose of the review is early diagnosis and treatment. Screening tests are usually given to people without current symptoms, but who may be at high risk for certain diseases or conditions.
Random Plasma Glucose Test – As part of your routine physical exam, your doctor may remove some blood to check several clinical parameters, including blood glucose. A measurement of 200 milligrams per deciliter (mg / dL) or higher indicates that you may have type 1 diabetes. In this case, your doctor will do additional tests to determine if you (or your child) have type 1 diabetes.
Islet Cell Antibodies – Increasing evidence shows that islet cell antibodies appear in the blood long before the development of diabetes symptoms. In many cases, these antibodies seem to increase a relatively slow attack on the pancreas, which, if detected early, may prove that it can be stopped. Although the evidence currently does not support the review for islet cell antibodies, as new treatments are developed to prevent the attack of these antibodies on the pancreas, it is likely that the review will take on more importance.
There are no review guidelines for type 1 diabetes.
Complications of type 1 diabetes
When blood glucose levels are outside normal values, they generate complications. These may include:
In the short term:
- Diabetic ketoacidosis
- Peripheral artery disease
- Diabetic foot ulcers
- Diabetic retinopathy
- Diabetic nephropathy
- Cardiovascular disease
- Diabetic neuropathy
Yes Diabetes is strictly controlled, the risks of complications can be reduced.
Hypoglycemia is a low blood sugar level, usually between 50 and 60 milligrams per deciliter (mg / dl) or 2.8 to 3.3 millimoles per liter (mmol / l). It can be caused by any of the following circumstances:
- Consume too much insulin in relation to the amount of food you eat.
- Eat too much insulin to treat fasting blood sugar.
- Skip a meal or eat portions smaller than usual without reducing the insulin dose.
- Do more physical activity or for longer than usual without lowering the insulin dose.
Symptoms of Hypoglycemia
Hypoglycaemia can be managed quite easily if you can recognize the symptoms and treat them immediately. Symptoms of hypoglycemia include the following:
- Accelerated heartbeat
Sudden ill humor or behavior changes, such as crying for no apparent reason.
- Clumsy or erratic movements
- Confusion or difficulty paying attention
- Tingling around the mouth
- Loss of consciousness that results in a coma
If you think you are hypoglycemic, check with the blood glucose monitor. Treat hypoglycemia if the blood glucose level is below the normal range. (If you do not know your normal blood sugar range, ask your doctor). Or, if you recognize the symptoms of hypoglycemia, you could treat it without waiting for the test.
If you have just started treatment, you may experience some of these symptoms when your blood sugar level is near the range that is normal for you. This is called relative hypoglycemia. This happens because the body is adapting from a high blood sugar level to a lower normal level. In this case, it is important to control the values if you have any of these symptoms. If you control your blood sugar level, you can avoid getting treated with normal levels.
If you have been diabetic for a long time or have frequent hypoglycemia, you may lose the ability to experience hypoglycemia with these symptoms. This is called asymptomatic hypoglycemia. Is very dangerous. With the authorization of your doctor, you should also check the level of sugar before driving or working with machinery to preserve safety.
Treatment of Hypoglycemia
The goal of treating hypoglycemia is to rapidly raise blood glucose levels to a normal range. For this, you should eat or drink some form of sugar, such as:
One or two glucose tablets or the equivalent of glucose gel
- Four ounces of fruit juice or soda (15 g of carbohydrates). In general, 15 g of carbohydrates raise the blood sugar level by 25 to 50 mg / dl (1.4 to 2.8 mmol / l).
- Three graham crackers (15 g of carbohydrates)
- Five or six hard candies
Always carry some form of medical alert identification. It will alert others that you are diabetic.
To treat hypoglycemia immediately, you should always carry some type of sugar with you.
Wait ten to fifteen minutes after ingesting sugar and then check the glucose level again. If it is still low, repeat the treatment.
If you faint because of hypoglycaemia or do not respond to the intake, you need urgent treatment. It can be an injection of glucagon. Glucagon is a hormone that raises the blood sugar level. Ask your doctor for a prescription, so that you always have it at hand. Also, teach your family and coworkers how to administer glucagon. If you do not get glucagon, you should be taken to the hospital for emergency treatment. Once it has been treated satisfactorily, you must identify the reasons that caused the condition to know how to prevent a recurrence.
Hyperglycemia is high blood sugar. Prolonged hyperglycemia is the main cause of many of the long-term complications that diabetics suffer (discussed below), although short-term hyperglycemia can cause a life-threatening condition called diabetic ketoacidosis. Hyperglycemia occurs when the person does not have enough insulin to get rid of the body's glucose. It can be caused by any of the following circumstances:
Take too little insulin for the foods you eat Eat without taking insulin Eat a larger portion than usual without adjusting the insulin dose Do more or less exercise than planned without adjusting the insulin dose Having stress from an illness or factors of daily life (it may be necessary to adjust the insulin dose)
Hyperglycaemia should be treated immediately to avoid further complications. Ask your doctor about how often sugar should be controlled.
Symptoms of hyperglycemia
High levels of sugar in the urine (ask your doctor if you must control urine) Frequent urination (polyuria) Increased thirst (polydipsia) Blurred vision If hyperglycemia is not treated properly, it can lead to ketoacidosis. When insulin is insufficient, blood sugar levels increase and the body begins to metabolize stored fatty acids. The byproducts of fat metabolism are ketone bodies, which are acids that accumulate in the blood and can be toxic.
Treatment of hyperglycemia
If the blood sugar level is usually high for more than a few hours, have a urine test to measure the ketones, for which you should use a urine ketone kit. If you have ketones, you should consult the doctor immediately or follow a previously agreed plan to treat the condition. In most cases, the treatment for the high level of sugar and ketones in urine will be to administer a larger amount of insulin and increase water consumption.
If you have frequent hyperglycemia, ask your doctor about the best way to prevent it. It may be necessary to adjust your diet and insulin administration regimen.
People with type 1 diabetes can manifest ketoacidosis, a serious condition that rarely occurs in people with type 2 diabetes. If the body does not get enough insulin, the sugar can not reach the cells for energy. When this happens, the body begins to metabolize stored fat for energy. The byproducts of fat metabolism are ketone bodies, which are acids that accumulate in the blood and can cause ketoacidosis. The most common reasons for the body to generate ketones are generally the same as for hyperglycemia, to which the following are added:
Take too little insulin when you have an infection; the body may need more insulin. This is the scenario in which ketoacidosis usually occurs. symptom
Signs and symptoms that indicate ketoacidosis include:
- Elevated levels of ketones in the urine or blood Breath smelling of fruit Abdominal pain Nausea and vomiting
- Dry mouth or other signs of dehydration Fatigue Reduced mental function and alertness Dyspnea Coma Treatment
In general, ketoacidosis is treated with more insulin and fluids. They may need to be given intravenous fluids.
Ask your doctor for a plan about when to measure and check ketones. Ketoacidosis is a life-threatening condition and requires immediate medical treatment.
Chronic hyperglycemia, as well as hypertension, can damage small blood vessels in the retina of the eye. Diabetes is the most common cause of blindness in people between 20 and 60 years of age in the United States. This damage, called diabetic retinopathy, usually occurs after a long time. Signs of eye damage include:
Double or blurred vision Rings, dazzling lights or white dots Dark or floating spots Pain or pressure in one or both eyes Difficulty seeing things outside the corners of the eyes Some people have no symptoms until the damage is considerable. Therefore, it is essential that you regularly consult your ophthalmologist to undergo a dilated pupil examination once a year, at a minimum. Diabetic retinopathy can be treated with laser therapy, called photocoagulation, or surgery. Stopping smoking and controlling high blood pressure are also important preventive measures.
Other eye conditions occur almost twice as often and at an earlier age in people with type 1 diabetes than in people without this disease. Cataracts and glaucoma appear. A cataract is a cloud over the lens of the eye. The lens, which is usually transparent, focuses light on the retina, but a cataract makes the vision blurry. This condition can be treated with surgery.
Glaucoma is caused by increased pressure in the eye, which damages the main nerve of the eye: the optic nerve. The damage first causes loss of vision from the sides of the eyes. If left untreated, glaucoma can cause blindness. Glaucoma can be treated with special drops for the eyes or laser surgery.
High blood sugar and high blood pressure damage the glomeruli of the kidneys, which are responsible for filtering waste from the blood. This damage allows proteins to be filtered out of the glomeruli and the waste, which should be eliminated with urine, to accumulate in the blood. The presence of small amounts of protein in the urine is called microalbuminuria. Your doctor will instruct you to have a urinalysis every year to monitor this situation. Two classes of drugs, the angiotensin convertase enzyme inhibitors and the angiotensin II receptor antagonists, can reduce the passage of proteins into the urine and delay the manifestation of diabetic nephropathy.
As the damage continues, more proteins are filtered and more debris accumulates. The presence of higher amounts of protein in the urine is called proteinuria or macroalbuminuria. In the long run, this damage can progress to kidney failure, a condition that requires dialysis or a kidney transplant. Restricting protein consumption in diabetic patients with chronic renal failure can reduce mortality rates.
People with type 1 diabetes are more likely to suffer from cardiovascular disease and die from it than non-diabetic people.
Diabetes can cause an increase in blood cholesterol levels, which clogs or narrows the arteries (atherosclerosis). Clogged arteries make it difficult to transport oxygen and other essential nutrients through the blood to vital organs and tissues, such as the heart, and can cause:
Chest pain (also called angina): This sensation of pain or pressure usually begins in the chest and radiates to the arm and may worsen when doing physical activity or after a large meal. People with long-standing diabetes may not feel chest pain. They have to be alert to other symptoms, such as sudden weakness or difficulty breathing. Heart attack: caused by the blockage of a blood vessel that carries oxygen and other essential nutrients to the heart. When part of the heart muscle does not get the nutrients it needs to function, it stops working. Symptoms include chest pain or a feeling of pressure, nausea, indigestion, extreme weakness and sweating. The symptoms may be more evident in patients with chronic diabetes.
Cardiomyopathy: it is a weakening of the heart muscle caused by the narrowing of small blood vessels throughout the heart. Peripheral arteriopathy (AP) of the lower extremities: the blood flow to the lower part of the body is reduced, which causes other problems such as pain, fatigue, tingling, swelling or muscle weakness. Complications of PA increase the risk of other cardiovascular disorders and functional disability.
Type 1 diabetes makes the patient 2 to 4 times more likely to suffer a stroke. A stroke is caused by a blockage in the blood flow to the brain. The effects of a stroke depend on the part of the brain that is damaged and could include:
- Sudden weakness or numbness of the face, arm or leg on one side of the body
- Sudden confusion, difficulty speaking or understanding
- Sudden onset of dizziness, loss of balance or trouble walking
- Sudden difficulty in seeing one or both eyes or sudden double vision Pain of sudden and intense head.
Many people with diabetes have mild to severe forms of nerve damage, called diabetic neuropathy. Having a high blood sugar for many years can damage the blood vessels that carry oxygen to the nerves. A high level of blood sugar can also hurt the lining of the nerves. Damaged nerves may stop sending messages or send them too slowly or at inappropriate times.
The nervous damage caused by diabetes could manifest as:
- Numbness, tingling or burning sensation in the hands and feet.
- Erectile dysfunction
- Diabetic foot ulcers as a result of loss of sensitivity
- Decrease in blood pressure when standing up
- Diarrhea at night
- Difficulty swallowing
- Neurogenic bladder with dribbling, weak flow of urine or difficulty in starting urination
- Transpiration after meals
The feet are especially vulnerable to the effects of type 1 diabetes. Damage to the peripheral nerves, which lead to the arms, hands, legs and feet, can affect sensitivity to stimuli such as pain, heat and cold. In addition to nerve damage, type 1 diabetes can also cause a reduction in blood flow. If you have a blister or ulcer on your foot, you may not feel it because of the neuropathy. And because of poor blood flow, this ulcer may not heal and have a higher risk of infection. In severe cases, this nerve damage can result in foot and leg amputations. Therefore, it is essential to wash and examine your feet daily. Remember to take off your socks and shoes when you go to the doctor's office, so you can check your feet.
If you are very prone to developing foot ulcers, controlling the temperature of your feet (with an infrared thermometer for your skin) can reduce the number of ulcers. You can purchase a product such as the TempTouch thermometer.
Mitigate the risk of complications
Submit to regular checkups
Often, doctors can detect early signs of complications. Perhaps most importantly, most of the complications listed above can be prevented if the recommended standards for diabetes care are followed.
If you have had diabetes for many years, your doctor may recommend that you do the following:
- A frequent check (every three to six months) of the glycohemoglobin (Hba1c) to ensure that the treatment is effective.
- An annual eye exam with drops to dilate the pupils. A periodic examination of the feet with a nylon 'monofilament' to determine that the sensitivity is normal.
- A urinalysis every year to detect microalbuminuria.
- Strict control of blood pressure, low-density lipoproteins (LDL) and triglycerides to reduce the long-term risk of heart disease and stroke.
- Consult the doctor to know what are the correct values in your case.
- Get vaccinated every year against the flu and periodically against pneumococci to reduce the risk of pneumonia.
- Depending on your age and risk factors, take a low dose of aspirin every day.
- Unfortunately, many patients do not adhere to these standards. As a result, the complication rates related to diabetes are higher than they should be.
Strive to keep your blood sugar level within a healthy range
It is very important that you know what these normal ranges are regarding:
Blood sugar levels Blood pressure levels Work with your doctor to determine the healthy ranges in your case.
If you have any of these warning signs, contact your doctor immediately:
- Vision problems, such as blurred or blotchy vision Tiredness Paleness Numbness or tingling in the hands or feet
- Repeated infections or slow healing of wounds Chest pain Vaginal itching Permanent headaches Cuts or blisters on the feet
Reducing Your Risk of Type 1 Diabetes
For most people at 'normal' risk of developing diabetes, there are no known ways to reduce their risk. However, if you already have diabetes, you can reduce your risk of complications from this disease by keeping your blood sugar levels within a normal range. This is done through a combination of insulin, a healthy diet, and regular exercise. Talk with your doctor to determine what is a healthy range of blood glucose for you (or your child).
In recent years, there has been considerable interest in identifying people whose blood contains antibodies to pancreatic islet cells, but who have no symptoms or signs of diabetes. It is considered that these people have 'prediabetes' and could be at high risk to develop the disease within a period of months or years. A variety of treatments are underway to try to prevent the development of prediabetes to type 1 diabetes. Although none of these treatments has yet proven to be completely effective and safe, it is very likely that the near future will see important advances in the screening to detect and prevent this serious disorder.
Talking to Your Health Care Professional About Type 1 Diabetes
You have a unique medical history. Therefore, it is essential to talk with your doctor or health care professional about your personal risk factors and / or experience with type 1 diabetes. By speaking openly and regularly with your doctor, you can play a role. Active in your care.
General Tips for Gathering Information
- Here are some tips that will make it easier for you to talk with your health care professional:
- Take someone else with you.
- It is helpful for another person to listen to what is said and think of questions to ask.
- Write your questions in advance, so you do not forget them.
- Write down the answers you get, and make sure you understand what you are listening to.
- Ask for clarification, if necessary.
- Do not be afraid to ask your questions or find out where you can find more information about what you are discussing.
- You have the right to know.
Specific Questions to Ask Your Health Care Professional
You will probably have many questions about diabetes, it is important to discuss them with your health care professional. These are some with which you can start.
About Type 1 Diabetes
- What caused my diabetes?
- Am I at risk for complications?
- What is the difference between type 1 diabetes and type 2 diabetes?
- What can I do to reduce the risk of complications?
- What is a realistic and healthy range of blood glucose for me?
About Your Risk of Developing Type 1 Diabetes
- Based on my medical history, lifestyle, and family history, am I at risk for type 1 diabetes?
- Are there any changes I can make to reduce my risk?
- Are there other people in my family who are also at risk?
About Treatment Options
- What type of insulin will I use?
- Where do I buy insulin?
- How do I inject insulin?
- Are insulin injections painful?
- Is a pen or an insulin pump right for me?
- How can I discreetly inject insulin when I am in public places or social situations?
- What happens when I travel?
- How do I adjust my insulin for changes in diet and exercise?
- Where do I get a blood glucose monitor?
- How do I use the blood glucose monitor and how often should I use it?
- Is there an alternative to insulin therapy? How often should I measure my hemoglobin A1c?
- How can I reduce my risk of complications?
- Can you channel me with specialists to help prevent and / or control some of the complications?
- How do I treat low blood sugar reactions?
- What are the pros and cons of new inhaled insulin versus injected insulin?
- How is the Pramlintide medication different from the insulin I have been using?
- When would you consider using Pramlintida with me?
- What can you tell me about the pancreas transplant?
About Changes in Lifestyle
- What type of diet should I consume?
- Can you channel me with a registered dietitian to help me plan my diet?
- Can I still eat sweets?
- How do I integrate them into my food plan?
- Can I drink alcohol?
- Do I have to eat differently from the rest of my family?
- How can I eat when I go to restaurants?
- Can you recommend some cookbooks for people with diabetes?
- Can I continue or start exercising?
- What type of exercise is best for me?
- When should I not exercise?
- Will I gain weight when I start using insulin?
- Are there classes or programs that can help me make these changes in lifestyle?
About the General Panorama
- Can you recommend a diabetes support group for me and my family?
- What can I tell my spouse, children, parents, and other family members and friends about my condition?
- How often will I need revisions?
- What is my life expectancy?