Type 1 diabetes

Type 1 diabetes is a chronic (lifelong) disease that occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately.

CAUSES, INCIDENCE, AND RISK FACTORS

Diabetes is a lifelong disease for which there is not yet a cure. There are several forms of diabetes, including:

Type 1 diabetes, often called juvenile or insulin-dependent diabetes

Type 2 diabetes, often called adult or noninsulin-dependent diabetes

Gestational diabetes, which occurs during pregnancy.

For all types of diabetes, the metabolism of carbohydrates (including sugars such as glucose), proteins, and fats is altered.

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel.

Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger.

In addition, the high levels of glucose in the blood causes the patient to urinate more, which in turn causes excessive thirst. Within 5 to 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced.

Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

SYMPTOMS

1. Increased thirst

2. Increased urination

3. Weight loss despite increased appetite

4. Nausea

5. Vomiting

6. Abdominal pain

7. Fatigue

8. Absence of menstruation

SIGNS AND TESTS

The following tests can be used to diagnose diabetes:

1. Urinalysis shows glucose and ketone bodies in the urine, but a blood test is required for diagnosis

2. Fasting blood glucose is 126 mg/dL or higher

3. Random (nonfasting) blood glucose exceeds 200 mg/dL (this must be confirmed with a fasting test)

4. Insulin test (low or undetectable level of insulin)

5. C-peptide test (low or undetectable level of the protein C-peptide, a by-product of insulin production)

TREATMENT

At diagnosis, the immediate goals of treatment are to treat diabetic ketoacidosis (also called DKA) and high blood glucose levels. Because of the sudden onset and severity of symptoms in type 1 diabetes, treatment for newly diagnosed people may involve hospitalization.

The long-term goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications such as blindness, kidney failure, and amputation of limbs.

These goals are accomplished through education, insulin use, meal planning and weight control, exercise, foot care, and careful self-testing of blood glucose levels.