Diabetes is a clinic condition in which the body is not able to control the amount of glucose (a form of sugar) in the blood. Glucose is needed by the body to produce energy, but too much glucose leads to serious problems. Glucose levels are normally controlled by the hormone, insulin, which is produced in the pancreas. With diabetes, there is either not enough insulin produced or the body is unable to use the insulin that is produced. There are two main types of diabetes, type 1 and type 2. Type 1 diabetes is also called insulin-dependent diabetes or juvenile diabetes. About 5% to 10% of people with diabetes have type 1.
Pathogenesis of Type 1 Diabetes
Type 1 diabetes is an autoimmune disease that involves the immunologic destruction of pancreatic beta cells, the insulin secreting cells of the pancreas. It is thought that autoimmune beta cell destruction is a factor in type 1 diabetes, a therapy that is supported by the detection of beta cell antibodies in the blood of pre-diabetics and newly diagnosed diabetic.
Furthermore, immunosuppressant therapy can preserve beta cell function in newly diagnosed diabetic patients. The autoimmune destruction of beta cells is thought to be caused by “environment factor” such as enterovirus, nutritional factors, interactions between enterovirus and nutritional factor, and chemical toxins.
In addition to environmental factor, evidence indicates that type1 diabetes has a genetic component. In monozygotic twins, if one twin develops type 1 diabetes mellitus the other twin has 30% to 70% greater chance of developing type1 diabetes mellitus, a rate several times higher than that for dizygotic twins and non-twin sibling.
The genetic basis for type 1 diabetes appears to be primarily human histocompatible leukocyte antigen (HLA) complexes, a group of approximately 128 genes that explains 30% to 50% of familial clustering of type 1diabetes.
In summary, it is obvious that the etiology of type 1 diabetes is multifactorial, involving several genes and environmental factors that lead to the destruction of pancreatic beta cells and insulin deficiency. Although there is no cure for type 1 diabetes, tight control of blood glucose by exogenous insulin therapy and healthy and physically active lifestyle may help delay or even prevent diabetic complications.
What causes type 1 diabetes?
Diabetes is disorder in which blood glucose levels are high. In normal health, blood glucose levels are precisely controlled by the hormone insulin. This is made by the beta cells in the pancreas gland, an organ behind the stomach. Minute to minute control of insulin production by the beta cells normally keeps blood glucose levels constant. After a meal, the rate of insulin production rises sharply.
Type 1 diabetes is the result of destruction of the beta cells in the pancreas. This is most often caused by the body’s defense mechanisms attacking the cells as though they were invades (an ‘autoimmune’ process). The process of beta cells destruction happens over a period of many months, but symptoms can start very suddenly once the number of functioning beta cells falls to a critical level.
Possible complications of type 1 diabetes
- Cardiovascular (heart and blood vessel) disease (stroke, atherosclerosis, and coronary-artery disease).
- Foot or leg amputation due to poor circulation.
- Kidney damage.
- Nerve damage (neuropathy)
- Sexual impotence in men.
- Hypoglycemia (low blood sugar).
- Hyperglycemia (high blood sugar).
- Ketoacidosis (very high blood sugar).
Symptoms of Type 1 Diabetes
The initial symptoms of type 1 diabetes often occur suddenly and are very serious. As insulin production decrease, glucose accumulates in the bloodstream instead of being transported into the body’s cells, which need it for energy. To generate this missing energy, the body breaks down fat tissue and release fatty acids. These fatty acids are then metabolized into toxic chemicals called ketones, which increase the acidity of the blood to dangerous levels (a condition called ketoacidosis).
The initials symptoms of diabetic ketoacidosis include excessive thirst and urination, dehydration, weight loss, nausea, vomiting, fatigue, dry or flushed skin, rapid breathing, abdominal pain, and mental confusion. One sure sign is breath that smells like fruit or nail polish remover. Diabetic ketoacidosis is a medical emergency that requires immediate hospitalization. If you or a loved one develops any of the symptoms of ketoacidosis, call your doctor or an ambulance immediately. Death can occur, but the vast majority of people recover with aggressive administration of insulin and fluids.
Examination for type 1 diabetes
Comprehensive physical examination, including:
- Blood pressure, cardiovascular assessment
- Peripheral neurological assessment
- Height, weight, BMI
- Waist circumference
- Feet-ulcers, neuropathy, peripheral vascular disease
- Urinalysis (especially looking for asymptomatic urinary tract infection and microabluminuria
- Visual acuity, retinal fundoscopy
Laboratory tests and further investigations:
- Blood glucose level
- Urinary albumin/ protein
- Full blood examination including hemoglobin and white cell count
- C-reactive protein
- Homocystiene (cardiovascular risk)
- Thyroid function tests (TFT) (TSH and free T4)
- Fasting lipids (cholesterol and HDL)
- Micronutrient assessment (especially iron, folate, vitamin B12 , B6 )
- Coeliac serology (association between type 1 diabetes and Coeliac disease —1 in 20 people with type 1 diabetes have Coeliac disease and as many as 1 in 10 test positive for transglutaminase lgA auto antibodies)
- Baseline retinal and visual assessment
- Bone densitometry for patients aged over 40.
Type 1 diabetes or type 2 diabetes?
Blood tests can help distinguish between type 1 and type 2 diabetes.
- Tests for islet cell and anti-GAD antibodies are positive in 90% of patients with type 1 diabetes.
- C-peptide levels would be abnormally low in type 1 and normal in type 2 diabetes.
Management of type 1 diabetes
Current management of Type 1 diabetes requires daily attention to diet, exercise, self monitoring of blood glucose, and multiple daily subcutaneous injections of insulin. The majority of patients with Type 1 diabetes use either a twice- daily mixed insulin programme or a basal/bolus programme. The former combines fast and intermediate- acting insulin either pre-mixed (using pen devices) or self-mixed (using vials and syringes).
The latter combines fast acting insulin with meals and an intermediate or long acting insulin at night. The basal/bolus programme provides more flexibility in terms of timing and content of meals and is generally favored in young adult patients. Patients should have a blood glucose goal range agreed with their diabetes team and should have strategies for dose adjusting their insulin to achieve this goal. The main approaches used for adjusting insulin dose are pattern recognition of self monitoring data, and carbohydrate counting.