Diabetes Mellitus Type 1 – Definition, Causes, and Treatment.

Definition

Diabetes Mellitus Type 1 is an auto-immune condition in which the body destroys the cells in the pancreas that produce insulin. This happens because the cells that make the insulin (beta cells) have been destroyed by the body’s own immune system. Insulin is the hormone that helps move sugar, or glucose, into your body’s tissues. Cells use it as fuel and also enables cells to use that glucose to produce energy.

Normal and damaged beta cells

Role of insulin in normal human body

Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

• The pancreas secretes insulin into the bloodstream.
• Insulin circulates, allowing sugar to enter your cells.
• Insulin lowers the amount of sugar in your bloodstream.
• As your blood sugar level drops, so does the secretion of insulin from your pancreas.

The role of glucose

Glucose, a sugar is a main source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and your liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• Your liver stores glucose as glycogen.
• When your glucose levels are low, such as when you haven’t eaten in a while, the liver breaks down the stored glycogen into glucose to keep your glucose levels within a normal range.

Malfunction of pancreas (Diabetes mellitus type 1)

In type 1 diabetes, there’s no insulin to let glucose into the cells, so sugar builds up in your bloodstream. This can cause life-threatening complications.

 

Damage to beta cells from type 1 diabetes throws the process off. Glucose doesn’t move into your cells because insulin isn’t there to do it. Instead it builds up in your blood and your cells starve. This causes high blood sugar, which can lead to:

• When there’s extra sugar in your blood, you pee more. That’s your body’s way of getting rid of it. A large amount of water goes out with that urine, causing your body to dry out.
• Weight loss. The glucose that goes out when you pee takes calories with it. That’s why many people with high blood sugar lose weight. Dehydration also plays a part.
• Diabetic ketoacidosis (DKA). If your body can’t get enough glucose for fuel, it breaks down fat cells instead. This creates chemicals called ketones. Your liver releases the sugar it stores to help out. But your body can’t use it without insulin, so it builds up in your blood, along with the acidic ketones. This combination of extra glucose, dehydration, and acid buildup is known as “ketoacidosis” and can be life-threatening if not treated right away.
• Damage to your body. Over time, high glucose levels in your blood can harm the nerves and small blood vessels in your eyes, kidneys, and heart. They can also make you more likely to get hardening of the arteries, or atherosclerosis, which can lead to heart attacks and strokes.

Evolution of research on diabetes mellitus type 1

• 1550 BC: Earliest Mention: The earliest traceable mention of diabetes in history came from an ancient Egyptian papyrus, speaking of a disease that causes rapid weight loss and frequent urination. Sound familiar? Unfortunately, no remedy is mentioned.
• 1000s AD: Diagnosis: Early physicians used the “uroscopy” method by examining the urine to diagnose diabetes mellitus (mellitus meaning “honey” in Latin). One tactic was to taste the urine to determine if there was sweetness.
• 1915: The Starvation Diet: Shortly before the discovery of insulin, diabetes specialists would often promote an extremely low-calorie diet, and prolonged fasting to minimize symptoms. The downside of this remedy was — not surprisingly — starvation.
• 1916: The first experimental tests with extracts of the pancreas were performed on diabetic dogs – successfully lowering their blood sugar.
• 1963: A Medicinal Trailblazer. Insulin became the very first human protein to be chemically synthesized. Before then, only animal insulin was used and distributed.
• 1969: Blood Glucose meters became available to hospitals and physicians.
• 1981: The first personal-use blood glucose meter (Bayer’s Glucometer) is released and available for diabetics to test their blood sugar on their own instead of only at the hospital.
• 2006: Dexcom releases the first Continuous Glucose Monitoring system (CGM) to track our blood sugar levels with even more precision.

Epidemiology in world wide

Type 1 diabetes may present at any age, but most typically presents in early life with a peak around the time of puberty. Its incidence varies 50–100-fold around the world, with the highest rates in northern Europe and in individuals of European extraction. Both sexes are equally affected in childhood, but men are more commonly affected in early adult life. The distinction between type 1 and type 2 diabetes becomes blurred in later life, and the true lifetime incidence of the condition is therefore unknown.

A variant form known as latent autoimmune diabetes in adults (LADA) has been described. The incidence of childhood type 1 diabetes is rising rapidly in all populations, especially in the under 5-year-old age group, with a doubling time of less than 20 years in Europe. The increasing incidence of type 1 diabetes suggests a major environmental contribution, but the role of specific factors such as viruses remains controversial.

Causes of Diabetes Mellitus type 1

• The exact cause of type 1 diabetes is unknown. Most likely it is an autoimmune disorder.
• This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue.
• With type 1 diabetes, an infection or another trigger causes the body to mistakenly attack the cells in the pancreas that make insulin.
• The tendency to develop autoimmune diseases, including type 1 diabetes, can be passed down through families.

Risk factors of Diabetes Mellitus Type 1

Some known risk factors for type 1 diabetes include:

• Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.
• The presence of certain genes indicates an increased risk of developing type 1 diabetes.
• The incidence of type 1 diabetes tends to increase as you travel away from the equator.
• Although type 1 diabetes can appear at any age, it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old, and the second is in children between 10 and 14 years old.

Complications of Diabetes Mellitus Type 1

Eventually, diabetes complications may be disabling or even life-threatening.

• Heart and blood vessel disease. Diabetes dramatically increases your risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
• Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs and eventually lose all sense of feeling in the affected limbs.

 

• Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.
• Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which requires dialysis or a kidney transplant.
• Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially causing blindness such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections that may ultimately require toe, foot or leg amputation.

 

Diabetic foot ulcer

• Skin and mouth conditions. Diabetes may leave you more susceptible to infections of the skin and mouth, including bacterial and fungal infections. Gum disease and dry mouth also are more likely.
• Pregnancy complications. High blood sugar levels can be dangerous for both the mother and the baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes isn’t well-controlled. For the mother, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and preeclampsia.

Signs and Symptoms of Diabetes Mellitus Type 1

The following symptoms may be the first signs of type 1 diabetes. Or they may occur when blood sugar is high.

• Being very thirsty
• Feeling hungry
• Feeling tired all the time
• Having blurry eyesight
• Feeling numbness or tingling in your feet
• Losing weight without trying
• Urinating more often (including urinating at night or bedwetting in children who were dry overnight before)

For other people, these serious warning symptoms may be the first signs of type 1 diabetes. Or, they may happen when blood sugar is very high (diabetic ketoacidosis):

• Deep, rapid breathing
• Dry skin and mouth
• Flushed face
• Fruity breath odor
• Nausea or vomiting; inability to keep down fluids
• Stomach pain

Diagnosis and Test

• A fasting blood glucose test measures your blood glucose level after 8 hours of fasting (no food or drink, except water). This test is not always reliable, and tends to be more accurate in the morning. Multiple tests conducted at separate times are generally required for a diabetes diagnosis.
• Oral glucose tolerance test. If your initial fasting blood glucose test results are normal, but you have some symptoms or risk factors for diabetes, this test is used to diagnose.
• A random blood glucose test measures your glucose level at an unspecified time. A high blood glucose level, in addition to having one or more symptoms of diabetes, could indicate that you have the disease. This test is less accurate than a fasting glucose or oral glucose tolerance test.
• The glycated hemoglobin test, or A1C test, is a different kind of blood test that provides an overview of your blood glucose levels for the past few months, rather than just a snapshot of your current level. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

Treatment and Medications

Type 1 diabetes occurs because your body doesn’t produce any insulin. This means you’ll need regular insulin treatment to keep your glucose levels normal. People with type 1 diabetes therefore require lifelong insulin therapy. Insulin comes in several different preparations, each of which works slightly differently.

Types of Insulin

There are several different types of insulin, which vary based on how quickly they start working, when they peak in action, and how long they last.

• Rapid-acting insulin, such as Afrezza, Humalog (insulin lispro), Apidra (insulin glulisine), and Novo Rapid and NovoLog (insulin aspart), starts working about 15 minutes after administration, peaks after about one hour, and continues to work for two to four hours, according to the American Diabetes Association.
• Regular (short-acting) insulin, such as Humulin R and Novolin R, starts working after about 30 minutes, peaks after two to three hours, and continues to work for three to six hours.
• Intermediate-acting insulin, such as NPH insulin (Humulin N and Novolin N), starts working after about two to four hours, peaks after 4 to 12 hours, and continues to work for 12 to 18 hours.
• Long-acting insulin, such as Levemir (insulin detemir) and Lantus or Toujeo (insulin glargine), starts working several hours after delivery and has a fairly steady effect over a 24-hour period.

Insulin injection into pancreas

Insulin cannot be taken orally because the stomach’s digestive juices will destroy the hormone. It must instead be taken by injection, using an insulin pen or a syringe, or through an insulin pump.

The Insulin Pen

This device contains either a cartridge or a prefilled reservoir of insulin which will usually last up to 30 days. It has a very small needle and the user can dial the required dose of insulin and push to inject it.

 

How to handle insulin pen

How to inject the insulin pen

The Insulin Pump

An insulin pump is a small pager-sized device which continually delivers insulin through a small tube sited just under the person’s skin. Extra insulin can be delivered with food and/or when the blood glucose level is high.

Medications

In addition to insulin, some people with type 1 diabetes may also take Symlin (pramlintide), an injectable drug that can help treat sudden increases in blood glucose levels after meals (postprandial hyperglycemia).

• Pramlintide works by slowing the rate at which food moves through the stomach, as well as by reducing the liver’s glucose production.

Other possible medications for type 1 diabetes include:

• GlucaGen (glucagon) to treat low blood glucose caused by insulin therapy
• Drugs for high blood pressure
• Drugs for cholesterol control
• Aspirin for prevention of heart disease

Life style care for treatment of type 1 diabetes

Certain lifestyle modifications may help people with type 1 diabetes stay healthy and better manage their disease. These include:

• Monitoring blood glucose levels by checking your glucose multiple times every day with glucose meters

BG monitoring device

• Eating a well-balanced diet and monitoring carbohydrate intake (carbs greatly affect blood glucose levels)
• Regular exercise, which can lower blood glucose and increase the body’s sensitivity to insulin

People with diabetes have a higher risk of developing foot problems, since the disease can damage nerves and blood vessels in the feet. This risk can be reduced by by:

• Not smoking
• Checking your feet every day, and getting regular foot exams throughout the year

 

• Treating athlete’s foot and other foot infections immediately
• Moisturizing the feet with lotion
• Wearing shoes designed to minimize diabetic foot problems

Prevention of Diabetes Mellitus Type 1

• Immunotherapy: Prevent the onset or progression of autoimmune destruction of insulin-producing Beta cells. Block the destructive immune T cells. Support Regulatory cells which protect against autoimmunity
• Make a commitment to manage your diabetes.
• Identify yourself.Wear a tag or bracelet that says you have diabetes. Keep a glucagon kit nearby in case of a low blood sugar emergency
• Schedule a yearly physical exam and regular eye exams.
• Keep your vaccinations up to date.High blood sugar can weaken your immune system. Get a flu shot every year. Your doctor will likely recommend the pneumonia vaccine, as well.
• Pay attention to your feet.Wash your feet daily in lukewarm water. Dry them gently, especially between the toes. Moisturize your feet with lotion. Check your feet every day for blisters, cuts, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn’t heal.
• Keep your blood pressure and cholesterol under control.
• If you smoke or use other forms of tobacco, ask your doctor to help you quit. Smoking increases your risk of diabetes complications, including heart attack, stroke, nerve damage and kidney disease.
• If you drink alcohol, do so responsibly.Alcohol can cause either high or low blood sugar, depending on how much you drink.
• Take stress seriously.The hormones your body may produce in response to prolonged stress may prevent insulin from working properly, which can stress and frustrate you even more.