Type 1 Diabetes

What is type 1 Diabetes?

Type 1 Diabetes is an autoimmune disorder commonly affecting children. It is also called insulin-dependent Diabetes or juvenile Diabetes as it commonly affects children. The body’s immune cells destroy the beta cells of the pancreas and insulin is not secreted, leading to the complete absence of insulin. So the external injection of insulin is the only way of treatment.

In this article, let’s analyse the causes, pathophysiology, risk factors, treatment and ways to prevent Diabetes complications. Let us discuss whether type 1 Diabetes is treatable or do we have a cure for type 1 Diabetes. You can learn how to differentiate type 1 from Type 2 Diabetes.

Most common age of diagnosis

Children between 4 to 6 yrs and early puberty (10 -14). Type 1 Diabetes is more common in developed countries and less common in developing nations. Type 1 Diabetes is less common than Type 2 Diabetes.

Risk factors of Type 1 Diabetes

It has genetic and environmental triggers. HLA predisposition is linked to HLA DR3/DR4 in whites. There are many environmental risk factors. Few of them are previous enteroviral infection like the coxsackie virus. 

Symptoms

Symptoms of high sugars like weight loss, increased thirst, increased urination, bed wetting, tiredness, irritability, increased hunger and infections. 

Diabetic ketoacidosis is an emergency, life-threatening situation with very high sugars. It is commonly seen in Type 1 Diabetes. It is detected by the following symptoms:

• Fruity odour
• Nausea, vomiting
• Stomach pain
• Ketones will be present in urine and blood
• Rapid breathing 

What are the tests to diagnose type 1 Diabetes?

Apart from confirming high blood sugars, the specific tests to find autoimmunity are GAD antibody assay and C peptide tests.

GAD antibody will be positive and C peptide will be low or absent. C peptide indicates how much of your beta cells are working and releasing natural intrinsic insulin. 

Treatment

As there is no insulin in the body, insulin has to be injected from outside in Type 1 Diabetes. It is different from Type 2 Diabetes where insulin is still secreted within the body. 

Different types of insulin injections are available in the market. Basically, combination of basal insulin and bolus insulin is the regime to mimic the natural functioning of your pancreas.

Basal insulin continues to release a small amount of insulin throughout the day similar to the normal pancreas. Bolus insulin covers all your 3 main meals. 

Fear of insulin injections

Nowadays, there are many less painful ways of administering insulin.

• Small-sized pen needles are available.
• Inhaled insulins (Afrezza)
• Insulin pumps
• Jet insulin injector

How to control your sugars?

• Monitor your sugars regularly at home using a home glucometer
• Use low carbohydrate, high protein, normal fat diet
• Increase physical activity
• Decrease stress levels
• Sleep adequately
• Laugh loudly
• Establish social connectivity
• Never miss even a single insulin injection. Give it at the right time before food.

Prevention of Diabetes complications

Maintain your blood sugar within a target range. Time in range is the duration of time your sugars are maintained within a normal range. It should at least be 70% for a single day. Use Continuous Glucose Monitoring Systems (CGMS) to keep your sugars within a time range.

• Check your HbA1c levels every 3 to 6 months.

• Regularly do lab tests like spot urine microalbumin and Urine protein to creatinine ratio once every 6 months for early detection of kidney damage. 

• Regularly do retinal screening for early detection of Diabetic eye damage. 

• Cardiac evaluation is also a must because heart attacks in Diabetics are silent. Coronary calcium scoring (CAC score) is a non-invasive early investigation for the detection of coronary lesions to prevent heart attack.

• Regularly self-examine your foot for any signs of nerve damage.

• Self-management of Diabetes is a very important skill to acquire because your knowledge will help you to detect early warning signs and get doctors’ help immediately whenever it is needed. 

How Type 1 Diabetes is different from Type 2 Diabetes? 

TYPE 1 DIABETES	TYPE 2 DIABETES
Common in children	Common in adults
Complete absence of insulin	Insulin resistance is the cause and insulin is still secreted by the pancreas
Insulin is the only treatment	Antidiabetic medicines and insulin is the treatment
Autoimmunity is the cause – GAD Antibodies will be present	Metabolic syndrome with insulin resistance is the cause – no antibodies
Type 1 Diabetes is not reversible	Type 2 Diabetes can be reversed

Is Type 1 Diabetes preventable? 

Prevention is not possible. Antibody tests can be done on family members for early detection of Type 1 Diabetes.

Is Type 1 Diabetes curable?

Currently, there has been no cure for type 1 Diabetes. Research is going on. Pancreatic islet transplantation and beta stem cell research are in progress.

Managing a Type 1 Diabetic child is a challenge. Frustration, depression and eating disorders are common. Get adequate help from the concerned specialist doctors and don’t hesitate in doing so.