Type 1 Diabetes (T1D): Symptoms, Causes, Treatments, Vs. Type 2

Type 1 diabetes is a chronic condition that usually starts in childhood, but can occur in adults (30-to 40-year-olds). In type 1 diabetes, the pancreas produces very little insulin. Insulin helps cells in the body convert sugar into energy. When the pancreas cannot make enough insulin, sugar starts to build up in the blood, causing life-threatening complications. Individuals with type 1 diabetes must take some form of insulin for the rest of their lives.

Unusual thirst is a very common symptom of type 1 diabetes. This condition causes the kidneys to remove excess sugar in the blood by getting rid of more water. The water is removed through urinating, causing dehydration and dehydration causes you to drink more water.

People with type 1 diabetes develop unintentional weight loss and an increase in appetite because blood sugar levels remain high and the body metabolizes fat for energy. Disrupted glucose metabolism also causes people to feel a lack of energy and drowsy for extended periods Excess urination also causes weight loss because many calories are leaving the body in urine.

The disruption in glucose metabolism in people with type 1 diabetes causes skin changes. Those with type 1 diabetes are at a higher risk for bacterial infections and fungal infections. Poor blood circulation in the skin may also occur. Those with type 1 diabetes are often infected with fungal infections caused by the yeast Candida albicans. Common fungal infections include athlete's foot, vaginal yeast infection in women, jock itch, ringworm, and diaper rashes in babies. Diaper rash caused by the yeast Candida albicans can spread to other areas of the body such as the stomach and legs.

If you have untreated type 1 diabetes, you might experience serious symptoms, such as

• blurry vision
• numbness or tingling in the extremities (especially the feet)
• loss of consciousness
• fatigue
• fruity breath
• dry mouth
• diabetic coma

In contrast to high glucose in the blood, occasionally those with type 1 diabetes can get low blood sugars (hypoglycemia) when their blood glucose level falls suddenly.

For people with type 1 diabetes, loss of consciousness, diabetic coma, and in some cases hypoglycemia, can all be medical emergencies. Some people who are undiagnosed may have no warning signs, yet still can develop diabetic coma or hypoglycemia.

The problem with type 1 diabetes is that the person's cells are deprived of the sugar they need for energy. Without the insulin produced by the pancreas, sugar has difficulty entering the body's cells. Consequently, the body cells start burning fat for energy, which causes ketones to build up in the blood. These acids can change the person's blood pH level and can trigger a life-threatening coma. This is termed diabetic ketoacidosis. Diabetic ketoacidosis is a medical emergency that needs to be treated quickly, usually in a hospital setting. Symptoms of diabetic ketoacidosis include the following:

• Flushed, hot, dry skin
• Blurred vision
• Feeling thirsty and excess urination
• Drowsiness
• Rapid, deep breathing
• Fruity breath odor
• Loss of appetite, belly pain, and vomiting
• Confusion

Type 1 diabetes usually starts in childhood or young adulthood, whereas type 2 diabetes usually starts in adulthood. In people with type 1 diabetes, the body's immune system attacks and destroys pancreatic cells (Beta cells) that produce insulin. In people with type 2 diabetes, the pancreas is not attacked and usually produces insulin. However, people with type 2 diabetes, for numerous reasons, cannot use the available insulin effectively.

People with type 2 diabetes can have the same symptoms as those with type 1 diabetes, however, people with type 1 diabetes usually have symptoms that occur more rapidly. Type 1 diabetes cannot be prevented, but type 2 diabetes can be prevented or delayed with a healthy lifestyle.

When the body's immune system destroys beta cells in part of the pancreas, type 1 diabetes develops. Beta cells in the pancreas produce insulin. Researchers are not sure why a person's immune system attacks its own insulin-producing cells. However, researchers and clinicians suspect that genetic susceptibility and environmental factors raise the risk for developing type 1 diabetes.

Scientists have identified genes and gene regions that raise the risk of developing type 1 diabetes, but they are not the only factors that cause the disease. Researchers suggest that environmental triggers such as a viral infection or perhaps dietary or pregnancy-related factors may also play a role in developing type 1 diabetes.

Although type 1 diabetes can develop at any age, about two-thirds of new cases are diagnosed in individuals under the age of 19. Researchers have noted two peak times for development of type 1 diabetes; the first is in early childhood and the second occurs at puberty. Type 1 diabetes affects males and females equally, and is more common in Caucasians than in other ethnic groups. A family history of type 1 diabetes also increases one’s risk for developing type 1 diabetes.

Simple blood tests can indicate the presence of abnormal sugar levels in the blood. If a person has any symptoms of diabetes, a fasting blood sugar test or even a random blood sugar test is usually the first step in diagnosis. A hemoglobin A1c test can reveal average blood sugar levels for the past 2 to 3 months. In most cases, these tests are repeated on at least two separate days. Other tests used are the glucose tolerance test or testing for specific antibodies in the blood.

Type 1 diabetes damages arteries and makes them susceptible to hardening (atherosclerosis), which can lead to high blood pressure and other heart and circulation problems. Unfortunately, undiagnosed or prolonged high blood sugar levels can result in damage to organ systems in the body over time. People with type 1 diabetes have a high risk of vision problems, heart disease, stroke, kidney failure, gum disease, tooth loss, and nerve damage (especially in the hands and feet). Other organs may also be damaged.

For people with diabetes, complications that can damage organs can be prevented or reduced by regulating their blood sugar level. This is done by pricking the finger and putting a drop of blood on a test strip. The strip is then placed in a monitor that reads the glucose level. Close monitoring of glucose levels allows you to regulate your blood sugar by either medication if the sugar is high, or taking in sugar if the level is low. If you are able to keep blood sugar levels in or near the normal range, you will decrease the likelihood of developing complications and have more energy and fewer problems related to diabetes.

Another device that measures glucose is termed a continuous glucose monitoring system (CGM). This system consists of a tiny sensor under the skin to check blood sugar levels. It sends the information to a device (some devices are as small as a watch) that records an average glucose value every five minutes for several days, depending on the sensor design. CGM is now accepted for long term use in some people with models that turn off insulin infusion when sugars start to drop. Some devices alert you if the blood glucose level falls outside of preset range.

Every person with type 1 diabetes needs to take insulin to help their body process sugar in the blood. Most people with type 1 diabetes take insulin in the injectable form and require several shots per day. There are different types of insulin available.

• Rapid-acting insulin starts to work within a few minutes and lasts for a couple of hours.
• Regular or short-acting insulin takes about 30 minutes to work and lasts 3-6 hours.
• Intermediate-acting insulin takes 2-4 hours to work and lasts up to 18 hours.
• Long-acting insulin can work for an entire day.

You and your doctor can adjust your insulin shots based on results of blood sugar testing. As previously stated, the goal is to keep glucose levels in the blood within normal range as often as possible.

Insulin can be injected using a needle and syringe, a cartridge system, or a pre-filled pen system. Inhaled insulin, insulin pumps, and a quick-acting insulin device can also be used. If injecting insulin into your body the best place is the abdomen, but the arms, thighs, and buttocks are also effective.

Insulin is a hormone from the pancreas that allows sugar to enter the cells. Insulin also lowers the amount of sugar in the bloodstream. Without insulin, sugar is unable to enter the cells. This means that cells that make up muscles and other tissues will not be able to receive their main source of energy. People with type 1 diabetes may have a buildup of sugar in the bloodstream, causing life-threatening conditions.

Insulin Side Effects

• Low blood sugar
• Headache
• Flu-like symptoms
• Weight gain when you first start using insulin
• Lumps, scars, or rash at injection site

Although insulin is a wonderful drug that helps people with diabetes, it needs to be used carefully. If a person takes too much insulin it is possible the blood sugar level will lower into dangerous levels. This situation is termed an insulin reaction (low blood sugar due to excessive insulin).

Too much insulin can result in symptoms that may be mild, moderate, or severe, depending on how low and how long the low blood sugar levels exist in a person's blood. Some signs and symptoms of low blood sugar include fatigue, excessive yawning, mild confusion, decreased coordination, sweating, muscle twitching, and pale skin. As these symptoms get progressively worse, seizures, loss of consciousness, and even death may occur.

People with diabetes, especially type 1 diabetes, are advised to carry about 15 grams of a quick-acting carbohydrate at all times. Quick-acting carbohydrates are foods or drinks containing glucose that is rapidly absorbed into the body and the blood. Examples include a half-cup of fruit juice or a non-diet soda, five Life Savers (small hard candies), two tablespoons of raisins, one cup of milk, or three glucose tablets. These carbohydrates may resolve mild to moderate insulin reactions. For severe reactions, a drug called glucagon should be injected under the skin by a family member or friend familiar with treating severe insulin reactions and the person should be seen by a medical health care professional.

Although many people administer insulin through several shots per day, some people can use an insulin pump. This pump delivers insulin around-the-clock by pushing insulin through a thin tube inserted into the person's skin. The insulin pump can be programmed to deliver exact amounts of insulin in a continuous dose as well as deliver extra doses certain times, typically when eating. People with diabetes are encouraged to discuss the advantages and disadvantages of this insulin delivery system with their doctor.

There is a test called the hemoglobin A1c blood test (also termed A1C) that is used to help determine how well a person is managing their blood glucose levels. This test is taken at the doctor's office and measures how well the blood sugar has been controlled over a 2- to 3-month span. If the results show poor blood sugar control (high A1c levels), this suggests that the person's insulin therapy, dietary habits, and/or physical activity be modified to lower blood sugar levels into a more healthy and normal range.

Some people with diabetes fail with insulin therapy and may have reactions to the insulin that is injected. These people may be candidates for islet transplantation. The procedure is a transfer of healthy insulin-producing cells from a donor into the pancreas of the person with type 1 diabetes. Although there are benefits to this procedure, there are also drawbacks including medications with serious side effects that must be used to prevent rejection of the donor cells. One major study found that 9 in 10 transplant patients had their A1c level under control 1 year after the procedure. However, this procedure is not a cure for type 1 diabetes.

People with type 1 diabetes benefit from exercise, but they need to take precautions to prevent sudden drops in blood glucose levels. Diabetics should check their blood sugars before exercising and may require eating a snack before or during exercise. They may need to adjust their insulin dosage before exercising to ensure they stay within normal ranges of blood glucose. People with type 1 diabetes may also need to check their urine for ketones – ketones suggest that your blood sugar is too high. Strenuous activity needs to be avoided if ketones are detected or if your blood sugar level is either high or low before exercise.

People with type 1 diabetes, like everyone else, need to eat a well-balanced diet. This will help their insulin therapy and reduce the chance of diabetic complications. There is no "diabetes diet." Even a person with type 1 diabetes can eat sweets as long as it is part of a well-balanced diet. That is not to say they can eat anything all the time, but they need to consider how sweets can fit into their well-balanced diet. Type 1 diabetics should also consider the fact that carbohydrates raise blood sugar levels faster than any other food. Food low in carbs, but high in calcium, potassium, fiber, magnesium, and other vitamins are excellent food choices for diabetics. Consider the following guidelines when planning your meals:

• Eat less unhealthy fat
• Get enough fiber
• Keep track of carbohydrate consumption
• Keep track of carbohydrates in sugar-free foods

Healthcare workers such as dietitians can help people with diabetes plan a well-balanced and varied diet.

Women with type 1 diabetes need to let their doctors know if they plan to become pregnant. Poor control of their blood sugars may cause complications such as birth defects. Planning ahead, even before conception, to control blood sugar levels can lower the risk of miscarriage and birth defects. During pregnancy, it is important to test blood glucose often and keep your A1c below 7%. Good blood sugar control can reduce other complications during pregnancy such as high blood pressure or retinal damage in the mother.

Preeclampsia is a condition that 18%-30% of pregnant women with diabetes develop. Preeclampsia develops after the 20-week mark and is characterized by high blood pressure and proteins in the urine. It is important to treat preeclampsia, if untreated it may harm the baby and put the mother at risk for stroke and seizures. Once the baby is born and if the mother is breastfeeding, it is important for her to check her glucose levels frequently.

In the United States, 13,000 children are diagnosed with type 1 diabetes each year. Diagnosis of diabetes in children is a life-changing situation because it affects the whole family. Parents must help children monitor blood sugar and plan family meals that are appropriate for the child with diabetes and other family members. Insulin dosages must be monitored, and blood sugar levels need to be checked by the child’s caregivers.

Diabetes in children is a 24-hour-a-day problem that needs to be considered when a child is attending school and participating in extracurricular activities. Parents and their children need to plan to follow through with insulin treatments even while the child is at school. These arrangements need to be planned in advance, as not every state or school may participate in the child’s care the same way.

Researchers are developing an artificial pancreas. This device is a combination of an insulin pump and continuous glucose monitoring system controlled by a computer program. The goal for the system is to have a device that mimics the function of a normal pancreas.

Additional Information on Diabetes

For more information about Diabetes, please consider the following:

• American Diabetes Association
• Diabetes Research Institute Foundation
• The National Institute of Diabetes and Digestive and Kidney Diseases