Type 1-Diabetes

Type1 Diabetes

Type 1 diabetes is a rare form of diabetes. Some 1.6 million Americans are living with type 1 diabetes, including about 200,000 youth (less than 20 years old) and 1.4 million adults (20 years old and older). 64,000 people are diagnosed each year in the U.S Your pancreas does not produce enough or no insulin. Patients, therefore, need to inject the hormone insulin regularly into their lives to lower their elevated blood sugar levels. Read more about the causes, symptoms, diagnosis, treatment, and prediction of type 1 diabetes!

Type 1 diabetes: a brief overview

  • causes: Autoimmune disease (antibodies destroy the insulin-producing beta cells in the pancreas); It is suspected that genetic and other factors (such as infections) are involved in the development of diseases
  • Age of onset: mostly childhood or adolescence
  • Common symptoms: severe thirst, increased urinary urgency, weight loss, dizziness, nausea, weakness, and in extreme cases disorders of consciousness to unconsciousness
  • Important investigations: Measurement of blood glucose and HbA1c, oral glucose tolerance test (oGTT), autoantibody screening test
  • treatment: insulin therapy

Type 1 diabetes: causes and risk factors

Type 1 diabetes is also called juvenile (adolescent) diabetes because it usually occurs in childhood and adolescence, sometimes in early adulthood. The body’s own antibodies destroy the insulin-producing beta cells of the pancreas. Once these autoantibodies have destroyed about 80 percent of the beta cells, type 1 diabetes becomes noticeable due to the elevated blood glucose levels:

The destruction of the beta cells creates a deficiency of insulin. This hormone normally causes circulating sugar (glucose) in the blood to reach the cells of the body, where it serves as an energy source. Insulin deficiency causes sugar to accumulate in the blood.

Why the immune system in people with type 1 diabetes mellitus attacks the beta cells of the pancreas is not yet clear. Scientists suspect that genes and other influencing factors play a role in the development of type 1 diabetes.

Type 1 diabetes: genetic causes

About 10 to 15 percent of type 1 diabetes patients under the age of 15 have a first-degree relative (father, sister, etc.) who also has diabetes. It speaks of a genetic predisposition. Researchers have already identified multiple gene changes as associated with the development of type 1 diabetes. As a rule, different gene changes collectively lead to type 1 diabetes mellitus.

A group of genes located almost exclusively on chromosome 6 appears to be particularly influential: The so-called human leukocyte antigen system (HLA system) has a significant influence on the control of the immune system. Certain HLA constellations such as HLA-DR3 and HLA-DR4 are associated with an increased risk of diabetes 1.

In general, however, type 1 diabetes appears to be less inherited than type 2. In identical twins, type 2 diabetes almost always develops. In type 1 diabetes, it is observed in only about every third identical twin.

Type 1 diabetes: other factors that influence

The incidence of type 1 diabetes can also be influenced by external factors. In this context, researchers discuss:

  • too short lactation after birth
  • a dose of cow’s milk in children too early
  • premature use of gluten-containing foods
  • Toxins such as Nitrosamine

You can also contribute to, or at least promote, the contagion of the immune system in type 1 diabetesPumpkins, measles, rubella, and Coxsackie virus infections are suspected.

It is also noteworthy that type 1 diabetes mellitus occurs frequently along with other autoimmune diseases. These include Hashimoto’s thyroiditis, gluten intolerance (celiac disease), Addison’s disease, and autoimmune gastritis (type gastritis).

Finally, there are also hints that damaged nerve cells may be involved in the onset of type 1 diabetes in the pancreas.

Between Type 1 and Type 2: LADA Diabetes

LADA (latent autoimmune diabetes in adults) is a rare form of diabetes that is sometimes considered late-onset type 1 diabetes. However, there is also an overlap with type 2 diabetes:

As with ‘classic’ type 1 diabetes, LADA can also detect diabetes-specific autoantibodies in the blood – but only one type (GADA), while type 1 diabetics have at least two different types of diabetes antibodies.

Another common feature of type 1 diabetes is that LADA patients tend to be fairly lean.

While type 1 diabetes almost always occurs in childhood and adolescence, LADA patients are usually older than 35 years at diagnosis. It is similar to type 2 diabetes (the age of onset is usually after the age of forty).

The slow disease development of LADA is also more comparable to type 2 diabetes. In many LADA patients, a change in diet and treatment with hypoglycemic tablets (oral antidiabetic drugs) will initially be sufficient to lower the elevated blood glucose levels. This is what the therapy looks like in many type 2 diabetics. As the disease progresses, LADA patients usually require insulin injections – in type 1 diabetes, it is vital from the start.

Due to the variety of overlaps, LADA patients are often diagnosed as type 1 or type 2 diabetics. Sometimes the LADA is also simply considered a hybrid of both major types of diabetes. In the meantime, however, it is likely that both diseases are present simultaneously as LADA and develop in parallel.

Type 1 diabetes: symptoms

People with type 1 diabetes are usually thin (as opposed to type 2 diabetes). It typically shows severe thirst (polydipsia) and increased urine production (polyuria). The trigger for these two symptoms is a high blood sugar level.

Many sufferers also suffer from weight loss, fatigue, and a lack of driving. In addition, dizziness and nausea may occur.

When blood sugar levels are significantly increased, patients with type 1 diabetes develop a consciousness disorder. Sometimes they even fall into a coma.

Read Diabetes Mellitus Symptoms to read more about the signs and symptoms of type 1 diabetes.

Type 1 diabetes: examinations and diagnosis

If you suspect type 1 diabetes mellitus, the right contact person is your GP (pediatrician, if applicable) or a specialist in internal medicine and endocrinology/diabetology.

First, the doctor will have a detailed conversation with you or your child to record the medical history ( case history ). It can accurately describe the symptoms and ask for premature or concomitant illnesses. Possible questions in this conversation are:

  • Is there an extraordinarily strong thirst?
  • Should the bladder be emptied unusually?
  • Do you or your child often feel weak and shaky?
  • Did you or your child accidentally lose weight?
  • Is anyone with type 1 diabetes in your family?

Diabetes test

The interview is followed by a physical examination. In addition, the doctor will ask for a urine sample and make an appointment with you for a blood sample. It must be done soberly. This means that in the eight hours of (morning) blood collection, the patient should not eat anything and should eat the most unsweetened, calorie-free drinks (such as water).

Based on the blood and urine sample, a diabetes test can be performed. An oral glucose tolerance test (oGTT) also helps diagnose diabetes.

Read all about the necessary tests for the diagnosis of diabetes mellitus in the article Diabetes test.

Type 1 diabetes: treatment

Type 1 diabetes is based on an absolute insulin deficiency, and therefore patients need to inject insulin for life. For children, human insulin and insulin analogs are recommended. It is administered with a syringe or (usually) a so-called insulin pen. The latter is an injection device that looks like a pen. Some patients also receive an insulin pump that continuously delivers insulin to the body.

For type 1 diabetes patients, it is extremely important to have a thorough understanding of the condition and insulin use. Therefore, every patient should attend special diabetes training after diagnosis.

Diabetes education

In diabetes education, patients learn more about the causes, symptoms, consequences, and treatment of type 1 diabetes, and learn how to properly measure blood sugar and administer insulin themselves. In addition, patients receive tips for living with type 1 diabetes, for example in terms of sports and nutritionFor example, patients learn how much insulin the body needs for what foods. Here, the percentage of usable carbohydrates in food is important. This affects the amount of insulin to be injected:

A unit of carbohydrate (KE or KHE) is equal to ten grams of carbohydrate, which increases blood sugar levels by 30 to 40 mg per deciliter (mg/dl). Generally, an insulin unit (IU) can lower this blood sugar increase by 30 to 40 mg per deciliter. However, the insulin sensitivity of the body cells varies at different times of the day. So people need twice as much insulin for a carbohydrate unit in the morning as in the afternoon. The daily requirement for standard level insulin is on average 40 insulin units.

Instead of the carbohydrate unit, the former Bread Unit (BE) in particular was used. One BE is equal to 12 grams of carbohydrates.

By the way: Participation in diabetes education is also recommended for caregivers in facilities attended by type 1 diabetics. These are, for example, teachers or educators of a pair of shorts for children.

Conventional insulin therapy

In regular (conventional) insulin therapy, patients inject insulin according to a specific schedule: insulin injection is given two to three times daily at fixed times and fixed doses.

An advantage of this fixed scheme is that it is easily applicable and especially suitable for patients with limited learning or memory ability. Another advantage is that no constant blood glucose measurements have to take place.

On the other hand, this fixed scheme leaves the patient relatively little creative freedom For example, if you want to change the meal plan spontaneously. It is therefore a relatively rigid lifestyle required. In addition, blood sugar cannot be adjusted as evenly with conventional insulin therapy as possible with intensified insulin therapy (su). consequent damage Diabetes mellitus is therefore expected in this scheme rather than in the intensified insulin therapy.

Enhanced insulin therapy (basic bolus principle)

As part of the intensified insulin therapy, long-acting insulin is usually injected once or twice a day. It covers the rapid need for insulin and is also called basic insulin ( basal ). Immediately before a meal, the patient measures his current blood glucose value and then injects normal insulin or short-acting insulin ( bolus ). Its dose depends on the previously measured blood glucose level, the carbohydrate content of the planned meal, and planned activities.

The basic bolus principle requires one good cooperation of the patient (Compliance). The blood sugar should be measured several times a day to avoid too much sugar or under sugar.

A major benefit of intensified insulin therapy is that the patient is free in the choice of food as well as the range of motion. The dose of bolus insulin is adjusted accordingly. If the blood sugar levels are permanently well adjusted, the risk of secondary diseases decreases significantly.

By the way: A new development is a small glucose sensor that is placed in the subcutaneous adipose tissue (such as the abdomen). It measures tissue sugar every one to five minutes (continuous glucose monitoring, CGM). The measurement results are sent by radio to a small monitor where the patient can read them. It can support enhanced insulin therapy (Sensor-assisted insulin therapy), Various alarm options warn the patient in case of hypoglycemia or hypoglycemia. The blood glucose measurements are still necessary because there is a physiological difference between tissue and blood sugar.

Insulin pump

Especially in young diabetics (type 1), a diabetes pump is often used. It is a programmable, small battery-controlled device with insulin that the patient constantly carries in a small bag, such as a belt. Via a thin tube (catheter), the insulin pump is connected to a fine needle that is placed in the subcutaneous adipose tissue on the abdomen.

As programmed, the pump delivers small amounts of insulin to the body during the day. It covers the basic daily requirement (fasting requirement) of insulin. With meals, you can also inject a random amount of bolus insulin using a button. It must be calculated in advance by the patient. For example, he takes into account the current blood sugar value (he has to measure), the planned meal, and the time of day.

The pump must be customized and adapted at a specialized diabetes practice or clinic. The patient must be intensively trained before use. The insulin cartridges in the pump are regularly replaced or refilled.

Especially children will be helped by the insulin pump given a lot of freedom. If necessary, you can disconnect the sugar pump for a short time (for example for a shower). During sports, however, the pump must be worn. Many patients report that they have significantly improved their quality of life thanks to the insulin pump.

However, the pump must be worn constantly, even at night. If the catheter, unnoticed, clogs or nods or the device fails, insulin delivery will be interrupted. Then dangerous hypoglycemia can develop rapidly ( diabetic ketoacidosis ). In addition, insulin pump therapy is more expensive than intensive insulin therapy.

By the way: The above Continuous Glucose Monitoring (CGM) can also be combined with an insulin pump. The glucose sensor placed in the subcutaneous adipose tissue sends the measured values ​​of the tissue sugar directly to the pump and warns of possible hypoglycemia or hypoglycemia. Doctors talk about Sensor-assisted insulin pump therapy (SuP), Here regular measurements of blood glucose are still needed.

Type 1 diabetes: disease progression and prognosis

Unfortunately, type 1 diabetes is an autoimmune disease that lasts a lifetime. However, some researchers believe that type 1 diabetes may be curable at some point in the future. The hope lies in the BCG vaccine. It has been used before to prevent tuberculosis. A few years ago it was discovered that it can kill immune cells responsible for type 1 diabetes. However, this potential therapeutic approach needs further research. No breakthrough has been achieved so far, but it seems that the treatment of type 1 diabetes will not be completely ruled out in the future.

Life expectancy

The life expectancy of type 1 diabetes has increased dramatically in recent decades due to advances in treatment (enhanced insulin therapy). Nevertheless, type 1 diabetes has a reduced life expectancy compared to the healthy population. A study from Scotland, for example, found that 20-year-olds with type 1 diabetes had a life expectancy of 11 years (men) and 13 years (women), respectively, compared to non-diabetics.

Complications

In the context of type 1 diabetes, various complications can occur. These include acute life-threatening conditions (hypoglycemia, ketoacidosis coma) and long-term consequences of diabetes. The better a patient’s blood glucose levels, the sooner they can be avoided.

Low blood sugar (hypoglycemia)

The most common complication of type 1 diabetes is low blood sugar (hypoglycemia) due to incorrect insulin calculation. It usually manifests through symptoms such as dizziness, weakness, nausea, and hand shaking. Avoiding a meal or exercising regularly can also lead to low blood sugar if the treatment is not adequately adjusted.

Ketoacidotic coma

One of the most feared complications of type 1 diabetes is ketoacidotic coma. In some cases, diabetes mellitus is only detected if this condition occurs. The ketoacidotic coma occurs as follows:

Due to the absolute insulin deficiency in type 1 diabetes, the body cells do not have enough sugar (energy). In response, the body increasingly degrades fatty acids from adipose tissue and proteins from muscle tissue to extract energy from it.

During their metabolism, acidic degradation products (ketone bodies) are produced. It lowers the pH of the body and causes Acidification of the blood (Acidosis). The body can exhale a certain amount of acid in the form of carbon dioxide through the lungs. The affected type 1 diabetes patients, therefore, show extremely deep breathing, the so-called Kussmaul breathing. The breath often smells of vinegar or nail polish remover and is an important diagnostic indicator.

Due to insulin deficiency, type 1 diabetes can increase blood sugar levels to levels up to 700 mg / dL. The body responds with one increased urine output: It excretes the excess glucose with large amounts of fluid from the blood through the kidneys. As a result, it begins to dry out and the blood salts concentrate. Possible consequences are arrhythmia.

The strong fluid loss and hyper-acidity of the blood are associated with Loss of consciousness. This makes the ketoacidotic coma Necessary! The patients should be treated immediately in intensive care.

Consequences of type 1 diabetes

The complications of type 1 (and type 2) diabetes are usually based on a permanently poorly adjusted blood sugar level. This damages the vessels over time. Doctors refer to this vascular damage as diabetic angiopathy. It can occur in all blood vessels of the body. In the area of ​​the kidneys, the vascular damage causes diabetic nephropathy of (diabetes-related kidney damage). If the net vessels are damaged, it presents diabetic retinopathy. Other possible consequences of diabetes-related vascular damage are, for example, coronary heart disease (CHD)stroke, and peripheral arterial disease (PAD).

The high blood sugar levels are poorly adjusted Type 1 diabetes (or 2) can also damage nerves over time ( Diabetic polyneuropathy ) and lead to severe functional disorders.

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