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Type 1 Diabetes

What it is

First of all, let's define diabetes.

  1. When you have a meal or a snack, some of the foods you eat - called carbohydrates - break down into sugar and go into your bloodstream.
  2. Think of your bloodstream as your highway system, and the blood sugar needs to travel where it is needed - your muscles, all of your organs, everywhere it can be used for energy.
  3. However, the sugar needs to be transported, or carried, and what carries it to its many destinations is insulin. So think of insulin as your UPS, FedEx or Post Office carrier. It is made by the pancreas, which sits right by the stomach.
  4. When things are normal, the pancreas makes the right amount of insulin all of the time, and blood sugar levels stay in the normal range.
  5. However, without insulin, the sugar just sits in the bloodstream, and the level of sugar goes higher and higher. This is type 1 diabetes.

Type 1 diabetes accounts for only 5 - 10 percent of all cases, and used to be called juvenile diabetes. Three-quarters of people who develop type 1 are under the age of 18, and most others are under 40 years old, but older adults develop it as well.

Many people think of type 1 diabetes as the more serious kind, because injecting insulin is the only treatment, but its type 2 counterpart can lead to the same long-term problems we all want to prevent. Another common distinction between the two forms of diabetes is the lack of insulin resistance in persons with type 1; in fact, most people with type 1 diabetes are quite sensitive to insulin and require smaller doses. However, overweight and obese people often experience insulin resistance, regardless of their form of diabetes.

What causes it

The exact cause of type 1 diabetes is unknown. Most experts believe it is an autoimmune disorder, which is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1 diabetes, an infection or some other trigger causes the body to destroy the cells in the pancreas that make insulin.

This kind of disorder can be passed down through families. In fact, in most cases of type 1 diabetes, people inherit risk factors from both parents. Such factors appear to be more common in whites, who have the highest rate of type 1 diabetes.

Moreover, many people at risk do not develop type 1 diabetes. Consequently, researchers want to know what the environmental triggers are. One might be related to cold weather, because type 1 diabetes develops more often in winter than summer, and it is more common in cold climates. Another trigger might be viruses, with researchers suspecting a virus that mildly affects most people may trigger type 1 diabetes in others.

Early diet may also play a role. Type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages.

Finally, in many people, the pathway to developing type 1 diabetes appears to take years. In studies that followed relatives of people with type 1 diabetes, researchers found that relatives who later developed diabetes had certain autoantibodies in their blood for years.

How you know you have it

Type 1 diabetes has a sudden onset, meaning, it presents with obvious signs usually over a period of a few days. Contrast that with type 2 diabetes, which may not be diagnosed for 8 - 10 years. However, like type 2, these are the most common symptoms:

  • Blurry vision
  • Excessive hunger
  • Excessive thirst
  • Frequent urination
  • Tingling or numbness in your feet or fingers
  • Unexplained weight loss
  • Unusual infections, such as skin or yeast infection
  • Unusual tiredness

The symptoms above may go unnoticed, or you and your family may attribute them to something else. So, if blood sugar continues to rise, you may experience these signs:

  • Deep, rapid breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity breath odor
  • Nausea or vomiting, and inability to keep down fluids
  • Stomach pain

These are symptoms of a deadly complication of acute high blood sugar called diabetic ketoacidosis. This calls for emergency treatment to lower your blood sugar and stabilize your fluid and electrolyte balance.

Your doctor will confirm the diagnosis of type 1 diabetes by one of these blood tests:

  1. A1c > 6.5% (A1c tests blood sugar control over the past 2-3 months)
  2. Fasting blood sugar > 126 mg/dl
  3. Random blood sugar > 200 mg/dl

What you can do

Yes, type 1 diabetes is a chronic disease with no known cure. However, you can live a long, happy life with diabetes. Research has shown your risk of problems greatly decreases by getting your blood sugar in good control and keeping it there!

Once you are diagnosed, ask your doctor to refer you to a diabetes educator at your hospital. Here is what you will learn:

  • How and when to check your blood sugar, and what the numbers tell you
  • How and when to give yourself insulin, and understand how the types of insulin your doctor prescribed work
  • How to manage your blood sugar when you are sick, and when to call your doctor if your blood sugar runs high
  • How to prevent complications, such as blindness, amputation, kidney failure and heart disease and stroke
  • Planning your meals and snacks. Counting carbohydrate grams or servings is essential
  • Starting an exercise routine, working up to 150 minutes a week
  • What to do if you have a low blood sugar (called hypoglycemia)
  • When to check for ketones in your urine. This may be when blood sugar is higher than 240 mg/dl, or when you are ill, especially with vomiting
  • Working with your doctor to have your A1c checked every 3 -6 months, and to keep blood pressure and cholesterol in target. Also, to make sure you receive all of the care you need - annual eye exam, flu vaccine and regular dental visits

Insurance/financial questions

With your doctor's prescription, your insurance company should cover your meter and supplies to check your blood sugar, your insulin and your pen needles or syringes. It may also cover an insulin pump and supplies. For the lowest co-pay, call the customer service number to ask if there is a particular brand of meter or insulin device you should use.

With your doctor's referral, diabetes education at your hospital's diabetes center should also be a covered benefit, but call your health plan's customer service number to make sure, and to see what your out-of-pocket costs will be.

Diabetes Products

Patients with Type 1 Diabetes are treated with insulin daily and administer it with a syringe, insulin pen, or insulin pump. In addition, they may use a Continuous Glucose Monitoring system (CGM) to monitor their blood glucose constantly. All patients test their Blood Glucose levels multiple times daily.