Type 1 Diabetes
(Insulin Dependent Diabetes Mellitus; Juvenile-Onset Diabetes; Ketosis-Prone Diabetes; "Brittle" Diabetes; Diabetes Mellitus Type 1; Diabetes, Type 1)
DefinitionDiabetes is a higher level of glucose in the blood than is normal. Glucose travels through your body in the blood. A hormone called insulin then helps glucose move from your blood to your cells. Once glucose is in your cells it can be used for energy. A problem making or using insulin means glucose can not move into your cells. Instead the glucose will build up in your blood.In type 1 diabetes, the body does not make insulin. This will lead to the build up of glucose in the blood, also called hyperglycemia. At the same time, your cells are not getting glucose they need to function well. Over a long period of time high blood glucose levels can also damage vital organs. The blood vessels, heart, kidneys, eyes, and nerves are most commonly affected organs.Type 1 diabetes is often found during childhood and young adulthood.
CausesOur immune system keeps us well by fighting off and destroying viruses and bacteria. Unfortunately, sometimes the immune system attacks healthy tissue. Most type 1 diabetes develop because the immune system attacks and destroys the cells that make insulin. These cells are in the pancreas.It is not yet clear why the immune system attacks these cells. It is believed that some people have genes that make them prone to getting diabetes. For these people, certain triggers in the environment may make the immune system attack the pancreas. The triggers are not known but may be certain viruses, foods, or chemicals.Type 1 diabetes may also develop as a complication of other medical conditions. It may develop in:
- People with chronic type 2 diabetes who lose the ability to make insulin.
- Some with chronic pancreatitis or pancreatic surgery. They may lose the cells that make insulin.
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Risk FactorsType 1 diabetes is more common in males. It can start at age 4 years and peak between the ages of 11-13 years. Other factors that may increase your chance of type 1 diabetes include:
- Family history of type 1 diabetes
- Certain ethnic groups, such as Northern European, Mediterranean, African American, or Hispanic
- Increased age of mother during pregnancy
- Risk increases with increase in birth weight
- Obesity during childhood
- Other autoimmune disorders, including:
- Cystic fibrosis
SymptomsType 1 diabetes may cause:
- Weight loss
- Increased urination
- Extreme thirst
- Fatigue, weakness
- Blurry vision
- Vomiting and nausea
- Abdominal pain
- Abnormally deep and fast breathing
- Dry skin and mouth
- Fruity breath odor
- Rapid pulse
- Low blood pressure
DiagnosisThe doctor will ask about your symptoms and medical history. A physical exam will be done.Type 1 diabetes is diagnosed based on the results of blood tests and other criteria. These include:
- Symptoms common with diabetes and a random blood test showing a blood sugar level greater than or equal to 200 mg/dL* (11.1 mmol/L)
- Fasting blood test showing blood glucose levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days—test is done after you have not eaten for eight or more hours
- Glucose tolerance test results with blood glucose greater than or equal to 200 mg/dL (11.1 mmol/L)—test is done after you eat glucose
- HbA1c level of 6.5% or higher—measure of blood sugar over the past 2-4 months
- Insulin level or C-peptide tests—to see how much insulin is being made by the pancreas
- Tests that look for antibodies that are working against your pancreas
TreatmentDiabetes treatment goal is to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.While diabetes makes blood glucose levels too high, treatment can make blood glucose levels go too low. This is called hypoglycemia. It can cause confusion, shakiness, anxiety, heart palpitations and more. If the levels fall too low it can cause seizures and loss of consciousness. You and your doctor will plan and adjust your medication and diet to keep the risk of hypoglycemia low.
InsulinInsulin injections replace the insulin you are missing. The amount given is based on your individual need and a blood glucose test you take before and after meals and at bedtime. You will need to have insulin shots two or more times daily.You may also have an insulin pump that automatically gives you small amounts of insulin through the day.
PramlintideAmylin is made in the pancreas along with insulin. In people with type 1 diabetes, this hormone, like insulin, is missing. The missing amylin may be responsible for the blood glucose rise after a meal in people with diabetes. The drug pramlintide may be used when insulin therapy is not enough to control blood sugar.
GlucagonGlucagon can be injected to quickly increase blood glucose level. People with type 1 diabetes should always have an emergency supply available in case of hypoglycemia.If you are diagnosed with type 1 diabetes consider getting a medical alert ID. It will let others know you have diabetes in case you are unable to communicate.
DietIf you have type 1 diabetes, you should meet often with a registered dietitian. Generally speaking, it is best to:
- Follow a well-balanced meal plan with a variety of food groups.
- Eat at regular times each day. Include a bedtime snack in your meal plans. Do not skip meals
- Avoid highly refined carbohydrates. This includes sugar or high fructose products like soda.
ExerciseExercise is encouraged as long as blood glucose levels are under control. Follow your doctor's advice on activity levels and changes you may need to make.You may need to adjust your insulin dose or diet if you are having low glucose levels after exercise.
Blood Sugar TestingRegular blood glucose checks throughout the day will help you manage your diabetes. Testing is often done with a blood glucose monitor. You can also ask your doctor about continuous monitoring systems that you wear all day.Keep a record of the results to show your doctor. Your treatment plan may change based on your test results. The HbA1c blood test is also used by your doctor to assess your overall glucose control.
Pancreatic Islet Cell TransplantThis is a procedure that is still being investigated. It involves transplanting islet cells from a donor to a person with type 1 diabetes. After the transplant, these new cells are able to produce insulin. In some cases, people who receive these transplants may no longer need insulin injections.
Closed-Loop Artificial PancreasThis device is still being studied and developed. It is a continuous glucose monitoring system (CGMS). This system can automatically checks glucose levels through the day. Insulin is then delivered as needed through the day and night. The monitoring system will allow you to keep your blood sugar levels within the normal range without daily testing or injections.
Pancreatic TransplantA pancreatic transplant may be recommended if you have:
- Severe kidney disease that requires a kidney transplant
- Acute diabetic complications or emergencies that can not be prevented by insulin
- Severe problems due to injecting large amounts of insulin
- Severe and frequent complications related to diabetes such as severe recurrent hypoglycemia
CounselingDepression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your diabetes.
PreventionThere are no current guidelines to prevent type 1 diabetes.Some research is looking at the effectiveness of suppressing the immune system. This may be helpful in people who are at high risk of developing type 1 diabetes.
American Diabetes Association
National Diabetes Information Clearinghouse
Canadian Diabetes Association
Public Health Agency of Canada
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3/12/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Cardwell CR, Stene LC, Joner G, et al. Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data. Diabetologia. 2010;53(4):641-651.
4/1/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Verbeeten KC, Elks CE, Daneman D, Ong KK.Association between childhood obesity and subsequent Type 1 diabetes: a systematic review and meta-analysis. Diabet Med. 2011;28(1):10-18.
9/11/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Tovote KA, Fleer J, et al. Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: results of a randomized controlled trial. Diabetes Care. 2014;37(9):2427-2434.
- Reviewer: Kim Carmichael, MD
- Review Date: 08/2014
- Update Date: 09/11/2014
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