Type 1 Diabetes: Symptoms, Causes & Treatments
About Type 1 Diabetes
Type 1 diabetes affects about 6 million Americans. It is most commonly diagnosed in infants, 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 yet 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 to be used for energy 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. People with type 1 diabetes must take insulin via injections or an insulin pump to prevent this. High blood sugar levels without a sufficient supply of available insulin can cause acute and long-term issues:
• In the short run, a lack of insulin via injections or pump initially cause the symptoms of high blood glucose noted in slide 1. If the person doesn’t receive insulin and fluids, they can develop diabetic ketoacidosis, a condition that needs immediate medical attention. The cells cannot use glucose for energy, which can lead to fatigue and rapid weight loss, among other problems
• In the long term, Hhigh blood sugar levels over the years mixed with large ups and downs of blood glucose levels can lead to complications, such as neuropathy (nerve damage), heart disease, eye damage to the retinas in the eyes, and kidney disease. Keeping good glucose control over the years can prevent these complications.
What's Happening Inside
1. After you eat, food is broken down into the component parts of carbohydrate, protein and fat to provide the body with 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 as it does in people who don’t have diabetes.
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, or they use an insulin pump. 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 obvious and can be done relatively quickly and simply.
• 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 long and healthy lives. 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. Insulin therapy allows the insulin a person takes to be available when it’s needed to keep glucose levels under control. There are several options for insulin delivery:
• Insulin pens look like thick ink pens and have one or two types of insulin in the cartridge. There are refillable and non-refillable pens. A very thin, short needle is attached to the pen for injections. Today more people use insulin pens than syringes, and most types of insulin are available in pen form.
• Insulin pumps or patches 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 (just under the skin); tubing runs from the site on the skin to the small device. This device must be worn on the body. The other type of pump (a patch or pod) uses no tubing. The pod or patch is filled with insulin. The user directs the delivery of insulin with a handheld device that doesn’t need to be worn on the body. The pod or patch is infused through a short cannula inserted just under the skin anywhere insulin can be given.
• 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
Blood glucose monitoring helps a person with type 1 detect blood glucose extremes, such as high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia). People with type 1 can make changes in their insulin doses, the food they eat, and more with results from monitoring.
Most meters can store a large number of glucose readings over time. People with diabetes should bring their glucose monitoring results to office visits to observe patterns and make changes in their overall plan with their health care provider.
Continuous Glucose Monitoring
Today an increasing number of people with type 1 diabetes use what’s called a continuous glucose monitor (CGM). The CGM consists of a sensor attached to the abdomen. On top of the sensor is a transmitter. Every 5 minutes, the transmitter sends the glucose result to either a receiver, smart phone, or the face of the insulin pump. People must still use a blood glucose monitor to calibrate their CGM. Most people with type 1 diabetes who have a health plan can get coverage for a CGM. Medicare is now covering one type of CGM, the Dexcom G5, for all beneficiaries who take insulin.
In addition, the ADA’s Standards of Medical Care recommend that people receive an A1C test (also called glycosylated hemoglobin) about four times a year. This measures blood sugar levels over the prior two to three months. The ADA recommends that most adults with diabetes have an A1C of 7 percent or lower. There are different A1C targets for children. 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. To manage diabetes and prevent long-term complications, a healthful meal plan should be rich in whole grains, fresh fruits, and vegetables, and low in saturated and trans fats. Learn more about what to eat when you have diabetes here.
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 or too high. People with type 1 diabetes should talk with their healthcare provider about how to adjust their insulin and food 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 a rise in their blood sugar levels.
Type 1 Diabetes Risk Factors
Prevention of Type 1 Diabetes
While a lot of research has been done, type 1 diabetes can’t totally be prevented. Some experimental treatments are being researched, and progress is made every year. If you have a parent or sibling with type 1, you can get screened through the free Pathway to Prevention screening made available through the government-funded program called TrialNet.
Adult Onset of Type 1 Diabetes: An increasing number of people are developing type 1 diabetes in adulthood. This is sometimes referred to as Latent Autoimmune Diabetes in Adults (LADA). Just like type 1 in younger people, the cause of LADA stems from an autoimmune attack that results in the pancreas no longer producing sufficient insulin. Many people with LADA are initially misdiagnosed with type 2 diabetes because many healthcare providers aren’t familiar with type 1 diabetes in adulthood. If you’re a relatively young adult diagnosed with type 2 diabetes and aren’t finding success with the usual glucose lowering medications used to treat type 2, contact your health care provider or seek further assessment, such as blood tests for a c-peptide level and GAD antibodies, which can differentiate type 1 and type 2.