Definition

Type 1 diabetes is a disorder in which the body does not make enough insulin to meet daily needs. Insulin is a hormone that helps the body convert food into energy. Without insulin, glucose (sugar) from the food you eat cannot enter cells and glucose builds up in the blood. Your body tissue becomes starved for energy.

Type 1 diabetes usually begins in children and young adults. If type 1 diabetes is not treated effectively, long-term, high blood sugar levels can damage the blood vessels, heart, kidneys, eyes, nerves, and other tissues.

Causes

Most cases of type 1 diabetes are caused by the body's immune system attacking and destroying insulin-producing cells in the pancreas. The current theory is that people whose genes make them prone to this disease are exposed to something in the environment that triggers an immune system attack on the pancreas. The trigger may be a virus, a food, a chemical, or a drug.

Current evidence suggests that enterovirus infection—which is common and usually causes diarrhea and fever with or without rash—may contribute to the development of diabetes in some children. Children with relatively high birth weights are more likely to get diabetes than are those with lower weights.

	The Pancreas
	© 2008 Nucleus Medical Art, Inc.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Studies show that the following may be risk factors for developing type 1 diabetes:

• Family history (parent, sibling) of type 1 diabetes
• Age: starts at age 4 with peak at ages 11 to13
• Sex: more common in males than females
• Race: more common in Caucasians, African Americans, and Hispanics than in Asians
• Ethnicity: Northern European or Mediterranean
• Bottlefeeding or short duration of breastfeeding
• Birth weight above 10 lbs
• Other autoimmune illness, including:
  • Hashimoto's disease
  • Graves' disease
  • Addison's disease
  • Pernicious anemia
  • Celiac disease
  • Vitiligo
  • Hypogonadism

Symptoms

Symptoms include:

• Weight loss
• Increased urination
• Extreme thirst
• Hunger
• Fatigue, weakness
• Blurry vision
• Irritability
• Skin infections
• Poor wound healing
• Headaches
• Weight loss
• Reduced or no appetite
• Impotence
• Numbness and tingling in hands and feet

Insulin-producing cell destruction may occur so quickly that ketoacidosis (commonly known as diabetic coma) is the first sign of a problem. Symptoms of ketoacidosis include:

• Vomiting and nausea
• Abdominal pain
• Dehydration (not enough fluid in the body)
• Drowsiness
• Abnormally deep and fast breathing
• Coma
• Dry skin and mouth
• Fruity breath odor
• Rapid pulse
• Low blood pressure
• Flushed face

Diagnosis

The doctor will ask about your symptoms and medical and family history, and perform a physical exam.

Type 1 diabetes is diagnosed based on the results of blood tests and other criteria, including:

• Symptoms of diabetes and a random blood test revealing a blood sugar level greater than or equal to 200 mg/dL* ( 11.1 mmol/L)
• Blood sugar tests after you have not eaten for eight or more hours revealing blood sugar levels greater than or equal to 126 mg/dL (7.0 mmol/L) on two different days
• Glucose tolerance test measuring blood sugar two hours after you consume glucose—rarely necessary to diagnose type 1 diabetes

Some children may receive testing for insulin levels or anti-pancreas antibodies to confirm the diagnosis.

Treatment

Diabetes treatment aims to maintain blood sugar at levels as close to normal as possible. Regular medical care is essential for preventing or delaying complications.

Insulin

Insulin is essential for life. Insulin injection replaces what the pancreas would have produced. The doses may be adjusted based on results of blood sugar tests conducted prior to meals and at bedtime. You will need to administer insulin two, three, or more times daily or wear an insulin pump that continually supplies a small amount of insulin. The pump connects to tubing and a small needle or catheter under the skin.

Pramlintide

Amylin is produced in the pancreatic beta cells like insulin. In type 1 diabetic patients, this hormone is deficient, as well as insulin. It has long been suspected that the post-meal glucose rise in type 2 diabetic patients is somehow related to the amylin deficiency. The drug pramlintide (Symlin) has recently been approved by the US Food and Drug Administration for the treatment of type 1 and 2 diabetes.

Diet

• Follow a balanced meal plan, eating consistent and moderate amounts of food at regular times each day.
• Do not skip meals.
• Eat plenty of fruits, vegetables, and fiber.
• Eat limited amounts of fat.
• Eat moderate amounts of protein and low-fat dairy products.
• Avoid foods high in sugar.
• Eat a bedtime snack with protein and a starchy food.
• Keep a record of the food you eat to help a dietitian or doctor revise your nutritional needs.

Exercise

Exercise is encouraged when blood sugar levels are under control and there are no complications. Follow your doctor's recommendations for activity levels and restrictions. You may need to adjust your insulin regimen or diet to compensate for low glucose levels associated with exercise.

Blood Sugar Testing

Checking blood sugar levels during the day helps you track the amount of glucose in your blood. Testing is easy with a blood glucose monitor. Keep a record of the results to show the doctor. Your treatment plan may change based on your test results.

Pancreatic Transplant

This procedure is recommended if you have:

• Severe kidney disease and have a kidney transplant at the same time as the pancreatic transplant
• Acute diabetic complications or emergencies not preventable by insulin
• Severe problems from injecting self with large amounts of insulin
• Severe and frequent diabetic complications

Prevention

Researchers are studying immunosuppressive treatments to prevent type 1 diabetes in high-risk patients.

RESOURCES:

American Diabetes Association
http://www.diabetes.org

National Diabetes Information Clearinghouse
http://diabetes.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca

Team Diabetes CanadaCanadian Diabetes Association
http://www.diabetes.ca/section_donations/TeamDiabetesIndex.asp

References:

American Association of Clinical Endocrinologists. American college of Endocrinology. Medical guidelines for the management of diabetes mellitus: the AACE system of intensive diabetes self-management. 2002 update. Endocrine Pract . 2002;8(suppl 1)S40-82.

American Diabetes Association website. Available at: http://www.diabetes.org .

The DCCT/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 2 diabetes four years after a trial of intensive therapy. N Engl J Med . 2000;342:381-389.

Diabetes mellitus type 1. EBSCO Publishing Dynamed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?id=116244sid=0c9c3733-81cc-4c2a-9684-cfe4d807b81b@sessionmgr9 . Accessed March 11, 2008.

Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet. 2008;371:117-125.

McMahon GT, Arky RA. Inhaled insulin for diabetes mellitus. N Engl J Med . 2007;356:497-502.

McQueen J. Prqmlintide acetate. Am J Heal Pharm . 2005;62:2263-2272

National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nccdphp/ .

Nutrition principles and recommendations in diabetes. Diabetes Care . 2004;27(suppl 1)S36-46.

Pancreas transplantation in type 2 diabetes. Diabetes Care . 2004;27:S105.

Paviakis M, Khwaja K. Pancrease and islet cell transplantation in diabetes. Curr Opin Endocrinol Diabetes Obes. 2007;14:146-150.

Physical activity/exercise and diabetes. Diabetes Care . 2004;27(suppl 1)S58-62.

Scheid DC, McCarthy LH, Lawler FH, et al. Screening for microalbuminuria to prevent nephropathy in patients with diabetes: a systematic review of the evidence. J Fam Pract . 2001;50:661-668.

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