CONDITIONS
Diabetes_Type 1
Diabetes Mellitus – Type 1
There are 3 types of diabetes –
Pre- diabetes: Where blood glucose levels are too high to be considered normal but not high enough to be labelled diabetes (fasting blood glucose level is between 100 mg/dL and 125 mg/dL). The risk of developing diabetes is significantly reduced by losing 5-10% of the body weight with healthy eating and active lifestyle.
Diabetes Mellitus Type 2 (T2DM): In type 2 diabetes (earlier known as non–insulin-dependent diabetes or adult-onset diabetes), 2 things may happen – a. not enough insulin is produced in the body (pancreas) or b. cells respond poorly to insulin and take in less sugar. This results in increase in the blood sugar levels.
Diabetes Mellitus Type 1 (T1DM): In Type 1 diabetes (earlier known as juvenile diabetes or insulin-dependent diabetes, the insulin-making cells (beta cells) in the body (in pancreas) is destroyed by the body’s own immune system. Because of this, insulin is unable to show its effects resulting in increase blood glucose levels. Hardly 10% of people suffer from this type of diabetes and most people suffering are children and young people.
India has the world’s highest number of children and adolescents suffering from T1DM.
In India, a trend of 3–5% increase/year is seen in Type 1 Diabetes Mellitus (T1DM) with three new cases of T1DM/100,000 children of 0–14 years every year.
What are the symptoms of diabetes?
The signs are often subtle but may become severe. These are:
- Excessive thirst
- Increased hunger (even occurs after eating)
- Dry mouth
- Frequent urination
- Unexplained weight loss
- Extreme tiredness
- Blurry vision
- Frequent infections of your skin, urinary tract, or vagina
- Crankiness or mood changes
- Sudden start of bedwetting in a child who was otherwise dry at night
- Stomach upset problems or vomiting may occur
What are the causes and risk factors for Type 1 diabetes?
- – Genetics
- – Exposure to viruses and other environmental factors
How does diabetes occur?
- – Dehydration
- – Weight loss
- – Diabetic ketoacidosis (DKA) (a condition that causes a build up of extra glucose and acidic ketones that may lead to ketoacidosis and may be life-threatening if not treated the right away.
- – Damage to different organs of the body.
What are the risk factors of developing T1DM?
Some factors as mentioned below may increase the chances of developing diabetes:
- – History of diabetes – Anyone with a parent or sibling with type 1 diabetes
- – Genetics – Having certain genes increases the risk of developing type 1 diabetes.
- – Age – Generally Type 1 diabetes appear at two noticeable peaks – a. In children between 4 and 7 years old; b. In children between 10 and 14 years old.
How is Diabetes Type 1 diagnosed?
The healthcare practitioner generally conducts a sugar test if type 1 diabetes is suspected.
Sugar test:
- The sugar test may be a random blood sugar test (taken at any random time)and confirmed by additional tests. Irrespective of the contents of last meal, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
- Fasting blood sugar test is a blood test post fasting overnight. A level of less than 100 mg/dL (5.6 mmol/L) is healthy, 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes while 126 mg/dL (7 mmol/L) or higher after 2 tests is considered diabetes.
- Glycated hemoglobin (A1C) test is a measure of the average blood sugar level for the past 2 to 3 months and an A1C level of 6.5% or higher on two separate tests could mean presence of diabetes.
A urine test may also be suggested to test for glucose or chemicals that are present in the urine in the absence of enough insulin.
What are the treatment options for Type 1 Diabetes Mellitus?
- Insulin therapy: A person diagnosed with type 1 diabetes would need insulin therapy throughout life. Various type of insulin may be administered depending on the glucose levels and the doctor’s assessment. These are as follows:
- Short-acting insulin (also called regular insulin): Starts working around 30 minutes after injection and lasts about 4 to 6 hours.
- Rapid-acting insulin: Starts working within 15 minutes and lasts about 4 hours ( Often used 15 to 20 minutes before meals).
- Intermediate-acting insulin(also called NPH insulin): Starts working in about 1 to 3 hours and lasts 12 to 24 hours.
- Long- and ultra-long-acting insulin: May provide coverage for as long as 14 to 40 hours.
- A combination of a long-acting insulin and a rapid-acting insulin injections may be given on daily basis to a person with T1DM. Insulin cannot be taken orally and is given either as shots (injections) or using an insulin pump.
- Counting carbohydrates, fats and protein: A registered dietician for diabetes will recommend a diet that includes fewer animal products and refined carbohydrates, such as white bread and sweets. A diet including nutritious, low-fat, high-fibre foods such as fruits, vegetables, and whole grains is recommended Counting carbohydrates provides a person with enough insulin and allows the body to properly use those carbohydrates.
- Monitoring blood sugar often: Depending on the type of insulin therapy selected, the doctor will advise the patient to check and record blood sugar level at least four times a day – before meals and snacks, before bed, before exercising or driving, and whenever there are chances of low blood sugar. Careful monitoring is required to is maintain the blood sugar level in the target range.
- Exercising regularly and keeping a healthy weight: Physical activity is known to lower blood sugar levels. People who have type 1 diabetes need regular aerobic exercises like walking or swimming. A moderate aerobic exercise for atleast 150 minutes a week is recommended and there should not be gap of more than 2 days without exercise. Approve with the doctor before beginning a new activity, and checking and monitoring the blood sugar level more often than usual is advised until the impact of that activity on blood sugar levels is understood. An adjustment of meal plan or insulin doses may also be required because of the increased activity depending on doctor’s advice.
The goal is to keep the blood sugar level as close to normal as possible to delay or prevent complications. Generally, the goal is to keep the daytime blood sugar levels before meals between 80 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.
What are the activities causing concern for people who have type 1 diabetes?
Driving: Since low blood sugar can occur at any time in a diabetic patient, it is advisable to check blood sugar anytime before driving and a snack with 15gms of carbohydrate (generally a chocolate or snack bar) should be eaten if it’s below 70 mg/dL (3.9 mmol/L).
Working: Certain settings in workplace such as jobs that involve driving or operating heavy machinery, or heavy physical work may cause low blood sugar posing a serious risk to the person and surrounding people. Adjustments about food and water should be made accordingly.
Being pregnant: There is higher risk of complications during pregnancy in type 1 diabetic women. An A1C value of less than 6.5% is recommended for women trying to get pregnant.
Being older or having other conditions: With patients who are weak or sick or have difficulty thinking clearly, a less strict A1C goal of less than 8% may be appropriate.
How can Type 1 diabetes be prevented?
Type 1 diabetes cannot be prevented yet, but research on further damage of the islet cells in newly diagnosed patients are being carried out.
Future directions also include researching on pancreas transplant or Islet cell transplantation (the cells producing insulin)
What are the initiatives by government of India for Type 1 Diabetes?
The children and adolescents face multitude of challenges for T1DM that includes a lack of free supply of insulin, syringes, glucose measuring devices and strips, along with a lack of structured diabetes education and counselling. Some essential components in the management of T1DM such as multiple daily injections of insulin, self-monitoring of blood glucose, structured diabetes education and psychosocial support is lacking.
The Government of India took initiative to launch the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in the year 2008 which was primarily adult centric. A recent study focusing on diagnosing diabetes in children was incorporated under this program. Unfortunately, known interventions specific to children and type 1 diabetes is lacking.
References
- Das AK. Type 1 diabetes in India: Overall insights. Indian J Endocrinol Metab. 2015 Apr;19(Suppl 1):S31-3.
- Type 1 diabetes. Mayo Clinic. January 2024. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/diagnosis-treatment/drc-20353017
- Type 1 diabetes. WebMD. January 2024. https://www.webmd.com/diabetes/type-1-diabetes
- Erika F. Brutsaert. Diabetes Mellitus (DM). Merck Manuals. January 2024. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/diabetes-mellitus-dm
- Kumar KM. Incidence trends for childhood type 1 diabetes in India. Indian J Endocrinol Metab. 2015 Apr;19(Suppl 1):S34-5.
