Type 1 Diabetes Mellitus

What is type 1 diabetes mellitus?

Type 1 diabetes is a disorder that occurs when your body produces little or no insulin. This problem with insulin causes the level of sugar in your blood to become abnormally high.

Insulin is a hormone produced by the pancreas. (The pancreas is the large gland that lies behind the stomach.) 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. Insulin helps the sugar leave the bloodstream and enter the cells. This is how insulin lowers the level of sugar in your blood.

When your body does not have enough insulin, sugar cannot get into your cells. As a result, you have high levels of sugar in your blood. When you have too much sugar in your blood, many problems begin to occur. 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 develops in childhood or early adulthood.

How does it occur?

Type 1 diabetes occurs when most of the insulin-producing cells in the pancreas have been destroyed. Usually the cause of this type of diabetes is not known. Sometimes the diabetes may be the result of a viral infection or injury of the pancreas. It may also result from an immune system disorder.

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
• excessive thirst, dry mouth, and the drinking of a lot of fluids
• increased appetite or loss of appetite
• visible 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 health care 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. If your morning fasting blood sugar (before breakfast) is above 126 milligrams per deciliter (mg/dL), you may be diabetic.

Sometimes another test called a glucose tolerance test is done. For this test a sample of your blood is taken when you have not eaten anything since the night before. Then you drink a sugar drink and your blood is tested 2 hours later. If after 2 hours your blood sugar level is over 200 mg/dL, you are diabetic.

How is it treated?

Giving your body more insulin is the primary treatment for type 1 diabetes. In addition you will learn how to control your blood sugar through diet and exercise. The goal is for you to be able to lead as normal a life as possible.

• Insulin therapy

  You will start having insulin shots as soon as the diagnosis is confirmed. Insulin is available in different forms: short-acting (regular), intermediate-acting (NPH, lente), and long-acting (ultralente). At first you may use short-acting insulin several times a day until your blood sugar is under good control. It is common to combine short-acting and long-acting forms in one dose (in one syringe).

  Insulin may be given by injection under the skin of the thigh or abdomen 1 to 4 times a day. You will learn how to measure your insulin dose, clean your skin, and give yourself shots.

  The insulin pump is a new way of giving 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.

  Because you are using insulin to lower your blood sugar, you must carefully follow your health care 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).

  If the insulin doesn't seem to be working, your health care provider will check for the following:

  • a change in your work habits or level of exercise
  • another medical problem, such as infection
  • improper technique of insulin injection
  • improperly stored insulin
  • failure to follow your diet plan
  • interaction of the insulin with another medicine you are taking.
• Diet

  The main goal of your diet plan is to maintain a normal blood-sugar level. You will be given 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 health care provider may refer you to a dietitian for help with diet planning and meal management. A dietitian can help you design a meal plan that fits your lifestyle. Your prescribed diet will include a lot of lean protein, complex carbohydrates (such as pasta, breads, and cereals), and foods with high fiber. Your 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. Talk to your health care provider about making an activity plan for you.

• Education

  There is a lot you will need to learn. You should attend diabetes classes or talk to your health care provider about how you can learn all you need to know. You can also check with the local American Diabetes Association chapter, hospital, or health department about classes in your area.

You will learn to check your blood sugar at home. You will need a glucometer, a small machine that tests your blood sugar. You will need some lancets (little blades to prick your finger) and some test strips to put a drop of blood on. Your health care provider will tell you when and how often you need to be checking your blood sugar.

Keep a log of your blood sugar measurements. Your health care provider will check the log at your appointments to see how well your treatment is working.

A test called hemoglobin A1c can show your average blood sugar control over the past 3 months. Your health care provider may do this test every 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.

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 and your new diet and on how well you are able to control your blood-sugar level.

How can I take care of myself?

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 delay or prevent these complications.

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 balance peak insulin effects and scheduled activities. Try to always have your meals and snacks 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 noncaloric drinks when you feel an urge to eat between meals.
• Limit the amount of alcohol you drink.
• 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 health care provider's instructions for giving yourself insulin.
• Ask your health care provider what causes low blood sugar and what to do when you have low blood sugar.
• Know when and how to test your blood.
• Follow your health care 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.

Guidelines for seeing your health care provider:

• Follow your health care provider's recommendations for frequent follow-up visits until your diabetes is under good control.
• When your diabetes is under control, see your health care provider every 3 to 6 months unless your provider needs to see you more often.
• Be sure to have an eye exam every year, or more often if suggested by your health care provider.

Other guidelines for managing diabetes:

• Learn how to do proper skin and foot care every day. Wear comfortable, well-fitting shoes to help prevent foot injury. Break in new shoes gradually.
• Exercise regularly according to your health care 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.
• Carry identification (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. Many hospitals have diabetes educators and dietitians who can help you. Ask your health care provider to refer you to these people.

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

The American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 800-DIABETES (800-342-2383)
http://www.diabetes.org

How can I help prevent type 1 diabetes?

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

• Follow the guidelines your health care 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 medication.
• Stop smoking. Smoking speeds up the damage to the heart and blood vessels.
• Have other medical problems treated, especially high blood pressure.
• Keep your appointments with your health care provider.
• Call your health care provider if you have any questions.