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What is Diabetes (Type 1)?

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Caring for those with type 1 diabetes


Whether you act as a caregiver for a loved one, a friend, or someone who needs a helping hand, it's essential to know all you can about their health issues. By understanding the causes and symptoms of their ailments, you will be able to provide better care for them, particularly when it comes to type 1 diabetes. Also referred to as juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is an incurable condition resulting from an insulin deficiency.

Insulin is a hormone produced by the pancreas that facilitates the transfer of glucose (sugar) into energy-producing cells. However, in the case of diabetes, the pancreas does not produce enough insulin for the body to handle this glucose transfer properly.

Type 1 diabetes typically develops in children and young adults, but it can also occur in mature adults. Unfortunately, there is no cure for type 1 diabetes, so it must be managed using insulin injections, diet control, and lifestyle changes to prevent complications. If you're aiding in caring for someone who has type 1 diabetes, this information should help better understand the condition and manage it properly.


What is type 1 diabetes


Type 1 diabetes, commonly known as juvenile diabetes, insulin-dependent diabetes, or type 1 diabetes mellitus, is a condition that is caused by the pancreas’ inability to produce adequate amounts of insulin, sometimes producing none at all. Insulin is a hormone that is extremely important because it allows for the acceptance of glucose (sugar) by cells to produce energy.

Without insulin, glucose cannot enter the cells in the body, and with nowhere else to go, it will accumulate in the bloodstream. When blood glucose levels get too high, it can cause significant damage to the body, leading to many type 1 diabetes-related symptoms and complications, such as nerve damage, kidney damage, and heart disease. And although there is currently no cure for type 1 diabetes, with the proper treatment protocol in place, most of these symptoms can be avoided.


What are the symptoms of type 1 diabetes


There are numerous symptoms attributed to type 1 diabetes. These signs and symptoms of diabetes appear abruptly, and therefore, the ability to recognize them is crucial.


The signs and symptoms of type 1 diabetes include:


●       Increased thirst

●       Frequent urination

●       Bed-wetting in children with no prior bed-wetting issues

●       Increased appetite or extreme hunger

●       Unintended weight loss

●       Irritability and temperament issues

●       Mood changes

●       Fatigue and weakness

●       Blurred vision


What are the causes of type 1 diabetes


The precise cause of Type 1 diabetes is unknown; however, it is theorized that an autoimmune reaction or autoimmune disease is to blame. An autoimmune reaction is essentially a condition where the body attacks itself by mistake. When this reaction occurs, it destroys the cells in the pancreas, which are known as beta cells. This beta cell destruction can continue unnoticed for months, and even years, before any signs or symptoms appear.

Another possible cause of type 1 diabetes is the idea that specific genes (traits passed from parent to offspring) may predispose an individual to diabetes, mainly since the condition usually develops during childhood or adolescence. Individuals who have these genes will not necessarily develop diabetes - they are simply at a higher risk of it occurring.


Other outlying factors that may cause type 1 diabetes are:


●       Genetics

●       Environmental factors

●       Exposure to viruses


What is the difference between type 1 vs. type 2 diabetes


There are two primary types of diabetes: type 1 diabetes and type 2 diabetes. The two types of diabetes share some similarities in that they have many of the same symptoms, and those symptoms often lead to the same complications. In the end, however, the diseases are poles apart.

As we mentioned, type 1 diabetes results from the pancreas’ inability to produce insulin, which inhibits the movement of glucose from the bloodstream into the body’s cells.

On the other hand, type 2 diabetes develops when the cells responsible for taking in the glucose don't respond well when triggered by insulin, even though the hormone level in the body is adequate. Due to insulin resistance, the glucose in the bloodstream is not entering the cells at an acceptable rate, and eventually, this causes the body to stop producing enough insulin.

There is also a difference in the prevalence of the symptoms related to type 1 and type 2 diabetes. With type 1 diabetes, the symptoms are easily recognizable because of the rapidity at which the condition develops. Contrarily, the development of type 2 diabetes can take many years, making the symptoms much more difficult to notice. Those with type 2 diabetes often don’t realize they have it until it causes complications.


What are the risk factors for type 1 diabetes


As with the causes of type 1 diabetes, the risk factors for type 1 diabetes are unconfirmed, but according to the National Institutes of Health (NIH), they include:

● Family history. As with other diseases and conditions, there is an increased likelihood of developing type 1 diabetes if other family members, such as a parent or sibling, already suffer from the condition.

● Genetics. Certain genes are found in the DNA of specific individuals that may predispose them to type 1 diabetes.

● Geography. Although the exact reason for the correlation has not been determined, it’s well-known that the rate of type 1 diabetes increases as the distance from the equator increases.

● Age. Type 1 diabetes can indeed develop in mature adults, but the probability of it developing in children and adolescents is much higher. For children, the chance of type 1 diabetes emerging peaks between 4 and 7 years of age, and in adolescents, it peaks between 10 and 14 years of age.


What complications arise from type 1 diabetes


The complications that can arise from type 1 diabetes are numerous. If left unchecked, they can have devastating consequences on the body’s major organs, including the heart, kidneys, and nerves — to name a few. If these complications of diabetes continue for an extended period, they can eventually become disabling or even life-threatening.

Whether you’re an individual caregiver or part of a health care team, continuous glucose monitoring and maintaining acceptable blood sugar levels are imperative, as this can drastically reduce the risk of complications.


These are the most common complications caused by type 1 diabetes:


● Heart disease. Type 1 diabetes significantly increases the risk of cardiovascular problems, such as heart attack, stroke, and high blood pressure. However, when obesity is coupled with type 1 diabetes, the chance of a cardiovascular problem arising is exponentially higher.

● Nerve damage (neuropathy). When blood sugar levels are too high, it can harm the lining of the small blood vessels (capillaries) that carry nutrients to the nerves, particularly in the legs. These damaged blood vessels can cause numbness or pain, which usually originates in the tips of the toes or fingers before slowly spreading to the rest of the limb. If untreated, the entire limb could lose its sense of feeling.

● Kidney failure (nephropathy). There are millions of little blood vessels within the kidneys, and they play a crucial role in supporting bodily functions by filtering waste and toxins from your blood. Without continuous glucose monitoring, excessive blood sugar could damage these blood vessels and, in turn, induce kidney disease and even kidney failure.

● Retina damage. The minute blood vessels of the retina are sensitive and, therefore, can easily be damaged by high blood sugar levels. By monitoring blood sugar levels and practicing insulin dosing, complications leading to cataracts, glaucoma, and blindness can be prevented.

● Foot infections. The nerve damage caused by high blood sugar levels can also wreak havoc on the feet. If this issue goes untreated, seemingly insignificant cuts and scrapes can evolve into serious infections, often requiring toe and foot amputations.

● Pregnancy complications. Complications from diabetes affect expecting mothers, and they can be dangerous for the baby. When blood sugar exceeds normal levels, it increases the risk of congenital disabilities and could cause a miscarriage or stillbirth. Type 1 diabetes also significantly raises the probability of the mother suffering pregnancy-induced high blood pressure, preeclampsia, and diabetic ketoacidosis, also known as DKA.

● Diabetic Ketoacidosis (DKA). A significant concern for type 1 diabetics, ketoacidosis occurs when harmful fatty acids, also known as ketones, are released from the liver when there is little or no insulin left in the body. DKA can cause life-threatening issues if not treated immediately.


How to prevent type 1 diabetes


There cause of type 1 diabetes is still unknown, and this means that there is no way to prevent the condition from developing. However, with support from the JDRF and the American Diabetes Association, researchers at the NIH continue to make progress in understanding what causes the self-destruction of the islet cells and beta cells within the pancreas and whether or not an autoimmune disease affecting the immune system is to blame.


Diagnosing Diabetes


Diagnostic testing for diabetes involves using one of three different tests, and the health care provider will decide which testing method to use. The three primary tests used in diagnosing type 1 diabetes include:

Glycated hemoglobin test. Also referred to as the A1C test, a glycated hemoglobin test is a blood test used to determine an individual’s average blood sugar level over the preceding two to three months. It does this by measuring the ratio of blood sugar to hemoglobin in the red blood cells. When blood sugar levels are high, it leads to the attachment of more hemoglobin, indicating type 1 diabetes.

There are certain preexisting health conditions and other external factors that can affect the accuracy of the A1C test, like pregnancy. Therefore, the diabetes care team, together with the health care provider, may opt for a different testing method, such as:

Random blood sugar test. Although less intuitive than the A1C test, the random blood sugar test is very similar in methodology. A blood sample is taken at random times over a specified period, and this technique of random sampling helps to ensure that the results aren't skewed. If the test samples indicate high blood sugar levels, it's suggestive of diabetes, especially if the individual is experiencing diabetes-related symptoms such as frequent urination and an unquenchable thirst.

Fasting blood sugar test. As the name indicates, the fasting blood sugar test involves fasting overnight before a blood sample is taken and analyzed. And just like the other diabetes tests, a high blood sugar level leads to the diagnosis of diabetes. This test can also indicate prediabetes, which is a condition that usually precedes diabetes.

If the outcome of the tests is a diagnosis of diabetes, then your health care team may recommend checking for autoantibodies, which are only present in type 1 diabetes. Checking for these autoantibodies will help determine whether the individual has type 1 or type 2 diabetes.


Post diagnosis of type 1 diabetes


The diagnosis of type 1 diabetes is usually followed-up with regularly scheduled diabetes management discussions provided by a diabetes educator. During these meetings, the health care provider will check A1C levels to ensure that they are stable. Any number of factors can cause fluctuations in A1C levels, but they are commonly the result of dietary changes.

Committing to a healthy diet is an important part of diabetes treatment, and having a meal plan developed by a dietitian can go a long way in preventing diabetic complications from arising. A healthy diabetic-friendly diet usually involves eliminating foods and fruity drinks high in sugar and salt, avoiding unnecessary carbohydrates, and eating plenty of fruits and vegetables.


Taking care of type 1 diabetes


The prevalence of diabetes will undoubtedly motivate researchers to find the cause of the condition and a cure. But one thing is certain: there is still a lot to learn about type 1 diabetes. On the other hand, those who have diabetes can take steps that will significantly reduce the likelihood of complications arising, such as eating healthy, exercising, and continually monitoring blood sugar levels. Whether you're a caregiver or part of a health care team assisting those who have type 1 diabetes, forming a better understanding of this condition will help properly care for those who have it.


Rob Fisher

A Nurse Director at a large medical center in Boston, MA, who holds a Master’s in Nursing Leadership and Administration and an MBA in Healthcare Management.

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