TYPE 1 DIABETES
Type 1 diabetes (T1D) is an autoimmune disease in which the pancreas is under an on-going attack by the immune system, interfering with the production of a hormone called insulin. Without insulin, glucose (sugar) accumulates in the blood and cannot be used to produce energy.
Insulin is necessary for survival. With Type 1 diabetes, lifestyle, diet, or exercise changes will not make insulin available again. Instead, the missing insulin must be replaced.
Children and adults with Type 1 diabetes have to monitor their blood glucose and inject or pump insulin into their bodies everyday for the rest of their lives to carefully regulate glucose levels. Too much insulin (hypoglycemia) or too little insulin (hyperglycemia) is dangerous. Balancing blood glucose levels and insulin dosages is a minute-by-minute job, even while sleeping.
Insulin is necessary for survival. With Type 1 diabetes, lifestyle, diet, or exercise changes will not make insulin available again. Instead, the missing insulin must be replaced.
Children and adults with Type 1 diabetes have to monitor their blood glucose and inject or pump insulin into their bodies everyday for the rest of their lives to carefully regulate glucose levels. Too much insulin (hypoglycemia) or too little insulin (hyperglycemia) is dangerous. Balancing blood glucose levels and insulin dosages is a minute-by-minute job, even while sleeping.
INSULIN
Insulin is a hormone made by the pancreas that unlocks cells to allow the entry of glucose (sugar) for energy production. Excess insulin causes fat to be stored for later use as energy. A healthy pancreas is very sensitive to the amount of glucose in the bloodstream and speeds up or slows down insulin production, as needed, to maintain perfect balance.
To keep people with Type 1 diabetes alive, synthetic insulins have been developed and are taken as multiple daily injections (MDI) or continuously via an insulin pump.
Normal pancreatic function is so complex that it's not possible for someone with Type 1 diabetes to have perfect balance. The complexity of counting the carbohydrate, protein, and fat intake, combined with overall health,
activity, stress, and glucose levels to determine insulin dosages creates a reality that is not only difficult, but life-threatening. It also causes a tremendous emotional and financial burden for both patient and caregivers.
To keep people with Type 1 diabetes alive, synthetic insulins have been developed and are taken as multiple daily injections (MDI) or continuously via an insulin pump.
Normal pancreatic function is so complex that it's not possible for someone with Type 1 diabetes to have perfect balance. The complexity of counting the carbohydrate, protein, and fat intake, combined with overall health,
activity, stress, and glucose levels to determine insulin dosages creates a reality that is not only difficult, but life-threatening. It also causes a tremendous emotional and financial burden for both patient and caregivers.
GLUCOSE
Everyone's body needs energy to work. Energy is produced when the stomach digests food. The stomach digests food by mixing it with fluids called acids and enzymes. As the acids and enzymes break down food, the carbohydrates (sugars and starches) in the food are turned into a type of sugar called glucose. The glucose is absorbed by the stomach and small intestines and then released into the bloodstream. It can be used immediately as energy or stored in the body for later use.
NORMAL BLOOD
GLUCOSE LEVELS
Individuals and caregivers of those with Type 1 diabetes are responsible for the constant monitoring of the blood glucose levels with finger pricks and a glucometer or via a continuous glucose monitor. A normal fasting blood glucose for an individual without diabetes is 70-100 mg/dL (3.9-5.6 mmol/L) and less than 180 mg/dL (10 mmol/L) within two hours of a meal. Blood glucose levels that are too low or too high can be life-threatening.
LACK OF INSULIN
Without insulin, glucose (sugar) can't leave the bloodstream and enter the body's cells to produce energy. When a person is developing Type 1 diabetes, before diagnosis and the start of insulin therapy, glucose levels build in the blood, resulting in a state called hyperglycemia. A blood glucose level of 200 mg/dL (11 mmol/L) to 1800 mg/dL (99.9 mmol/L) or higher is an indicator of Type 1 diabetes.
HIGH BLOOD GLUCOSE
As undiagnosed Type 1 diabetes progresses, blood glucose levels climb. When blood glucose levels are higher than 180 mg/dL (10 mmol/L) the kidneys excrete glucose through the urine, causing frequent urination. The person will feel thirstier because of dehydration. Children may begin wetting the bed, waking several times a night to urinate, or soaking through diapers.
Losing glucose in the urine is the same as losing energy because the glucose isn't available for the cells to use or store; as a result, one might have headaches, feel tired, lose weight or feel hungry all the time. Vision can become blurry. Itchy skin, infections, injuries that won't heal, and oral (thrush) or vaginal yeast infections are common.
When blood glucose remains elevated and ketones increase, symptoms worsen. The smell of the person's breath can become affected, smelling fruity or like nail polish remover. As the body tries to rid itself of the ketones, shortness of breath will advance to rapid, shallow breathing, then gradually become deep, labored gasping. This progression of Type 1 diabetes symptoms indicates the development of a complication called diabetic ketoacidosis (DKA).
Losing glucose in the urine is the same as losing energy because the glucose isn't available for the cells to use or store; as a result, one might have headaches, feel tired, lose weight or feel hungry all the time. Vision can become blurry. Itchy skin, infections, injuries that won't heal, and oral (thrush) or vaginal yeast infections are common.
When blood glucose remains elevated and ketones increase, symptoms worsen. The smell of the person's breath can become affected, smelling fruity or like nail polish remover. As the body tries to rid itself of the ketones, shortness of breath will advance to rapid, shallow breathing, then gradually become deep, labored gasping. This progression of Type 1 diabetes symptoms indicates the development of a complication called diabetic ketoacidosis (DKA).
DIABETIC KETOACIDOSIS
(DKA)
When the body doesn't have enough insulin to help convert glucose into energy, it starts burning body fat and tissue instead. This sounds like it might work well, but burning too much fat and tissues for energy produces a byproduct called ketones. High levels of ketones (an acid) in the blood can rapidly lead to a condition called diabetic ketoacidosis (DKA), which can cause brain swelling, hemorrhage, and neurological damage.
DKA can progress quickly. If this happens, you or your loved one need immediate medical emergency attention! DKA is life-threatening if not treated quickly.
DKA can progress quickly. If this happens, you or your loved one need immediate medical emergency attention! DKA is life-threatening if not treated quickly.
DIAGNOSIS
Glucose testing is very inexpensive and can be performed as a screening measure in any doctor's office, urgent care center, or emergency room. The presence of high glucose levels should alert your medical team to the possibility of an underlying condition of undiagnosed Type 1 diabetes and diabetic ketoacidosis, which are fatal if left untreated. It's important to rule out high glucose levels at sick-care visits when presenting with symptoms similar to influenza, strep, viruses, and other common illnesses.
If glucose levels are high on a finger stick test or a urine dip test, medical personnel will perform additional tests to confirm Type 1 diabetes. Patients with Type 1 diabetes will have anti-bodies to their own pancreas, especially in the early phases. They will also have low C-peptide levels. C-peptide is a protein that is made along with insulin in the pancreas.
PLEASE NOTE:
If you suspect you or a loved one has high blood glucose or if VOMITING AND LETHARGY COMBINED WITH LABORED BREATHING are present, do not consume sugar and seek emergency medical care immediately. Insist medical personnel Test One Drop of blood or urine for glucose (sugar) levels. DKA can be fatal!
If you suspect you or a loved one has high blood glucose or if VOMITING AND LETHARGY COMBINED WITH LABORED BREATHING are present, do not consume sugar and seek emergency medical care immediately. Insist medical personnel Test One Drop of blood or urine for glucose (sugar) levels. DKA can be fatal!
MISSED DIAGNOSES
Each year many people with untreated Type 1 diabetes face the life-threatening complications of diabetic ketoacidosis because their diagnosis was delayed or missed. While most who suffer from life-threatening DKA at Type 1 diabetes onset recover after hospitalization and are able to manage their disease with insulin and live active lives, many are permanently disabled (traumatic brain injuries, limb loss) or die because their symptoms and complications progressed too far before diagnosis.
Type 1 diabetes diagnoses are delayed or missed for various reasons. At first, symptoms may progress slowly, go unnoticed, or seem too minor to be life-threatening. For instance, more than one parent has mistaken their child's symptoms of muscle cramps, flushed skin, and thirst to be the result of exercise or playground activity. Whereas, an older person might think yeast, fatigue, vision changes, aches, etc. to be a normal part of aging. Multiple stories reveal that the general public and medical care providers (too often) assume worsening symptoms to be associated with common illnesses such as flu, strep, stomach virus, urinary tract infections, growth spurts, etc.
As if that is not enough, many people who have Type 1 diabetes are first diagnosed as having "Type 2 diabetes" which is an altogether different disease.** Without insulin treatment, a large number of the people who are mistakenly diagnosed as having Type 2 diabetes later go into DKA.
Type 1 diabetes diagnoses are delayed or missed for various reasons. At first, symptoms may progress slowly, go unnoticed, or seem too minor to be life-threatening. For instance, more than one parent has mistaken their child's symptoms of muscle cramps, flushed skin, and thirst to be the result of exercise or playground activity. Whereas, an older person might think yeast, fatigue, vision changes, aches, etc. to be a normal part of aging. Multiple stories reveal that the general public and medical care providers (too often) assume worsening symptoms to be associated with common illnesses such as flu, strep, stomach virus, urinary tract infections, growth spurts, etc.
As if that is not enough, many people who have Type 1 diabetes are first diagnosed as having "Type 2 diabetes" which is an altogether different disease.** Without insulin treatment, a large number of the people who are mistakenly diagnosed as having Type 2 diabetes later go into DKA.
OTHER NAMES FOR
TYPE 1 DIABETES
Though officially named Type 1 diabetes today, you may also hear the disease referred to in the following ways:
- T1D
- T1
- Type 1
- Type One
- Juvenile diabetes
- Diabetes mellitus type 1
- Insulin-dependent diabetes mellitus
- IDDM
OTHER FACTS
ABOUT T1D
Anyone can be diagnosed with Type 1 diabetes, regardless of health, race, genetics, or socio-economic level.
Type 1 diabetes can occur at any age–from infancy into the sixties and beyond.
Children five and under are more susceptible to DKA complications due to communication challenges.***
The most prevalent symptom of Type 1 diabetes is frequent or excess urination.
Genetics play a part in determining who is likely to develop Type 1 diabetes, yet not everyone has a family history.
Type 1 diabetes has nothing to do with diet or lifestyle; it is not caused by eating sugar or lack of exercise.
Type 1 diabetes isn't preventable or reversible.
There's no cure for Type 1 diabetes. Insulin dependency is a life-long treatment; it's not a cure.
Less than 10% of people with diabetes have the "Type 1" form of the disease.
Type 1 diabetes can occur at any age–from infancy into the sixties and beyond.
Children five and under are more susceptible to DKA complications due to communication challenges.***
The most prevalent symptom of Type 1 diabetes is frequent or excess urination.
Genetics play a part in determining who is likely to develop Type 1 diabetes, yet not everyone has a family history.
Type 1 diabetes has nothing to do with diet or lifestyle; it is not caused by eating sugar or lack of exercise.
Type 1 diabetes isn't preventable or reversible.
There's no cure for Type 1 diabetes. Insulin dependency is a life-long treatment; it's not a cure.
Less than 10% of people with diabetes have the "Type 1" form of the disease.
OTHER TYPES
OF DIABETES
Here is a list and brief explanation of other types of diabetes:
Type 2 diabetes- a metabolic disorder where the body's cells become resistant to insulin doing its job, increasing
the production of insulin, and resulting in fat storage. It is most common type of diabetes (almost 90% of all cases) according to the NIH. Type 2 diabetes is also known as "non insulin-dependent diabetes mellitus" (NIDDM) and used to be called “adult-onset” diabetes because it was so unusual in children. It is thought to be brought on by a genetic predisposition to poor insulin action and secretion, often exacerbated by obesity and inactivity.**
gestational diabetes- occurs in 2% to 10% of pregnancies and resolves itself when the pregnancy ends. "Diabetes in pregnancy is a risk factor for diabetes in the next generation." -Dr. Dana Dabelea, professor of epidemiology and pediatrics at the Colorado School of Public Health
LADA- a form of Type 1 diabetes with very slow onset that occurs in adults and is sometimes called Type 1.5. Because insulin is not initially required and considering age, adults with LADA may first be mistakenly diagnosed as having Type 2 diabetes, especially if they are obese and have family history of Type 2.
monogenic diabetes- a rare type of diabetes caused by a single gene mutation (1-2% of all diabetes cases)
neonatal diabetes mellitus- a monogenic form diagnosed in first 6 months of life, recessive (both parents contribute mutant gene). Body does not produce enough insulin for life, but sometimes gets better on its own.
maturity-onset diabetes of the young (MODY)- a monogenic form occurring before age 25 with no insulin requirement and inherited from one parent. Body produces enough insulin for life, but not enough to maintain normal levels.
An additional 1% to 5% of diabetes cases result from other specific conditions, e.g., diseases, genetic defects, syndromes, certain surgeries and medications, injuries, drug or chemical exposure, or infections, etc. For more detailed information, visit Causes of Diabetes at niddk.nih.gov.
Type 2 diabetes- a metabolic disorder where the body's cells become resistant to insulin doing its job, increasing
the production of insulin, and resulting in fat storage. It is most common type of diabetes (almost 90% of all cases) according to the NIH. Type 2 diabetes is also known as "non insulin-dependent diabetes mellitus" (NIDDM) and used to be called “adult-onset” diabetes because it was so unusual in children. It is thought to be brought on by a genetic predisposition to poor insulin action and secretion, often exacerbated by obesity and inactivity.**
gestational diabetes- occurs in 2% to 10% of pregnancies and resolves itself when the pregnancy ends. "Diabetes in pregnancy is a risk factor for diabetes in the next generation." -Dr. Dana Dabelea, professor of epidemiology and pediatrics at the Colorado School of Public Health
LADA- a form of Type 1 diabetes with very slow onset that occurs in adults and is sometimes called Type 1.5. Because insulin is not initially required and considering age, adults with LADA may first be mistakenly diagnosed as having Type 2 diabetes, especially if they are obese and have family history of Type 2.
monogenic diabetes- a rare type of diabetes caused by a single gene mutation (1-2% of all diabetes cases)
neonatal diabetes mellitus- a monogenic form diagnosed in first 6 months of life, recessive (both parents contribute mutant gene). Body does not produce enough insulin for life, but sometimes gets better on its own.
maturity-onset diabetes of the young (MODY)- a monogenic form occurring before age 25 with no insulin requirement and inherited from one parent. Body produces enough insulin for life, but not enough to maintain normal levels.
An additional 1% to 5% of diabetes cases result from other specific conditions, e.g., diseases, genetic defects, syndromes, certain surgeries and medications, injuries, drug or chemical exposure, or infections, etc. For more detailed information, visit Causes of Diabetes at niddk.nih.gov.
**According to the National Institutes of Health (NIH), as many as 10% of those who are diagnosed with Type 2 diabetes may actually have Type 1 diabetes. People who are diagnosed with Type 2 are not usually started on insulin therapy. Without insulin treatment, a large number of the people who are mistakenly diagnosed as having Type 2 diabetes later go into DKA. Although this mostly occurs in adults over the age of 40, it can happen to anyone–even children. If you or your loved one (adult or child) is diagnosed with Type 2 diabetes, request your medical health care provider obtain an autoantibody test to officially distinguish between the two types and assure a proper diagnosis and proper treatment.
***In the the U.S., 208,000 people under the age of 20 had Type 1 diabetes in 2012. Type 1 is currently increasing at a rate of 23%. (NDEP, CDC, NIH) According to Diabetes Care, Volume 34, November 2011, the reported prevalence of DKA in children, in 2011, was:
<5 years of age 17.3 - 54%
<3 years of age 39.7%
<2 years of age 60%.
These statistics are considered to be low, as they are five years old, and will be updated as more accurate information is discovered.
***In the the U.S., 208,000 people under the age of 20 had Type 1 diabetes in 2012. Type 1 is currently increasing at a rate of 23%. (NDEP, CDC, NIH) According to Diabetes Care, Volume 34, November 2011, the reported prevalence of DKA in children, in 2011, was:
<5 years of age 17.3 - 54%
<3 years of age 39.7%
<2 years of age 60%.
These statistics are considered to be low, as they are five years old, and will be updated as more accurate information is discovered.
KEY TERMS
auto-immune disease: a disease in which the body's immune system attacks healthy cells
diabetic ketoacidosis (DKA): a life-threatening condition caused by the buildup of ketones due to high blood glucose
enzymes: digestive juices made in the pancreas that break down food
glucose: sugar made from digested foods and used by the body for energy
hypoglycemia: lower than normal glucose levels or too much insulin
hyperglycemia: higher than normal glucose levels or too little insulin
insulin: a hormone that is produced in the pancreas or injected to regulate glucose levels
insulin pump: manually operated artificial pancreas
ketones: acidic byproduct of fat metabolism produced when there is a lack of sugar for energy
LADA: also called latent autoimmune diabetes of adults, late-onset autoimmune diabetes of adulthood or aging, slow onset type 1 diabetes, or diabetes type 1.5
metabolic disorder: occurs when abnormal chemical reactions in your body disrupt the process your body uses to make energy from the food you eat
pancreas: a gland behind the stomach that produces insulin and digestive enzymes/secretions
Type 1 diabetes: an autoimmune disease in which the beta cells of the pancreas are under an on-going autoimmune attack making the hormone called insulin unavailable
Type 2 diabetes: a complex metabolic disorder in which many of the body's functions related to insulin are hindered, increasing the production of insulin, and resulting in fat storage
diabetic ketoacidosis (DKA): a life-threatening condition caused by the buildup of ketones due to high blood glucose
enzymes: digestive juices made in the pancreas that break down food
glucose: sugar made from digested foods and used by the body for energy
hypoglycemia: lower than normal glucose levels or too much insulin
hyperglycemia: higher than normal glucose levels or too little insulin
insulin: a hormone that is produced in the pancreas or injected to regulate glucose levels
insulin pump: manually operated artificial pancreas
ketones: acidic byproduct of fat metabolism produced when there is a lack of sugar for energy
LADA: also called latent autoimmune diabetes of adults, late-onset autoimmune diabetes of adulthood or aging, slow onset type 1 diabetes, or diabetes type 1.5
metabolic disorder: occurs when abnormal chemical reactions in your body disrupt the process your body uses to make energy from the food you eat
pancreas: a gland behind the stomach that produces insulin and digestive enzymes/secretions
Type 1 diabetes: an autoimmune disease in which the beta cells of the pancreas are under an on-going autoimmune attack making the hormone called insulin unavailable
Type 2 diabetes: a complex metabolic disorder in which many of the body's functions related to insulin are hindered, increasing the production of insulin, and resulting in fat storage