Diabetes Type 1
Symptoms and Diagnosis
Normally, your pancreas produces insulin which allows glucose to enter the cells of your body. In type I diabetes (DMT1), there is little or no insulin production by the pancreas. Glucose remains in the bloodstream instead of entering the cells. DMT1 can lead to many short and long term health effects.
Type II diabetes is more common than type I diabetes. Type II occurs when the body doesn’t respond to normally to insulin or when there is less insulin production than normal.
What are the Symptoms of Type I Diabetes?
The symptoms caused by type I diabetes are due to the excess sugar in your blood stream. These symptoms include:
- Excessive thirst and hunger
- Frequent urination
- Weight loss
- Blurry vision
These symptoms can occur suddenly, and if you experience any of them you should see a doctor right away.
What are the Causes of Type I Diabetes?
No one is exactly sure what causes DMT1. In many cases your own body attacks and destroys the cells in the pancreas that produce insulin. Some researchers believe this is in response to a viral infection, and other research points towards a genetic component.
What are the Complications of Type I Diabetes?
Type I diabetes can affect nearly every organ of your body so it is important to treat the disorder under the care of a physician. The most important complications are:
- Heart disease: Having DMT1 increases your risk for heart attacks, stroke and problems with circulation to any part of your body.
- Nerve damage: Due to poor circulation, the nerve endings in your body can be damaged leading to numbness, tingling, pain or a burning sensation. This is called neuropathy, and it usually appears first in the fingertips and toes and can then spread upwards. If the diabetes is not treated properly, complete loss of sensation can be the result. The nerves supplying your digestive tract can also be affected leading to nausea, vomiting, diarrhea or constipation. In men, difficulty with penile erection can occur.
- Kidney damage: Diabetes can lead to decreased kidney function (nephropathy) and, in severe cases, complete kidney failure which requires dialysis or organ transplant.
- Eye damage: Poor circulation to the eyes can lead to diabetic retinopathy which can lead to vision problems or even blindness.
- Diabetics are also at increased risk for cataracts and glaucoma.
- Foot problems: The combination of nerve damage and circulation problems greatly increases your risk for foot damage. Due to decreased sensation, you are more prone to injuring your foot. The poor circulation delays healing and leads to infections. In the worst case, these problems can lead to foot amputation. This can be avoided though with good sugar control.
- Skin and mouth infections: Diabetes increases your risk for skin and gum infections. These can be bacterial or fungal.
- Bone disease: Diabetes can cause you to develop thinning of the bones, or osteoporosis.
- Pregnancy issues: Miscarriages and birth defects are more common in diabetics with poorly controlled disease. Also, conditions like preeclampsia (very high blood pressure) are more common in diabetics.
How is Type I Diabetes Diagnosed?
Various medical organizations, like the American Diabetes Association, have agreed on the criteria to diagnose DMT1. These criteria include:
Hemoglobin A1c (glycated hemoglobin or HBA1c): This blood test reveals your average blood glucose levels over the past 2 to 3 months. You have diabetes if your HbA1c is greater than or equal to 6.5% or more on two separate occasions.
In some cases the A1c test is not available or it might be inaccurate due to pregnancy or variations in your hemoglobin. In these cases other tests can make the diagnosis of diabetes, such as:
- Random blood glucose test: Any blood sugar reading over 200 mg/dl (independent of the time of your last meal) shows that you likely have diabetes. Symptoms (see above) also help confirm the diagnosis.
- Fasting blood glucose test: After an overnight fast if your blood sugar level is 100-125 mg/dl then you have pre-diabetes. If your fasting blood glucose is 126 mg/dl or more (from two tests taken on different days) than you have diabetes.
Blood tests looking for specific autoantibodies can also help distinguish between Type I and Type II diabetes. The presence of ketones in your urine also helps confirm DMT1 diagnosis.
Type I diabetes has specific symptoms and potential complications. The diagnosis is made by testing your blood glucose levels. You can read about DMT1 treatment in Part Two of this article.
Currently, there is no known cure for type I diabetes (DMT1) so treatment is for life. The main components of treatment are insulin, exercise, diet, blood sugar monitoring and weight control. This can be a big task, but your doctor is there to help you along with other health specialists like nutritionists and counselors.
Goals of Treatment
The main goal of DMT1 is to minimize the risk of diabetic complications like heart, eye and kidney disease. Ideally, your blood sugar levels should be:
- Between 80-120 mg/dl during the day
- Between 100-140 mg/dl at bedtime
- Another goal of treatment is to avoid the symptoms of high or low blood sugar (see below).
Blood Glucose Monitoring
Your doctor will make decisions about your treatment based on your blood sugar readings so it is important to take measurements. Glucose monitoring involves a device that pricks the tip of your finger to produce a drop of blood. The drop is placed on a measuring strip that then goes into a glucose monitor machine that gives you a reading. You might be asked to do this up to four times a day.
Continuous Glucose Monitoring (CGM) is a new way to measure your blood glucose levels. It is especially useful if you have episodes of very low blood sugar without noticeable symptoms (hypoglycemia unawareness). This special monitor has a very fine needle that is inserted under the skin, and you wear the device all day. Measurements are taken every few minutes, and the information helps your doctor adjust your insulin dosage.
Your blood sugar levels can be affected by many different factors such as diet, physical activity, drugs, illness, alcohol, stress and, for women, menstrual cycles.
Insulin Therapy and Other Medications
There are three types of insulin that your doctor can choose from. They are fast, intermediate and long acting insulin. The fluctuations in your glucose levels and mealtimes will help you and your doctor decide which combination is the best to use.
Normally, insulin is injected under the skin using a syringe. There are also insulin pens which look like a pen and allow for easy insulin injection. Finally, there are insulin pumps which you can wear clipped to a belt around your waist, leg or arm. Insulin pumps are connected to a tube (catheter) that is placed under the skin of your abdomen. The pump delivers insulin to your body automatically. You can even program the pump to deliver more insulin at mealtime.
Your doctor might recommend a high blood pressure medication calledan ACE inhibitor. Even if you don’t have high blood pressure, this medication helps protect your kidneys. Also, the recommendations for cholesterol control are stricter for diabetics, so your physician may prescribe a cholesterol lowering medication.
The best approach is to focus your food choices on things like fruits, vegetables and whole grains. White breads and sugary foods should be avoided, and animal sources of food should be limited. A nutritionist can also advise you about carbohydrate intake which helps guide your insulin regimen.
Like any other person, diabetics need exercise. Consult with your doctor on this as you should measure your blood sugar levels closely when starting a new exercise regimen. Physical activity helps keep insulin requirements lower.
Driving and Work
If you drive or operate heavy machinery, it is best to check your blood sugar beforehand and regularly thereafter. Low blood sugar can make you drowsy or lightheaded so it is best to consult with your doctor about how to best manage these situations.
In DMT1, complication rates of pregnancy are higher for the mom and the baby. If you plan to have a child, let your doctor know right away. The goal should be HbA1c level of less than 7% before pregnancy. Good diabetic control is especially important during the first two months of pregnancy.
Low Blood Sugar (Hypoglycemia)
Glucose control is never exact, and in some cases your blood sugar will dip too low. This can occur if you don’t eat regularly or if your physical activity increases suddenly. The symptoms of low blood sugar are:
- Intense hunger
- Nervousness, anxiety or irritability
- Lightheadedness and fatigue
- Pale complexion
- Rapid or irregular heart beat
- Blurry vision
If the low blood sugar goes on for too long you can have serious symptoms such as lethargy, confusion, loss of coordination, erratic behavior and convulsions. It is important to learn to recognize the symptoms of low blood sugar and to have a source of sugar on hand at all times, such as hard candy, glucose tablets or fruit juice. After taking in the sugar source, recheck your blood sugar in about 15 minutes. If your reading remains low, take in more sugar and check your level again in 15 minutes. Keep repeating this until you get a normal reading. Then eat a mixed food source like peanut butter, jelly and crackers to stabilize your sugar.
High Blood Sugar (Hyperglycemia)
Your blood glucose can be too high if you eat too much or if you become ill. The symptoms of hyperglycemia are:
- Increased thirst, hunger and urination
- Blurry vision
- Tiredness and confusion
In these cases you will need to check your blood sugar and take extra insulin to bring your blood sugar down. You can ask your doctor about the best dosage in these situations. In more severe cases you can develop diabetic ketoacidosis. Ketones are made when your body breaks down fat as an energy source. Ketones can be detected in the urine using a special test stick. You might have symptoms such as nausea, vomiting, stomach pain and sweet smelling breath. In these cases you should consult with your doctor immediately.
The treatment of type I diabetes includes medications, diet, exercise and education along with the help of a professional team of experts. The goal is to prevent complications and control symptoms associated with diabetes. Even though it is a big challenge you can still lead a productive and healthy lifestyle.
Dr. A is simply the best! She goes above and beyond to provide the best treatment options for you. She is truly and personally concerned about her patients.