Type 1 diabetes

Type 1 diabetes is also known as infantile diabetes, early diabetes or insulin-dependent diabetes and means that the sugar levels in the blood are too high.
In type 1 diabetes, the pancreas does not produce insulin.
Insulin is a hormone that allows glucose to enter the cells for the necessary energy production.

Without insulin, too much glucose remains in the blood.
Over time, elevated blood sugar can lead to serious problems of the heart, eyes, kidneys, nerves, gums, and teeth.

Type 1 diabetes is mainly diagnosed in children and adolescents, but adults can also develop it.


Why does the pancreas stop producing insulin?

In most cases, type 1 diabetes is considered an autoimmune disease. The normal immune system produces antibodies to attack bacteria, viruses and other germs.
In autoimmune diseases, the immune system produces antibodies against its own body. Those who suffer from type 1 diabetes produce antibodies against the beta cells of the pancreas.
These destroy the cells that produce insulin.
Studies show that the origin can be a genetic predisposition and environmental factors, such as a viral infection.
Rarely, type 1 diabetes develops from other causes. For example, due to severe inflammation or surgical removal of the pancreas for various reasons.

Symptoms and complications

The most common symptoms of type 1 diabetes are:

  • increased thirst,
  • frequent urination,
  • Ravenous appetite
  • Weight loss.

Other symptoms caused by type 1 diabetes include fatigue, nausea, and blurred vision triggered by the hyperglycemia.
The urge to urinate is caused by osmotic diuresis in hyperglycemia.
If you involuntarily wet yourself during the night, this can be a sign of incipient diabetes in young children.
Thirst is the answer to dehydration (dehydration state).
Fatigue and weakness can be caused by muscle degeneration, decrease in circulating blood volume, and potassium deficiency.

Muscle cramps are provoked by an imbalance of mineral salts.
Blurred vision is an effect of hyperglycemia on the retina and vitreous.

Symptoms usually begin a few days or weeks before the first clinical presentation.
However, the destruction of beta cells can begin months or even years before the onset of clinical signs.
Symptoms may appear suddenly.
It is not uncommon for patients with type 1 diabetes to experience diabetic ketoacidosis, which can exist on its own, due to stress due to a medical condition, or due to surgery.
A sudden onset of symptoms in young, lean patients with ketoacidosis has always been considered as a diagnostic criterion of type 1 diabetes.
Over time, patients with type 1 diabetes lose weight despite increased appetite.
Weight loss does not occur if treatment begins immediately after the first symptoms of the disease appear.

Gastrointestinal symptoms include:

  • Nausea, abdominal discomfort, pain, intestinal disorders.
  • Acute hepatic steatosis can lead to stretching of the liver capsule, which leads to abdominal pain in the upper right area.
  • Persistent abdominal pain may indicate another serious cause of diabetes (for example, pancreatitis).

Up to 50% of patients with type 1 diabetes are affected by neuropathy, but symptomatic neuropathy usually develops late.
Peripheral neuropathy shows sensory disturbances and tingling sensations in both hands and feet, it occurs in a glove-like or stocking-like form and is bilateral and symmetrical.

Diagnosis of type 1 diabetes

The main diagnostic tests for diabetes are blood tests to measure glucose, which are done on an empty stomach and several times a day.
The examinations are carried out regularly during pregnancy, also to evaluate gestational diabetes.
Examinations to diagnose diabetes are:

The fasting blood glucose test
Blood sugar levels are controlled after 12 and 14 hours of fasting.
You can drink water, but any other drink should be avoided.
Diabetes patients should delay taking diabetes medication until they have finished the test.

Random test of blood sugar
Blood sugar levels are checked several times during the day, and it doesn’t matter when you eat.
Blood sugar levels tend to remain constant in people who don’t have diabetes.

Oral glucose intolerance test
The patient needs to drink a drink with a high glucose content.
The blood samples are taken at regular intervals of two hours.

Immediately after the diabetes test
The fasting blood glucose test confirms that the person has diabetes if higher blood sugar levels than normal are shown.
Sometimes the result of fasting blood sugar is borderline.
In this case, a glucose intolerance test can be performed.
This test confirms diabetes if blood sugar remains elevated for a long time after the test.

Accuracy of test results
Depending on the test used, blood sugar levels can be affected by many factors, including:

  • eating or drinking;
  • taking medications that raise blood sugar levels, such as birth control pills, some diuretics and corticosteroids;
  • physical illnesses or surgery that can temporarily alter blood sugar levels.

Treatment of type 1 diabetes

There is no definitive treatment for diabetes, so the goal of treatment must be to keep blood sugar levels normal to keep symptoms under control and prevent health problems and complications.
The doctor should explain in detail what type 1 diabetes is and help the patient understand what the appropriate drug therapy consists of and what lifestyle changes are needed.
One should integrate sports activities into everyday life and start a diet to lower blood sugar levels and possibly also to reduce body weight.
The doctor must carefully follow the disease in order to identify in time possible health problems that may arise.

Standard therapy for diabetes
The goal of diabetes therapy is to help people with the disease control blood sugar levels and reduce the risk of complications to a minimum.

There are diabetes centers all over Germany that are certified by the German Diabetes Society.

Diabetes management includes:

  • Access to information and adequate support for people with type 1 diabetes.
  • An agreed-upon care plan that helps all people with diabetes to carry out their treatment and maintain a healthy lifestyle.
  • Information, help, and support for people with diabetes to help them learn to control their blood sugar, maintain acceptable blood pressure, and reduce risk factors that can lead to complications.
  • Access to services to detect and treat potential complications, such as screening for diabetic retinopathy (in which elevated blood sugar levels damage the retina at the back of the eye) and treatment of the feet.
  • Effective care for all people with diabetes who are being treated in hospital for various reasons.

Insulin therapy

Type 1 diabetes occurs because the body does not produce insulin. Therefore, regular insulin treatment is needed to maintain normal blood sugar levels.
Insulin is available in several forms that have a slightly different form of action.
For example, some have a duration of action of a whole day, others last up to eight hours, while still others work very quickly but do not last long.
Treatment may consist of a combination of different types of insulin.

Insulin injections
In most cases of type 1 diabetes, it is necessary to perform insulin injections. The insulin must be injected because if it were taken as a tablet, it would be digested in the stomach like food and could not enter the bloodstream.
Once the diagnosis has been made, a doctor specializing in diabetes will perform the injections and also explain when and how to administer them.
The doctor will also show how to store insulin and how to properly dispose of the cannulas.
Insulin injections are performed via a syringe or insulin pen, which is used to inject insulin under the skin.
Most people need two to four injections a day.
A nurse or doctor will teach the patient or a relative about the correct way to inject insulin.

Microinfusion or insulin pump
An alternative to insulin injection is insulin treatment using an insulin pump.
An insulin pump is a small device that contains the drug and is the size of a deck of cards.
The pump is connected to the body via a long, thin tube, which carries a hypodermic needle at the end, which is placed under the skin.
Most people insert the needle in the abdomen, but you could also place it in the flank, thigh, gluteal muscle or arm.
The insulin pump releases the drug into the bloodstream at an adjustable rate.
This means that there is no longer any need to inject, even if blood sugar levels need to be controlled to ensure that the body is getting the right amount of insulin.
The pump for insulin therapy can be used by adults, adolescents and children (under the supervision of an adult) who have type 1 diabetes.
However, it is not suitable for everyone.
The doctor may recommend therapy with the pump if low sugar levels (hypoglycemia) occur more frequently.

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