Management of Type 1 Diabetes

Introduction:

Type 1 diabetes, earlier known as juvenile diabetes or insulin-dependent diabetes, is a condition in which the pancreas does not produce insulin or produces very little insulin. Insulin is an important hormone used by the body to help glucose enter the cells. The absence of insulin causes sugars to accumulate in the blood leading to complications. Various factors like genetics and viral infections contribute to type 1 diabetes. Though more common in children and teens, the condition can develop at any age. Type 1 diabetes has no cure, and the treatment aims at managing the sugar levels and maintaining a healthy lifestyle and nutritious diet.

What Are the Causes of Type 1 Diabetes?

The exact cause of type 1 diabetes is unknown. However, the body's defense mechanism destroys the cells of the pancreas that produce insulin. Genetic factors that are carried from the parents to the child or specific viral infections may also be the cause.

What Are the Risk Factors for Developing Type 1 Diabetes?

Some risk factors for type 1 diabetes include:

• Genetics: The occurrence of certain genes in the body can pose a risk for developing the condition.

• Family History: Parents or siblings with type 1 diabetes increase the risk in children.

• Location: Chances of higher incidence are observed when the location where the person stays is away from the equator.

• Age: Though type 1 diabetes can occur at any age, chances are between the ages of 4 to 7 and 10 to 14.

What Are the Symptoms of Type 1 Diabetes?

Symptoms of type 1 diabetes occur suddenly. They include:

1. Excessive thirst.

2. Frequent urination.

3. Increase in hunger.

4. Unexplained weight loss.

5. Bed-wetting.

6. Irritability and mood swings.

7. Tiredness.

8. Blurred vision.

What Are the Complications of Type 1 Diabetes?

Uncontrolled type 1 diabetes can lead to complications that affect important organs of the body. The following complications that occur include:

• Diseases of the heart and blood vessels can cause high blood pressure and stroke.

• Neuropathy or nerve damage that causes tingling sensation or numbness in the feet.

• Damaged nerves in the stomach and intestines cause nausea, vomiting, and constipation.

• Nephropathy or kidney disorders that occur due to damage to the filtering system.

• Diabetic retinopathy can affect the retina of the eye, causing blindness.

• Dry mouth or fungal and bacterial infections of the mouth can occur.

• Injuries to the foot can lead to serious complications that may require amputation or removal of the foot.

• Diabetes in pregnancy can lead to stillbirth, miscarriage, or birth defects in babies.

What Is Hypoglycemia Unawareness?

Few people may lose the ability to sense that their blood sugars are becoming low, called hypoglycemia unawareness. The body can no longer respond with symptoms like confusion or lightheadedness. The more the patient experiences low sugars, the more are the chances of hypoglycemia unawareness. Increasing the blood sugar target levels or avoiding episodes of hypoglycemia by being more careful can help recover from the condition.

How to Diagnose Type 1 Diabetes?

The doctor diagnoses type 1 diabetes based on the following blood tests:

• A1C Test or Glycated Hemoglobin Test: This test measures the average blood sugar values over 2 to 3 months. A value of 6.5 percent or greater in two successive tests confirms diabetes.

• Random Blood Sugar Tests: Blood samples collected at a random time that have values greater than 200 mg/dL (milligrams per deciliter) on repeated testing help diagnose diabetes.

• Fasting Blood Sugar Test: The values of blood samples collected after an overnight fast, if less than 100 mg/dL indicates no diabetes, 100 to 125 mg/dL indicates prediabetes and greater than 126 mg/dL on repeated tests confirms diabetes.

How Is Type 1 Diabetes Managed?

Diabetes management involves teamwork in which the patient plays a pivotal role and is supported by the health care team, which includes:

• Primary doctor.

• Dentist.

• Eye doctor.

• Dietitian.

• Diabetes educator.

• Pharmacist.

The treatment plan for type 1 diabetes includes the following:

1. Taking insulin.

2. Following a healthy balanced diet.

3. Frequent blood sugar monitoring.

4. Regular physical activity.

1. Insulin Therapy:

Patients diagnosed with type 1 diabetes require treatment with insulin throughout their life. Insulin is available in many types that include:

• Short-acting insulins like Novolin R and Humulin R.

• Rapid-acting insulins like Insulin Glulisine (Apidra), Insulin Lispro (Humalog), and Insulin Aspart (Novolog).

• Intermediate-acting insulins like Insulin NPH (Novolin N and Humulin N).

• Long-acting insulins like Insulin glargine (Lantus, Toujeo Solostar), Insulin Degludec (Tresiba) and Insulin detemir (Levemir).

Methods of Insulin Administration:

Insulin is administered either through injections or pumps. It cannot be taken orally as the stomach enzymes degrade insulin and prevent it from functioning.

• Insulin Injections:

Injections are available in the needle and syringe form, and the pen form includes disposable and refillable varieties. Doctors may prescribe a combination of long-acting and rapid-acting insulins together that closely resembles the body's normal insulin regulation.

• Insulin Pump:

An insulin pump is a device that is worn on the outside of the body. It is connected through a tube to a catheter that delivers insulin into the body. The pumps are programmed in such a way that it automatically dispenses insulin into the body when the glucose levels rise. Insulin pumps and continuous monitoring of blood glucose help maintain blood sugar under control.

Medications that the doctor may prescribe to manage other conditions include:

1. Aspirin is prescribed in cases where the doctor may anticipate an increased risk of heart disease.

2. Medicines for high blood pressure (BP) like angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are advised in diabetic patients who have blood pressures over 140/90 millimeters of mercury (mm Hg).

3. Drugs that lower cholesterol help prevents heart diseases in diabetics. Hence monitoring of the blood lipid levels is mandatory.

2. Balanced Diet:

Patients with type 1 diabetes are advised to have a nutritious diet low in carbohydrates and high in fiber that includes fruits, vegetables, and whole grains. Processed foods, sweets, or foods rich in fat are to be avoided. The dietician may suggest a meal plan for the patient based on age, activity, and schedule. The meal plan includes the food groups that can be considered as options rather than a single type of meal per day.

3. Continuous Glucose Monitor (CGM):

Testing the blood sugars regularly helps to assess how insulin therapy and diet plans are working. The healthcare professional may suggest a continuous glucose monitor (CGM) that measures the blood sugars every few minutes. It is a device that has a sensor inserted under the skin and attached to a monitor which displays the readings. It can be worn for a week before being replaced. CGM is used as an alternative to the finger-prick testing method.

4. Regular Physical Activity:

Physical activity and exercise should be a routine for diabetics. A daily activity that includes walking, swimming, or cycling is recommended for at least an hour or about 150 minutes of aerobic activities per week. The health care team can offer suggestions based on insulin dosage and food habits. A regular activity along with therapy and a meal plan can help keep the blood sugars at normal ranges.

Conclusion:

Type 1 diabetes is a condition that requires management throughout life. When undergoing treatment, care has to be taken in special situations like driving or at the workplace to prevent the sugar levels from going too low or too high. Friends, family, and colleagues have to be kept informed about the condition at all times. Proper insulin therapy, along with a healthy diet and regular exercise, can help keep the sugar levels in check.