Diabetes Mellitus: Type 1

What is type 1 diabetes mellitus?

Type 1 diabetes is a lifelong disorder that happens when your body stops making insulin. The lack of insulin causes the level of sugar in your blood to become abnormally high.

When you digest food, your body breaks down much of the food into sugar (glucose). Your blood carries the sugar to the cells of your body for energy. The pancreas gland makes insulin, which your body needs to move the sugar from the bloodstream into the cells.

When your body does not have enough insulin, sugar cannot enter your cells. Sugar builds up in the blood. Too much sugar in your blood can cause many problems. These problems can be life-threatening if they are not treated. However, proper treatment can control your blood sugar level.

Type 1 diabetes is also called juvenile diabetes and was formerly called insulin-dependent diabetes. This type of diabetes usually starts in childhood or early adulthood. When you have type 1 diabetes, you will need to take insulin for the rest of your life.

How does it occur?

Type 1 diabetes occurs when most or all of the insulin-producing cells in the pancreas have been injured or destroyed. Usually the exact cause is not known. Sometimes the diabetes may be the result of a viral infection or injury of the pancreas. Or it may result from an immune system disorder, which is when the body recognizes part of itself as foreign and attacks it--in this case, attacking the pancreas.

What are the symptoms?

Symptoms may develop suddenly. Or they may develop gradually over days to weeks. Symptoms vary widely from person to person. Common symptoms include:

• increased urination
• increased thirst and dry mouth
• increased appetite or loss of appetite
• unexpected weight loss
• blurred vision
• tiredness
• fruity odor to breath.

If diabetes is not treated, you could develop a life-threatening chemical imbalance called ketoacidosis and possibly go into a coma.

How is it diagnosed?

Your healthcare provider will ask about your medical history and your symptoms and examine you. He or she will test the level of sugar in your blood. Three blood tests may be done to diagnose diabetes:

• a fasting plasma glucose test (FPG), also called a blood sugar
• insulin level
• c-peptide level

The FPG test is easier, faster, and less expensive to do. A sample of your blood is tested in the morning before you have eaten anything. If this test shows you have a fasting blood sugar of 126 milligrams per deciliter (7.0 millimoles per liter) or higher, you may have diabetes. Two FBG tests may be needed for a diagnosis.

The insulin and c-peptide tests check to see if your body is making insulin.

How is it treated?

Insulin is the main treatment for type 1 diabetes. The goal is for you to keep your blood sugar level in a normal range. Good blood sugar control involves using the correct insulin dose, eating a healthy diet, and getting regular exercise according to your healthcare provider's recommendation. Controlling your blood sugar can prevent sudden, life-threatening imbalances of your metabolism as well as the long-term complications of diabetes.

If your type 1 diabetes comes on suddenly, treatment usually begins in the emergency room. There you will receive insulin by IV (in your vein) until your blood sugar is back to a safe level and your metabolism is back in balance. Before you go home you will be switched from receiving IV insulin to giving yourself shots of insulin. Your healthcare provider and clinic staff will continue to teach you about caring for yourself when you have type 1 diabetes over the next several days as you learn to manage your diabetes at home, at school, at work, and at play.

If your type 1 diabetes comes on over several days or a couple of weeks, you may be diagnosed at your healthcare provider's office. Your provider will get your blood sugar into a safe range right away and begin to teach you how to care for your diabetes at home.

Whether you were diagnosed at the hospital or your provider's office or clinic, insulin is the mainstay of your treatment. The other 2 important parts of diabetes management are diet and exercise.

• Insulin therapy

  Different types of Insulin are available. They vary by how quickly they act to lower the blood sugar level and how long their effects last. Several kinds of insulin may be used to keep your blood sugar in the recommended range 24 hours a day.

  Commonly used types of insulin preparations and their names are:

  • rapid-acting insulin: Humalog, NovoLog, Apidra
  • short-acting insulin: Humulin R, Novolin R (regular)
  • intermediate-acting insulin: Humulin N, Novolin N ( NPH)
  • long-acting insulin: Lantus/Levemir

  You and your healthcare provider will work together to find the types and doses of insulin that will keep your sugar levels in the recommended range. You will need to check your blood sugars at home, often 4 or more times a day to start. Based on when your sugar is high or low, your daily activities, and your work or school schedule, you will probably take a combination of insulins, usually a short-acting and a longer acting, to give you better control. Your provider may teach you how to combine different insulins in 1 syringe, so it's only 1 shot. There are also premixed insulin combinations that can be purchased with a prescription.

  Shots of insulin may be given under the skin of the thigh or abdomen 1 or more times a day. You will learn how to measure your insulin dose, clean your skin, and give yourself shots.

  The insulin pump is another way to give the body insulin. The pump is worn at the waist like a pager. A tube connected to the pump is inserted under the skin. As your blood sugar level changes, you can adjust the amount of insulin pumped through the tube. The insulin pump is usually not considered for use until you and your healthcare provider are comfortable that you have learned how to check your blood sugar, manage your insulin, and keep your blood sugar normal.

  A medicine called pramlintide (SYMLIN) is now available to help if you are taking mealtime insulin but it is not controlling your blood sugar sufficiently. It is injected just before 1 or more meals. Insulin doses may need to be adjusted because adding SYMLIN can cause very low blood sugar (hypoglycemia) up to 3 hours after a shot.

• Diet

  The main goal of your diet plan is to maintain a normal blood sugar level. Your healthcare provider will give you guidelines about which foods you should eat and how many calories you should eat each day. The number of calories recommended for your daily diet is based on your weight and whether you need to maintain, lose, or gain weight. You will also learn how to space your meals so you avoid going too long without food.

  Your provider may refer you to a dietitian for help with diet planning and meal management. A dietitian can help you design a meal and snack plan that fits your lifestyle. Your prescribed diet will include a lot of lean protein, complex carbohydrates (such as whole-grain pasta, breads, and cereals), and foods with high fiber. Your regular diet should not include sugar-rich food such as soft drinks, candy, and desserts.

• Exercise

  Exercise is very important. A good activity plan can help control your blood sugar level. It also helps keep you healthy and avoid the long-term complications of diabetes. Talk to your healthcare provider about making an activity plan for you.

Blood sugar tests

Because you are using insulin to lower your blood sugar, you must carefully follow your healthcare provider's directions for checking your blood sugar. This will not only help you achieve good blood sugar control to prevent the complications of diabetes, but it will also help you prevent possibly life-threatening low levels of blood sugar (hypoglycemia).

You will learn how to check your blood sugar at home. You will need a glucose meter, a small machine that tests your blood sugar. You will need some lancets (little blades or needles to prick your finger) and some test strips to put a drop of blood on. Your provider will tell you when and how often you need to check your blood sugar. When you have just been diagnosed with diabetes you will need to check your blood sugar more often. After you have your diabetes under control, your provider will tell you how you can decrease your sugar checks.

Keep a log of your blood sugar measurements. Many glucometers now keep a record of your recent sugar readings in them. Your provider will check the log at your appointments to see how well your treatment is working. It is very important that you take your blood sugar log or your glucometer to every appointment. This is the basis for deciding whether your insulin regimen needs to be adjusted.

A blood test called hemoglobin A1C (or just "A1C") can show your average blood sugar control over the last 2 or 3 months. Your provider may do this test every 2 or 3 months to check your overall control of your blood sugar level. This is the best way to see if you are keeping your diabetes under control. However, it does not replace daily blood sugar measurements. They show whether your treatment is working throughout the day.

Sick-day plan: Diabetes is harder to control when you are sick. Blood sugar can get very high during an illness and become a medical emergency. Be prepared for illness with a sick-day plan, which will include checking your blood sugar more often and knowing how to adjust your insulin dose. Your healthcare provider will work with you to develop a plan designed specially for you.

Doctors are working to find new and more effective ways to treat diabetes. For example, transplants of the whole pancreas or just some cells from the pancreas are becoming more frequent. Research is ongoing into transplants of just the pancreas cells that make insulin. These transplants are called islet cell transplants. If your body does not reject the whole pancreas or the islet cells, this tissue may make enough insulin for you to not have to take insulin any longer.

How long will the effects last?

Type 1 diabetes is a lifelong condition. Its symptoms increase or decrease depending on your response to the insulin, your new diet, and on how well you are able to control your blood sugar level.

Taking good care of yourself to avoid complications is especially important with diabetes. Possible diabetic complications include heart disease, stroke, blindness, kidney failure, and nerve damage, especially to your feet and legs. Carefully controlling your blood sugar will prevent or delay these complications. It is also important to not smoke because smoking cigarettes is very harmful to the blood vessels. Smoking speeds up and worsens the complications of diabetes.

Keep your regular appointments with your healthcare provider. Ask when you should start or how often you need:

• a urine protein test to check for microalbumin, a type of protein.
• a blood test to check creatinine
• a yearly dilated eye exam
• the pneumonia vaccine
• a TB (tuberculosis) test

How can I take care of myself?

Guidelines for eating

• Choose foods with lean protein, complex carbohydrates, and lots of fiber. Choose foods low in saturated fats. Read labels.
• Distribute your total calories evenly throughout the day.
• Time your meals to match your peak insulin effects and scheduled activities. Try to always have your meals, snacks, and exercise at the same time each day.
• When you increase your activity, check your blood sugars more often. You may need to eat more or decrease the insulin you are taking. This will help prevent low blood sugar.
• Learn how to make proper food choices when you eat out.
• Ask for diabetic meals when you travel (for example, in hotels and on planes). Order your meals ahead of time.

Guidelines for managing calories

• Avoid compulsive eating.
• Drink water or other calorie-free drinks when you feel an urge to eat between meals.
• Limit the amount of alcohol you drink. It can cause low blood sugar as well as worsen nervous system problems caused by diabetes.
• Buy only the types of food allowed by your diet plan.
• Eat on a regular schedule.
• Eat slowly and chew food thoroughly.

Guidelines for managing insulin

• Follow your healthcare provider's instructions for giving yourself insulin.
• Ask your healthcare provider about the symptoms and causes of low blood sugar and what to do when you have low blood sugar.
• Know when and how to test your blood.
• Follow your healthcare provider's instructions for adjusting your insulin dosage according to the results of blood tests.
• Carry some form of sugar at all times, so you can treat low blood sugar quickly.
• Carry a protein snack, such as cheese and crackers, to make sure you eat as often as you should.
• Make sure your family members know what to do if your sugar is too high or too low.

Guidelines for seeing your healthcare provider

• Follow your healthcare provider's recommendations for frequent follow-up visits until your diabetes is under good control.
• When your diabetes is under control, see your healthcare provider every 3 to 6 months unless your provider needs to see you more often. Always take your blood sugar log or glucometer log to your appointments with you.
• Eyes are affected by diabetes. You should have your eyes checked within 5 years of diagnosis if you are under 30 and right away if you are over 30. You will then need eye checkups at least every year. Women with diabetes who become pregnant should have their eyes checked each trimester because diabetic eye problems can worsen quickly during pregnancy. Excellent blood sugar control can reduce the risk of worsening diabetic eye disease.

Other guidelines for managing diabetes

• Learn how to do proper skin and foot care every day. Check your feet every day. Wear comfortable, well-fitting shoes to help prevent foot injury. Break in new shoes gradually.
• Exercise regularly according to your healthcare provider's advice. Exercise helps the insulin do its job better. It also helps you to maintain a normal blood pressure and a healthy heart. Wear well-fitting, supportive, and well-cushioned shoes when you exercise.
• Ask your provider if you need to check your urine for ketones. Ketones are chemicals that show that your sugar is too high. Your provider will tell you when and how to check for ketones, if you need to. It is usually necessary only if you are starting to come down with an illness or if your sugars have been running too high.
• Carry a medical ID (such as a card or bracelet) that says you have diabetes, in case of an emergency.

Learn about diabetes and its complications so you can make the correct decisions to control your blood sugar levels. There is a lot to learn. Talk to your healthcare provider about how you can learn all you need to know. You can also check with the local American Diabetes Association chapter, your local hospital, or the health department about diabetes educators and dietitians who can help you or about classes in your area. It's good for your family to also learn about diabetes.

You can get diabetic cookbooks and more information about diabetes from:

The American Diabetes Association
Phone: 800-DIABETES (800-342-2383)
Web site: http://www.diabetes.org.

How can I help prevent type 1 diabetes or its complications?

Type 1 diabetes cannot be prevented. However, many of the problems associated with the disease can be avoided or reduced if you:

• Follow the guidelines your healthcare provider gives you.
• Maintain a normal blood sugar level.
• Learn how to inject insulin correctly, including where to inject it.
• Learn how to test your blood sugar.
• Know when to adjust your medicine.
• Eat a healthy diet.
• Exercise regularly according to your provider's recommendation.
• Do not smoke. Smoking speeds up the damage to the heart and blood vessels.
• Have other medical problems treated, especially high blood pressure and high cholesterol.
• Keep your appointments with your provider.
• Call your provider right away if you are seriously ill or are unable to control your sugar.
• Make an appointment to see your provider if you have any questions.