Diabetes type 1 is a long-term autoimmune condition that interferes with blood sugar regulation. Because type 1 diabetes (T1D) primarily affects children and young people, it was formerly known as “Insulin-Dependent Diabetes Mellitus” (IDDM) and “Juvenile-Onset Diabetes.” Though it does need dedication to monitoring your blood sugar levels, controlling what you eat, and adhering to your insulin and medication regimens, T1D is a manageable condition. A full and active life is what most individuals can expect with that devotion.
T1D causes
Though the exact causes of T1D are uncertain, viral infections frequently appear to be linked to the disease. Being an autoimmune disease, T1D indicates that your immune system has been “confused” in some way. In genetically sensitive individuals, this confusion can occasionally be triggered by a viral infection. The viral infection may set off the immune system, and in individuals who are genetically predisposed, this could ultimately lead to the immune system attacking the pancreatic beta-cells, which are responsible for producing insulin.1.
The body’s immune system’s function is to defend “self” against everything it believes to be “non-self.” The cellular immune system and the humoral immune system are the two primary “arms” of the immune system. When self and non-self signals are confused in type 1 diabetes, the immune system reacts by killing the pancreatic beta-cells, which are responsible for producing insulin.
- The cellular immune system eliminates anything that it senses or believes to be non-self by using different kinds of T-lymphocytes, often known as white blood cells, or T cells, together with other immune cells. Cellular immunity pertains to the immune system’s reaction against bacteria, viruses, and cancerous cells. Rejection following a transplant is also influenced by cellular immunity.
- Another subtype of lymphocyte known as a B-lymphocyte or B-cell is a part of the humoral immune system. Antibodies are a particular class of protein produced by B cells that bind to objects that they perceive as foreign. These blood-borne antibodies play a role in the immune system’s reaction against bacteria, viruses, and occasionally cancerous cells.
- The majority of T1D patients have both arms of the immune system contributing to the beta cells that secrete insulin being destroyed. As an illustration, antibodies to the enzyme glutamic acid decarboxylase (GAD) are present in roughly 85% of individuals with T1D. An enzyme called GAD is present in the pancreatic beta cells.
- It’s critical to understand that having one autoimmune illness raises the chance of developing another, including rheumatoid arthritis, thyroid conditions (such as Graves’ disease and Hashimoto’s thyroiditis), celiac disease, and others.2. Periodically, you or your child should be checked for these kinds of problems.
Environmental and Genetic Susceptibility
Many genes interact to cause Type 1 Diabetes (T1D); the genes most commonly linked to T1D belong to the HLA-DR and DQ groups (haplotypes).1. Other genes—such as those linked to T cell activation (CTLA4, PTPN22, IL2RA), among others—are also linked to type 1 diabetes. The risk of T1D is increased by having one or more of these genes, but there also appears to be a link between T1D and environmental variables.
As previously discussed, viral infections can occasionally cause T1D. These infections include enterovirus, which typically causes moderate respiratory and flu-like symptoms, as well as the mumps, rubella, and coxsackie B4 viruses. Low vitamin D levels, cow’s milk, and exposure to hazardous chemicals are some possible environmental concerns.
Identification
Although T1D, although frequently known as juvenile onset diabetes, is primarily diagnosed in youngsters, approximately 50% of cases are found in adults over the age of twenty. Latent autoimmune diabetes of the adult (LADA) or Type 1.5 Diabetes is the term used to describe T1D in individuals diagnosed in their twenties.3.
The following are the typical signs of T1D:
- A rise in thirst
- An increase in the frequency of urine
- heightened desire to eat
- A mysterious weight loss
Bedwetting is one symptom that very young children may experience. Additional symptoms may include nausea, stomach discomfort, blurred eyesight, irritability or odd behavior, and exhaustion. While newborns may experience a severe diaper rash brought on by (often) candida, a kind of yeast, young girls may get vaginal yeast infections.
These symptoms could appear out of the blue and coincide with those of diabetic ketoacidosis (DKA), a potentially dangerous diabetic complication. The following are symptoms of DKA to be aware of: 4
- An abrupt rise in urine production and thirst
- vomiting and nausea
- stomach ache
- Abrupt exhaustion
- Breathing difficulties or shortness of breath
- A breath with a “fruity” fragrance
- Perplexity
- Furthermore, the diagnosis is dependent on lab data, particularly because these symptoms are frequently not very evident in the early stages. Among the requirements for diagnostic lab values are: 5
- A fasting plasma glucose (sugar) level of 7.0 mmol/L (126 mg/dL) or higher, OR
- an oral glucose tolerance test (OGTT) with a 2-hour plasma sugar (glucose) level of more than or equal to 200 mg/dL (11.1 mmol/L), OR
- Any individual with symptoms of high blood sugar who has a random plasma sugar (glucose) level of more than or equal to 200 mg/dL (11.1 mmol/L).
- A1c levels, which might vary depending on the age of the T1D patient, can also be used for diagnosis and management.
T1D complications
Since uncontrolled or inadequately controlled T1D can impact the heart, blood vessels, brain system, kidneys, bones, and eyes, it can lead to some serious consequences. Although these complications can strike anyone at any age, they typically strike older adults who develop diabetes later in life.
Management of Type 1 Diabetes
T1D patients need to be closely monitored for blood sugar levels and get insulin replacement medication for the rest of their lives. This frequently necessitates an early hospital stay and extensive family participation in young children. The most current recommendations state that A1c level objectives should be fewer than 7.5%, however this can vary from person to person.Six Most T1D patients need two or more daily insulin injections to manage their blood sugar levels, at least initially. Stable blood glucose levels are one of the key objectives of treatment for any kind of diabetes. This is commonly known as keeping up “tight glycemic control.” It has been demonstrated that strict glycemic management limits and minimizes the consequences of diabetes.
Young children can gradually learn to manage their own blood sugar levels. However, blood sugar monitoring is necessary for anybody with T1D. Blood sugar levels are often measured every day before meals, one to two hours after meals, and right before bed. These blood sugar levels can be used to modify insulin dosing. This calls for active parental participation as well as extensive family education, training, and support, particularly for young children.
There are several types of insulin that are accessible; these include short acting (within 45–75 minutes), intermediate acting (within 5–10 minutes), long acting (within 45–75 minutes), and ultra-long acting. Depending on the patient’s demands, a mix of these insulins may be recommended. Insulin “pen injectors” can be useful, particularly for small children who might find administering needle injections on a daily basis problematic.7.
Among the several insulins and administration techniques that are accessible are:
- Insulins that act quickly include Novolog and Humalog.
- Novolin and Humulin are examples of short-acting insulins.
- Among the long-acting insulins are Levemir and Lantus.
- Humulin N and Novolin N Insulin Pens are examples of intermediate acting insulins.
- Insulin-producing pumps
Although insulin is typically the only medical intervention needed, good food, exercise, and nutritional habits are also crucial.
Overall Dietary and Exercise Guidelines
The generally recognized dietary guidelines are as follows:8
- Refined (processed) carbs should make up no more than 10% of your daily total. Fruit and whole, unprocessed foods provide complex carbs, which should make up between 50 and 55 percent of daily caloric intake.
- About 30–35% of daily calories should come from healthy fats, which can be found in fresh vegetables, fish, poultry, lean meats, eggs, and dairy products.
- About 10–15% of daily calories should come from lean, high-quality protein.
- Snacks and meals should be had as often as feasible.
Everyone who has T1D has to exercise frequently. Be advised that blood sugar levels can be affected by physical exercise, infections, other ailments, and stress in any form. Following physical exertion, as well as during times of illness, trauma, or other physical, mental, or emotional stress, blood sugar levels should be regularly monitored.9.
Resilience and Assistance
Receiving a T1D diagnosis can be emotionally taxing for all parties involved, but families may experience additional challenges. Informational and emotional support groups are offered to assist individuals and families in coping, especially since eating disorders, sadness, and anxiety are common in children with type 1 diabetes.2. Make sure the school is aware of your child’s condition and that they wear a medical ID bracelet. Make sure that all of your questions and concerns are addressed, and maintain contact with all those engaged in your child’s care. Although research is still in its early stages, people with T1D can now anticipate living a healthy and active life provided they adhere to insulin medication, strict glycemic management, and recommended diet and exercise regimens.
Citations
- http://emedicine.medscape.com/article/117739-overview#showall
- http://www.ndep.nih.gov/media/SNN_September_2006.pdf
- http://www.aafp.org/afp/2010/0401/p843.html
- http://www.mayoclinic.org/diseases-conditions/diabetic-ketoacidosis/basics/symptoms/con-20026470
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797383/
- [Guideline] Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. Diabetes Care. 2014 Jun 16.
- http://www.uptodate.com/contents/diabetes-mellitus-type-1-insulin-treatment-beyond-the-basics?source=see_link
- Pihoker C, Forsander G, Wolfsdorf J, Klingensmith GJ. The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes. 2009 Sep. 10 Suppl 12:58-70
- http://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/basics/treatment/con-20029197