Type 1 Diabetes Mellitus: Symptoms, Diagnosis, Treatment:
In the United States, an estimated 0.55 percent of adults have type 1 diabetes mellitus. This makes up around 5 percent of people with diabetes.
While no full cure for this type is available, the range of management options means that a person with the disorder can lead a full and active life.
Type 1 diabetes requires lifelong treatment once it develops. The body does not produce enough insulin, and blood glucose levels remain high unless a person takes steps to manage high blood sugar.
What is type 1 Diabetes Mellitus?
Diabetes occurs when the glucose, or sugar, in the blood is poorly controlled and consistently high.
Type 1 occurs when the body does not produce enough of the hormone that allows cells to absorb and use glucose. This hormone is called insulin.
While a person can prevent type 2 diabetes mellitus by avoiding a sugar-rich diet and inactive lifestyle, preventing type 1 is not possible. The immune system attacks clusters of cells in the pancreas that would normally produce insulin, called islets, stopping or slowing insulin production.
Without enough insulin, glucose cannot enter the cells and remains in the bloodstream.
A person with type 1 diabetes will need to take insulin for the rest of their life. Not doing so can result in ever-increasing blood sugar levels and dangerous complications.
Type 1 diabetes can occur at any age, although it is more common in children and young adults.
Symptoms of Type 1 Diabetes Mellitus
The physical effects of type 1 diabetes include:
- Polydipsia (increased thirst)
- Polyphagia (increased hunger)
- Polyuria (frequent urination)
- Blurred or unclear vision and problems with sight
- Tiredness and fatigue
- Weight loss without an apparent trigger or cause
Refer any clear signs of diabetes to a primary care physician, who will administer tests to confirm that these are a result of diabetes.
The honeymoon phase:
After receiving a diagnosis of type 1 diabetes, the islet cells responsible for insulin secretion may continue to produce the hormone for a while before ceasing.
During this time, a person will need fewer insulin shots to maintain healthy levels of blood glucose.
Doctors refer to this as the “honeymoon phase” or honeymooning.
This phase can lead to a person with type 1 diabetes mistakenly thinking that they are getting better. The honeymoon phase, while giving the impression of recovering symptoms, still requires close monitoring and regular adjustments of insulin dosage.
Sticking to the recommended treatment plan is essential while honeymooning.
Complications of Type 1 Diabetes Mellitus:
If a person does not manage these symptoms, a range of dangerous complications might develop.
These include:
Diabetic retinopathy: Excess glucose leads to a weakening of the walls of the retina, the part of the eye that detects light and color. As retinopathy progresses, small blood vessels may form behind the eyes that might bulge and rupture, causing vision problems.
Diabetes is one of the leading causes of blindness among working-age adults.
Diabetic neuropathy: High blood sugar reduces circulation, damaging nerves in the hands and feet and leading to a loss of sensation or abnormal sensations such as burning, tingling, and pain.
As diabetes can also reduce the body’s ability to heal, minor cuts and injuries can lead to more permanent damage, especially as a person may not immediately notice them.
Diabetic nephropathy, or diabetic kidney disease: The kidneys filter glucose from the blood. Too much glucose can overwork them, and progressively cause kidney failure, which may progress to needing dialysis.
Cardiovascular disease: Diabetes can lead to a range of abnormalities that impair the function of the heart and arteries, including coronary heart disease, peripheral arterial disease, and stroke.
As a result of poor circulation, diabetes can also increase the risk of amputations.
Gum disease: Type 1 diabetes can increase the risk of gum disease and tooth loss, meaning that a person with this type should be very careful to maintain dental health.
Depression: Diabetes has strong links with depression.
Diabetic foot problems, which are very serious complications, leading to foot ulcers, osteomyelitis, peripheral neuropathy and charcot foot. These complications are mainly due to damages nerves and poor/delayed healing due to very poor blood circulation.
Diabetic ketoacidosis (DKA) is an acute complication of diabetes that occurs when a person does not meet the requirement for insulin, and the body undergoes extreme stress.
Diabetic ketoacidosis leads to very high blood sugars. The body experiences a shift in metabolism and starts breaking down fat instead of sugar, producing ketones as a waste product.
Ketones can be harmful to the body and cause acidosis. DKA is a medical emergency that requires hospitalization and treatment with intravenous insulin etc.
Carefully managing type 1 diabetes can dramatically reduce the risk of these complications. A landmark study called the Diabetes Care and Control Trial (DCCT) has shown that good blood sugar control can significantly reduce the risk of microvascular complications.
Many of the initial blood tests indicate the presence of diabetes but do not specify which type of diabetes is present
Doctors use clinical and laboratory clues to differentiate between the two types of diabetes.
While exceptions can occur, people with type 1 diabetes tend to present at a much younger age and are lean. Individuals with type 2 diabetes mellitus are typically older and overweight.
The doctor will then test for autoantibodies against pancreatic cells in the blood. While antibodies would help the immune system combat diseases and infections, autoantibodies occur when the immune system is attacking healthy tissues incorrectly.
The doctor can also measure C-peptide, an indicator of how much insulin the body produces. They expect it to be lower in type 1 diabetes, as this relates to the destruction of the insulin-producing cells.
Treatment for Type 1 Diabetes Mellitus:
People with type 1 diabetes mellitus need to take insulin several times a day, including around mealtimes, as the body no longer produces the hormone.
There are several ways to take insulin, such as through multiple daily injections or through a pump. Inhaled insulin is also available, though it is for use around meal-times only.
The timing of an insulin shot is important, and a doctor will work out a schedule with a person who has diabetes to best manage their glucose levels.
Different types of insulin work for different periods.
- Rapid acting: lispro (Humalog) and aspart (NovoLog)
- Regular insulin: Humulin, Novolin
- Intermediate acting: NPH (Humulin N, Novolin N)
- Long-acting: detemir (Levemir), glargine (Lantus)
With the advent of continuous blood sugar monitors, integration is now possible with an insulin pump as part of a hybrid closed-loop system, which serves as an artificial pancreas.
The patient wears a continuous blood sugar monitor and an insulin pump. The two communicate with each other.
However, even with this technology, the individual is still responsible for manually checking their blood sugar and taking insulin before mealtime. A fully automated system without patient input is not yet available.
Takeaway:
Type 1 diabetes is less common than type 2 diabetes. It is an autoimmune disorder in which the immune system attacks and destroys healthy tissue in the pancreas which would otherwise be producing insulin.
As a result, insulin is insufficient or non-existent in the body, and a person with type 1 diabetes will need to take insulin on a life-long basis. Symptoms include weight loss, increased hunger and thirst, and problems with eyesight.
Without treatment, these symptoms can develop into nerve damage, heart complications, and blindness.
Daily injections of insulin are vital for a person with type 1 diabetes. In recent years, a hybrid closed-loop system can serve as an artificial pancreas to detect blood glucose levels and provide timely doses of insulin.
However, these have not yet completely replaced manual insulin shots, and people with type 1 diabetes will still require insulin injections at meal-times.