Type 1 diabetes mellitus, formerly known as juvenile diabetes or insulin-dependent diabetes, occurs when the pancreas stops producing the hormone insulin.
Insulin tells the body's cells to absorb the sugar known as glucose from the blood and to use it as fuel. Without it, cells starve for want of energy while blood sugar levels rise out of control.
How is type 1 diabetes different than type 2? Type 2 diabetes is a much more common type of the disease in which the cells of the body stop responding normally to the effects of insulin or the body produces some, but not enough, insulin.
How many people have diabetes? The American Diabetes Association (ADA) estimates that 20.8 million Americans, or about 7% of the population, have diabetes, but the vast majority of these cases (90-95%) are of type 2 diabetes. Researchers estimate that more than 1 million Americans – and perhaps as many as 3 million – have type 1 diabetes, many of them children and young adults.
Having diabetes increases the risk of several serious diseases and other complications. While there is no cure for Type 1 diabetes, the condition can be managed through the use of insulin shots and dietary control and people with diabetes can live full, healthy lives.
The signs of type 1 diabetes are similar to those of type 2 diabetes.
Someone can have diabetes without knowing it because the symptoms aren't always obvious and they may develop gradually over time. Some people may have no symptoms at all, while for others the initial symptoms may range from very mild to life-threatening conditions such as diabetic ketoacidosis.
One major difference between type 1 and type 2 diabetes: Type 1 is most often diagnosed in children, teenagers, or young adults, while type 2 occurs most frequently in middle aged and older adults.
Symptoms that may occur with type 1 diabetes include:
- frequent urination
- extreme thirst
- increased appetite
- drowsiness, fatigue, or lethargy
- blurred vision
- unexplained weight loss
- fruity or sweet odor on your breath
- sores that heal slowly
- dry, itchy skin
- tingling or loss of feeling in the feet
- sugar in urine
Type 1 diabetes occurs when specialized cells called beta cells found in the pancreas -- an organ located behind the stomach -- are destroyed. Without them, the body is incapable of producing any insulin.
When someone without diabetes eats a meal, the nutrients are absorbed into the bloodstream by the digestive tract. This causes a rise in blood sugar which signals the beta cells of the pancreas to release insulin. Insulin travels in the bloodstream and signals the cells of the body to take up sugar from the blood and use it as their primary source of energy. It also signals certain cells to store excess sugar for later use.
While it is clear that the loss of the pancreatic beta cells is the cause of type 1 diabetes, the reason these cells die is less clear. Researchers believe that the body's immune system mistakenly attacks the beta cells leading to their demise. Approximately 85 percent of patients have antibodies in their blood that are directed against islet cells.
Type 1 diabetes is an autoimmune disease, a type of disease that occurs when the immune system attacks normal body cells. The reason that the immune system goes awry in type 1 diabetes is unknown, as it is with other types of autoimmune diseases. Researchers believe genetics may play an important role in the development of type 1 diabetes. Environmental conditions such as exposure to certain viruses may also play a role.
Since the exact cause of type 1 diabetes in unknown, it is difficult to determine who is at risk for developing the disease. One factor that seems to increase your risk of type1 diabetes is having a close relative with the disease.
Other known risk factors include:
- Race: Type 1 diabetes is more common among non-Hispanic whites, African Americans, and Hispanic Americans, while it is less common among Asians.
- Sex: Type 1 diabetes is more common in males than it is in females.
- Age: Unlike many chronic diseases, type 1 diabetes affects mostly younger people. The disease usually starts in children aged 4 years or older, and is most commonly diagnosed between the ages of 11 and 13 years. A small number of people are not diagnosed unitl their late 30s or early 40s.
If you are experiencing any of the symptoms of type 1 diabetes, see the doctor to get checked out. The tests to diagnose diabetes are relatively simple and if you do have the disease, it is important to find out before serious complications develop.
When you visit the doctor: She will perform a standard physical exam and take your personal and family medical history. In addition, the doctor will perform simple tests to help diagnose type 1 diabetes.
Treating type 1 diabetes involves monitoring your blood sugar and taking insulin shots. It also involves lifestyle changes, including increasing your activity level, eating right, and maintaining a healthy weight. Talking with your doctor or dietitian about exercises you can do and foods you can eat can help you improve your overall health.
If you are diabetic: The goal of treatment is to keep your blood sugar level within normal limits, ideally between 70 -140 mg/dL. Controlling your blood sugar not only prevents short term complications such as ketoacidosis, it can also reduce the risk of diabetes-related heart complications by 50 percent.
All about blood sugar: Your doctor can help you determine how often you should check and record your blood sugar; usually, it is several times each day. Blood sugar monitors come in many varieties, but all of them require a small amount of your blood to estimate your blood sugar level. Recent advances in technology have made blood sugar determination far less painful and time consuming, allowing diabetics to monitor their levels as often as is necessary.
Insulin is commonly self-administered by a shot into the abdomen, upper arms, thighs or hips. Another method of administration is an insulin pump which is implanted under the skin and continuously releases insulin into the blood.
Untreated diabetes can lead to some serious health complications. If you have diabetes, the best way to avoid diabetes complications is to manage your blood sugar well.
Some short-term complications of diabetes include:
- Diabetic ketoacidosis: This occurs when lack of insulin causes cells to starve for want of sugars and can lead to unconsciousness and coma, even death.
- Hyperglycemia: High blood sugar or high blood sugar can occur when you eat too much sugar or do not take enough insulin. It can cause frequent urination, increased thirst, dry mouth, blurred vision, fatigue, and nausea; if left untreated, hyperglycemia can lead to heart problems or coma.
- Hypoglycemia: Your blood sugar can drop too low if you take too much insulin or do hot eat enough sugar. Symptoms of hypoglycemia include sweating, shakiness, weakness, hunger, dizziness, and nausea; if left untreated, it can lead to drowsiness, confusion, and eventually, unconsciousness.
Consult your doctor if you're concerned that you might have diabetes, especially if you notice any of the symptoms of type 1 diabetes such as increased thirst, frequent urination, extreme hunger, weight loss, fatigue, or blurred vision.
If you have already been diagnosed with diabetes, contact a health professional right away if you experience any symptoms of diabetes complications. See the doctor regularly for checkups and have regular foot and eye exams to identify problems with your feet or vision early, before they become serious.
These tests may include:
- Fasting blood glucose test: After fasting overnight (at least 8 hours) a blood test can be performed to check your blood sugar. If your blood glucose level is 126 milligrams per deciliter (mg/dL) or above after fasting for 8 hours on two separate testing occasions, you have diabetes. If your blood glucose is between 100 and 125mg/dL, this is considered prediabetes, which is a risk factor for developing type 2 diabetes.
- Random (non-fasting) blood glucose test: If you have a blood sample taken -- regardless of how long it has been since you last ate -- and your non-fasting blood glucose is higher than 200 mg/dL, the doctor will suspect diabetes. This is especially true if you are having other diabetes symptoms such as increased thirst and urination. A fasting blood glucose test must be done to confirm the results.
- Oral glucose tolerance test: This test examines how well your body metabolizes sugar after it is introduced into your body. After fasting overnight, the doctor will provide you with a sample of sugary liquid to drink. Then, a blood sample is taken every 30 to 60 minutes after you drink the solution for 2 to 3 hours. Diabetes is diagnosed if your blood glucose level is higher than 200 mg/dL after 2 hours. If your blood glucose is between 140 and 200 mg/dL it is considered “impaired glucose tolerance” or prediabetes.
Your doctor may do other tests to distinguish between type 1 and type 2 diabetes, which is an important consideration in determining how best to treat the condition. A test for your blood insulin level can help determine that you have type 1 diabetes if it shows that you have little or no ability to produce insulin. Another test is a blood test for immune system molecules called antibodies directed against the beta cells of the pancreas, which are found only in people with type 1 diabetes.
Your doctor may also recommend a glycated hemoglobin (A1C) test, which shows your average blood sugar level over the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. Generally, a target A1C result is 7 percent or less.