Type 1 Diabetes

About type 1 diabetes 

Type 1 diabetes is also known as insulin-dependent diabetes mellitus.

Glucose and insulin

Glucose is a simple form of sugar found in foods and sugary drinks - it's absorbed as a natural part of digestion. One function of your blood is to carry glucose around your body. When glucose reaches body tissues, such as muscle cells, it's absorbed and converted into energy. Insulin helps with the absorption process so it’s critical for regulating the glucose concentration. If you have a shortage of insulin, glucose can build up in your blood.

Insulin is secreted into the blood by your pancreas - a gland found behind your stomach. Type 1 diabetes develops when the cells in your pancreas that make insulin - called beta cells - are destroyed by your body's own immune system. Because of this, type 1 diabetes is known as an autoimmune disease.

Types of diabetes

There are two main types of diabetes: type 1 and type 2. Almost 900,000 Australians have diabetes. Type 1 diabetes is the rarer form, affecting about 10 percent of Australians with diabetes.

Symptoms of type 1 diabetes 

The initial symptoms include:

• weight loss
• excessive passing of urine
• constant thirst
• tiredness
• blurred vision
• itchy skin around your genitals or regular infections, such as thrush.

The symptoms can develop quickly - usually over a few weeks. In particular, marked weight loss, often over a short period of two to eight weeks is the main distinguishing symptom between type 1 and type 2 diabetes. The other symptoms listed above can occur in either type.

Complications of type 1 diabetes 

If type 1 diabetes isn't diagnosed or controlled properly, you can develop high blood glucose levels (hyperglycaemia). Sometimes the treatment itself can cause low blood glucose levels (hypoglycaemia). Both of these conditions can lead to complications.

Low blood glucose

Low blood glucose can occur if you exert yourself or don't eat enough foods that contain glucose while taking insulin. It can also happen if you take too much insulin, which leads to your cells taking up more glucose and therefore blood glucose levels falling. If you have low blood glucose, generally defined as under 3.5–4.0 mmol/L, you may feel faint, sweat and feel your heart pounding. If you don't treat this by eating or drinking something sugary, it can lead to confusion, collapse and even coma. This is often called a 'hypo'.

High blood glucose

Most patients will develop high blood glucose levels from time to time. These will settle either of their own accord or in response to a change in the dose of insulin you're taking. Rarely, glucose can build up in your blood and reach dangerous levels if you don't have enough insulin in your bloodstream. This condition is called diabetic ketoacidosis and causes additional symptoms, including:

• vomiting
• stomach pain
• rapid breathing
• fruity or sweet acetone smelling breath (like nail polish remover).

Diabetic ketoacidosis needs immediate medical treatment in hospital. Without this, the condition can lead to coma and even death.

Long-term, poorly controlled high blood glucose can be very damaging to your health and can increase your risk of heart disease, stroke, kidney failure, nerve damage and blindness. The risk of blindness has been greatly reduced in the last 20 years because of advances in specialist eye treatment and better insulin products. There is also better understanding now of how the body's functions are affected by diabetes.

Causes of type 1 diabetes 

The exact cause of type 1 diabetes isn't known. However, it's possible that it may be triggered by a virus or other autoimmune diseases, or it may run in your family.

Diagnosis of type 1 diabetes 

If you think you may be developing diabetes, visit your GP. It's important to seek help early so you can get the treatment you need.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. They may also ask for a urine sample to be tested for glucose and ketones. Urine doesn't usually contain glucose, but it can be detected if you have diabetes. However, diabetes is usually diagnosed with a blood test to measure the level of glucose in your blood. This might be a fasting glucose test, which is taken after you haven't eaten for at least eight hours, or a random glucose test done at any time.

If your GP can't make a definite diagnosis after these tests, you may have a glucose tolerance test. This measures how your blood glucose level changes over time after you swallow a sugary drink. You will need to fast overnight before having this test.

Treatment of type 1 diabetes 

There isn't a cure for type 1 diabetes but it can be controlled.

Medicines

Type 1 diabetes can be controlled with insulin. This allows glucose to be absorbed into cells and converted into energy, stopping it building up in the blood.

There are different kinds of insulin that work at different rates and act for different lengths of time. Each can have varying rates of success in different people - ask your doctor or diabetes educator for advice on which type is best for you.

There are two main methods of taking insulin:

• Insulin injections. This is the most common form of treatment, where insulin is injected under the skin. You will usually need to give yourself injections two to four times a day, using either a small hypodermic needle or a pen-type syringe with refillable cartridges.
• Portable insulin pumps. This may be appropriate for you if you find it difficult to control your blood glucose with regular injections despite careful monitoring of its level. These are about the size of a pack of cards and can be attached to your waist. Insulin pumps can be programmed to inject you with insulin at a rate that you can control. However, these aren't appropriate for most people with diabetes.

Your doctor will advise you on the most appropriate method for you.

Self-help

Controlling your blood glucose

If you have diabetes, it's very important to carefully control your blood glucose level in order to stay as healthy as possible. However, you may have a 'hypo', or near hypo, from time to time, so it's a good idea to keep some sugary food or glucose tablets with you to control it. You can also buy glucose gels that rapidly increase your blood glucose level.

A hypo is an emergency – so it's vital that friends and relatives know what to do should you have a hypo. They should ring 000 if concerned or if you can’t swallow or be woken.

You can monitor your blood glucose levels with a home test kit. It involves taking a pinprick of blood from the side of your finger and putting a drop on a testing strip. A meter will read the result automatically.

You can adjust both your diet and insulin to keep your blood glucose level within the normal range. Your 'normal' range will be specific to you but a general guide for adults is:

• before meals: 4 to 7 mmol/L
• After meals: less than 9 mmol/L.

Your GP or diabetes educator can guide you on how to monitor and manage your blood glucose and will give you continuing support.

A healthy lifestyle

In addition to controlling blood glucose, your lifestyle is key to ensuring that diabetes has as little impact as possible on your health.

• A healthy diet is essential if you have diabetes and it's important to eat regular meals. Special diabetic foods aren't necessary for a healthy diet; you just need to eat a balanced diet that is low in saturated fat, sugar and salt and high in fibre, vegetables and fruit. Include carbohydrates, such as pasta, potatoes or sugary foods such as fruit in each meal. Your GP, dietitian/nutritionist or diabetes educator can help you design a healthy eating plan.
• Exercise promotes a healthy circulation and will help you to stay a healthy weight. The National Physical Activity guidelines recommend all adults take half an hour of moderate activity on at least five days a week to help maintain good health. The National Heart Foundation of Australia also suggests that people living with diabetes or people at risk of developing diabetes who have no limitations to exercise should try to build up to 45–60 minutes of moderate-intensity exercise on most days of the week in order to lose weight.
• If you have diabetes, there's no need to give up alcohol completely, but it's important to drink sensibly. The National Health and Medical Research Council recommends that adults drink no more than two standard drinks each day. However, don't drink on an empty stomach - eat food containing carbohydrate before and after drinking and monitor your blood glucose levels regularly.
• Smoking is unhealthy for everyone, but quitting is especially important for people with diabetes. This is because you already have an increased risk of developing cardiovascular disease or circulatory problems. Smoking makes the chance of developing these diseases even greater.
• It's also important to keep your blood pressure and the level of cholesterol in your blood well controlled. High blood pressure and high cholesterol levels have been linked to heart attack and stroke. You're more at risk if you have diabetes.

You can control your blood pressure by following the tips above, but you may also need to take medication. Similarly, the best way to control the level of cholesterol in your blood is to reduce the amount of fat in your diet.

Further information 

Diabetes Australia
http://www.diabetesaustralia.com.au

Sources 

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Last published: 30 July 2011

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