Type 1 Diabetes: Symptoms, Causes & Treatments
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About Type 1 Diabetes
Type 1 diabetes affects about 3 million Americans and can occur at any age. It is most commonly diagnosed in children and adults younger than 30, but surprisingly more adults are being diagnosed with type 1 diabetes during adulthood. A diagnosis of type 1 later in life is sometimes called Latent Autoimmune Diabetes in Adults (LADA).
Symptoms of type 1 diabetes may include:
- increased thirst
- increased hunger
- rapid weight loss
- blurred vision (temporary)
- fatigue (tiredness)
- frequent urination
The Cause of Type 1 Diabetes
Experts now know that type 1 diabetes occurs when the immune system attacks the insulin- and amylin-producing beta cells in the pancreas of people who are genetically at risk for developing type 1. Researchers aren't sure why the immune system destroys these beta cells, though some believe one or more viruses, yet to be determined, could be to blame.
Diabetes can be diagnosed when blood glucose levels (also known as blood sugar levels) are higher than normal. Food is broken down into glucose through digestion and released into the bloodstream. Typically, glucose enters the body's cells with the help of insulin. Glucose is the cells' main source of energy.
In people with type 1 diabetes, the pancreas no longer produces enough insulin, which causes blood glucose levels to rise unless the person with type 1 takes insulin via injection or an insulin pump. High blood sugar levels without available insulin cause two problems:
• The cells cannot use glucose for energy, which can lead to fatigue and rapid weight loss, among other problems.
• High blood sugar levels can lead to complications, such as neuropathy (nerve damage), heart disease, eye damage, and kidney disease.
What's Happening Inside
1. After you eat, food is broken down into molecules the body can use for energy and repair. The carbohydrate in foods is broken down into glucose.
2. Glucose (shown here as purple hexagons) enters the bloodstream.
3. The beta cells in the pancreas no longer make a sufficient supply of insulin (shown here as yellow dots) to keep blood sugar levels under control.
4. Typically a person with type 1 diabetes uses a couple types of insulin injected several times a day just under the skin in the abdomen, arms, legs, or several other places. Insulin helps the glucose get into the body's cells to be used for energy.
How Type 1 Diabetes is Diagnosed
Type 1 diabetes can be diagnosed with one of three simple blood tests.
• A1C test: In 2010, the American Diabetes Association (ADA) began recommending the hemoglobin A1C (abbreviated as A1C) blood test to determine the diagnosis of diabetes in its Standards of Medical Care for Diabetes. Internationally this is becoming the preferred test rather than a blood glucose check, which only shows a blood glucose result at one point in time. The A1C test is able to detect the ups and downs of blood glucose over the last two to three months. It's also convenient because fasting isn't required.
Normal: 5.6% or lower
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or greater
Blood sugar results, either fasting or random, can also be used to diagnose diabetes. Typically blood sugar levels in the person being diagnosed with type 1 diabetes are quite high. The diagnosis is relatively quick and simple.
• Fasting blood glucose test: Taken after eight hours of fasting (though water is permitted), this test indicates diabetes if the blood sugar level is higher than 126 mg/dl.
• Random blood glucose test: Taken anytime (nonfasting), this test indicates diabetes if the blood sugar level is higher than 200 mg/dl. If one result does not clearly indicate prediabetes or diabetes, a second blood glucose measure should be done.
Type 1 Diabetes Treatment
With good blood sugar control over the years, people with type 1 diabetes can live a long and healthy life. Along with controlled blood glucose levels, control of blood pressure and blood lipids (cholesterol) are also very important to reduce the risks of diabetes complications, such as heart disease, blindness, or kidney failure. Treatment for type 1 diabetes includes:
1. Insulin: People with type 1 diabetes require insulin to survive, because their bodies don't produce sufficient insulin on their own. The point of insulin therapy is to provide the insulin the body would make normally. There are several options for insulin delivery:
• Insulin pens look like thick ink pens and have one type of insulin in the cartridge. A needle is attached to the pen for injections. Today more people use insulin pens, and most types of insulin are available in pen form.
• Insulin pumps deliver insulin 24/7 based on dosing the wearer sets in consult with a health care provider. Today there are two main types of pumps. One type uses an infusion set that is inserted subcutaneously; tubing runs from the site on the skin to the device. This device must be worn on the body. The other type of pump uses no tubing. A person wears a pod filled with insulin that is attached to the infusion set inserted under the skin anywhere insulin can be given. The wearer communicates with the pod using a handheld device that doesn’t need to be worn on the body.
• Syringes are filled with insulin, which is delivered via injection.
There are also a variety of insulin types, including rapid-acting, intermediate-acting, and long-acting. People who use an insulin pump typically use only rapid-acting insulin. People who take injections typically use long-acting insulin once or twice a day, and then take rapid-acting insulin when they eat.
Tracking Blood Glucose
2. Monitoring: People with type 1 diabetes need to eat meals at regular times and test their blood sugar several times a day to make decisions about the amount of insulin they need to take.
Blood glucose monitoring also helps a person with type 1 detect blood glucose extremes, such as high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia).
Most meters can store a large number of glucose readings over time. To make changes in a treatment plan, people with diabetes and their health care providers can monitor glucose meter results to see patterns or other indicators.
Today an increasing number of people with type 1 diabetes use what’s called a continuous glucose monitor (CGM). They wear a sensor attached to their abdomen, and a glucose result is recorded either on their insulin pump or on the receiver of a separate device every few minutes.
In addition, the ADA’s standards of diabetes care recommend occasional A1C testing (also called glycosylated hemoglobin), which measures blood sugar levels over the prior two to three months. The ADA recommends that most people with diabetes have an A1C of 7 percent or lower. However, you and your health care provider should decide together on the best target for you.
3. Healthful Eating Plan: Meal planning is necessary to maintain good blood sugar control and to predict the amount of insulin needed. To manage diabetes and prevent complications, a healthful meal plan should be rich in whole grains, fresh fruits, and vegetables, and low in saturated and trans fats.
4. Exercise: Physical activity can help reduce blood sugar levels, maintain a healthy weight, and lower the risk of diabetes-related complications. However, exercise can also cause blood sugar to go too low. People with type 1 diabetes should talk with a physician about how to adjust insulin and carb intake before starting an exercise program. People with type 1 diabetes who don’t have enough insulin in their circulation at the time they exercise can experience elevations in blood sugar as well.
Type 1 Diabetes Risk Factors
Because it is not known what causes the immune system to attack the insulin-producing beta cells, it's impossible for researchers to predict who will develop type 1 diabetes. There might be a heightened risk for people with a parent or sibling who has type 1 diabetes.
Adult Onset of Type 1 Diabetes: Sometimes referred to as Latent Autoimmune Diabetes in Adults (LADA); slow-onset type 1 is rare, though the number of cases seems to be increasing.
The cause of LADA seems to be the same as traditional type 1 diabetes—an autoimmune attack that results in the pancreas no longer producing insulin. Many people with LADA are initially misdiagnosed with type 2 diabetes because they are older than 30 (most people with type 1 are diagnosed as children or young adults). Further testing is often required for a correct diagnosis.