Type 1 Diabetes Mellitus

Diabetes (“passing through”) mellitus (“sweet”) or DM is a group of metabolic disease characterized by increase in serum blood glucose (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. Our body needs a constant supply of certain amount of glucose needed for energy utilization. Insulin is needed for the glucose to enter the cells. Without enough supply of insulin, glucose will remain within the bloodstream and depriving the cells of the nutrients.

  • What is Type 1 diabetes mellitus?
  • What are the causes of Type 1 diabetes mellitus?
  • What are the Risk Factors?
  • What are the Symptoms of Type 1 diabetes mellitus?
  • How is Type 1 DM diagnosed?
  • What are the Complications of Type 1 Diabetes Mellitus?
  • Conclusion

diabetes mellitus type 1

The major classifications of diabetes mellitus are:

  • Type 1 diabetes mellitus
  • Type 2 diabetes mellitus
  • Gestational diabetes mellitus
  • Diabetes mellitus assoicated with other medical conditions or syndrome

What is Type 1 diabetes mellitus?

Type 1 diabetes mellitus, previously known as juvenile-onset diabetes mellitus and insulin dependent diabetes mellitus (IDDM), results when the beta cells in the Islets of Langerhans of the pancreas is destroyed due to some autoimmune response. Normally, beta cells works by producing the hormone insulin which is needed by the body for energy. In the case of Type 1 diabetes mellitus, there is a deficient supply of insulin thereby the person needs constant injection of the said substance for life.

What are the causes of Type 1 diabetes mellitus?

The exact cause of Type 1 diabetes mellitus is unknown. Despite this ambiguity of knowledge, research have postulated three possible reasons on how the disease came to be: autoimmune response, genetics, and viral infection.

AUTOIMMUNE RESPONSE. An autoimmune response is when the body’s own immune system starts to fight off and eventually destroy the beta cells. This particular scenario is likened to a soldier with a blindfold. The immune system cannot detect who’s the enemy to destroy and the normal cells to keep. In this battle of fighting off the supposed to be invading pathogens or antigens, the normal beta cells are being eliminated as well. In the end, there will be no more supply of insulin to help the body cells fuel up for energy.

GENETICS. One reason that links family heredity or genetics to Type 1 diabetes mellitus is the discovery of at least 18 gene locations – labeled as IDDM1 to IDDM18. According to this rsearch, IDDM1 region contains the HLA genes that is responsible for the autoimmune response.  However, this is still not considered the main reason for the development of Type 1 diabetes mellitus. In one study, it was cited that there is only a 10% chance to have diabetes mellitus if a first-degree relative has diabetes.

VIRAL INFECTION. There are several viruses implicated in the development of Type 1 diabetes mellitus. The family of coxsackie viruses are highly regarded in this study.  Coxsackie virus, as well as mumps and congenital rubella, are believed to have caused the destruction of the beta cells leading to the development of Type 1 diabetes mellitus.

What are the Risk Factors?

It was mentioned that the former name of Type 1 diabetes mellitus is juvenile onset diabetes mellitus. That’s because it is most typical in children and adolescents. It usually appears between infancy and the late 30s. Studies have suggested that the following are risk factors for the occurrence of Type 1 diabetes mellitus:

  • When there is history of being ill in early infancy
  • If a parent has Type 1 diabetes mellitus (children are more likely to get the disease if the father is the one affected than from a mother who has the condition)
  • With medical history or present autoimmune disorders like Addison’s disease, Hashimoto’s thyroiditis, Grave’s disease, pernicious anemia, or multiple sclerosis.
  • Maternal factors like late pregnancy of the mother and history of preeclampsia during pregnancy

Video of Type 1 Diabetes mellitus

What are the symptoms of Type 1 diabetes mellitus?

Most medical professionals associate the 4 cardinal signs when discussing the symptoms of diabetes mellitus. These symptoms are true to all types of diabetes:

  • Polyuria (excessive urination)
  • Polydipsia (excessive thirst)
  • Polyphagia (excessive hunger)
  • Weight loss

Because glucose is unable to enter the cells, the cells starve, causing hunger. The large amount of glucose in the blood causes an increase in serum concentration, or osmolality. The renal tubules are unable to reabsorb all the excess glucose that is filtered by the glomeruli, and glycosuria results. Large amounts of body water are required to excrete this glucose, causing polyuria, nocturia, and dehydration. The increased osmolality and dehydration cause polydipsia.

Detecting polyuria in children can also include the recurrence bed-wetting even if the child has been toilet trained already. Just because they are children, do not neglect the sudden craving for sweets and cold drinks as this may signal that their sugar levels are already skyrocketing.  High blood glucose may also cause the following symptoms:

  • fatigue
  • blurred vision or other changes in eyesight
  • irritability
  • headache
  • nausea and vomiting

A child who goes to school may have trouble functioning, is seen apathetic or restless. An undetected Type 1 diabetes mellitus can lead to a diabetic coma of diabetic ketoacidosis wherein ketones may have already build up in the blood and urine. This is a very serious complication of Type 1 diabetes mellitus that needs to be corrected immediately.

How is Type 1 DM diagnosed?

Type 1 diabetes mellitus can be diagnosed through several blood tests, particulalry the blood glucose tests. The results of the tests plus the person’s accompanying complaints can help the doctors arrive at a final diagnosis of Type 1 diabetes mellitus.

The following tests are being used by doctors today to help them arrive to the final diagnosis of Type 1 diabetes mellitus.

FASTING BLOOD SUGAR (FBS). This test measures the amount of sugar (glucose) in the body after the person have not eaten for at least 8 hours, thus the word fasting. Part of the instruction prior to blood extraction is to adhere on the order of NPO or nothing per orem which means that the person should not to eat for at least 8 hours including drinking of water. That is why it is usually done in early morning before eating. the normal range for FBS is 70 to 99 milligrams per deciliter, written as mg/dL. If the FBS is more than 126 mg/dL diabetes is diagnosed. A second test may be required if the first test is not clearly diagnostic. If the fasting plasma glucose is between 100 and 125 mg/dL, the patient has impaired fasting glucose (IFG).

GLYCOSYLATED HEMOGLOBIN (HbA1c). This test is also known as glycohemoglobin test. As glucose tends to attached itself to hemoglobin, this test reveals average blood sugar levels for the past 2-3 months. Doctors use this test to assess the person’s adherence and compliance to the diabetes regimen, i.e., performing exercise, adequate nutrition, and taking of medications. The normal range of HbA1c is between 4% and 5.6%.

  • 5.7% – 6.4% – Increased risk of diabetes
  • 6.5% or higher – Indicates diabetes

It is highly recommended that for people with diabetes, they should maintain a hemoglobin A1c less than 7%. The higher the levels, the higher the risks of developing complications related to diabetes.

OTHER TESTS. Since diabetes affects so many body systems, additional tests recommended for baseline data include:

  • lipid profile
  • serum creatinine
  • urine microalbumin levels to monitor kidney function
  • urinalysis
  • electrocardiogram

What are the complications of Type 1 diabetes mellitus?

Overtime, a person can develop complications from Type 1 diabetes mellitus. The risk of having complications is also high among persons who do not manage their blood glucose to the desired level. This can be seen on those who do not follow strict dietary changes, stick to an exercise regimen, take their medications diligently, and visit their doctors for a follow-up check-up.

ACUTE COMPLICATIONS. Since utilization of blood glucose directly influences one’s physical activity, acute complications of diabetes mellitus occasionally happens in relation to the increase or decrease of blood glucose. If not corrected immediately, it can lead to life-threatening conditions and can result to one’s demise. But the good news is, it can often be prevented with appropriate care. Another point to consider is that these complications are considered symptoms, not diseases.

Hyperglycemia. An increase in the blood glucose is called hyperglycemia. There are several causes for hyperglycemia:

  • Eating more than the meal plan prescribes. More caloric intake (carbohydrates) with having less available insulin in the body can develop an imbalance in the system thus creating an increase in blood glucose.
  • Stress. The release of counter-regulatory hormones, including epinephrine, cortisol, growth hormone, and glucagon. These hormones all increase the blood glucose level.
  • Low immunity profile. Persons with diabetes are advised to stay healthy as possible in order to prevent themselves from getting sick. An infection or illness can tilt the body’s homeostasis and that can increase the levels of blood glucose.
  • Decreased activity or engaging in strenuous activity. That’s right. Either way, the utilization of blood glucose and insulin availability is altered if the person tends to be lazy or exercising less than usual or very active in all activities

A person with hyperglycemia may present the following complaints:

  • Headaches
  • Increased thirst (polydipsia)
  • Difficulty concentrating
  • Blurred vision
  • Frequent urination (polyuria)
  • Fatigue (weak, tired feeling)
  • Weight loss
  • Blood sugar more than 180 mg/dL

Hypoglycemia. Another sudden complication of diabetes mellitus is hypoglycemia or  low blood glucose levels. It occurs when there is not enough glucose available in relation to circulating insulin. This is sometimes referred to as an insulin reaction.  Causes of hypoglycemia may include:

  • skipping a meal
  • exercising more than usual
  • accidentally administering too much insulin
  • neglecting to eat or exercising more after taking medications

A person with hypoglycemia may present the following complaints:

  • Hunger
  • Sweating
  • Tremor
  • Blurred vision
  • Headache
  • Irritability

As the brain is continuously deprived of glucose, neurological symptoms may occur and can lead t0 confusion, seizures, and coma.

LONG-TERM COMPLICATIONS. Since Type 1 diabetes mellitus is a life-time medical condition, chronic elevation of blood glucose eventually leads to these kinds of complications:

Macroangiopathy (macrovascular) complications. This involves the large blood vessels of the body thereby compromising blood supply to the major organs like the brain, heart and even the peripheral circulation to the feet and legs is affected. Because of diabetes, these persons are more likely to have hypertension, elevated low-density lipoprotein (LDL) cholesterol and triglycerides, and increasing platelet functions, leading to increased tendencies of clotting.  As such, incidence of strokes, heart attacks and feet problems related to poor circulation are most likely to occur in the advancing condition of diabetes mellitus.

Microangiopathy (microvascular) complications. Blood circulation in the tiny vessels are also compromised in long-term diabetes. The organs affected are the eyes and kidneys. In the eyes, retinopathy occurs. This involves damage to the tiny blood vessels that supply the eye. Small hemorrhages occur, which can cause blindness if not corrected. Diabetes can also lead to cataract formations. It is advised that patients should undergo a yearly eye examination to monitor these medical conditions. Complication of diabetes involving the kidneys is called nephropathy. It is caused by damage to the tiny blood vessels thereby compromising blood circulation to the area. If nephropathy occurs, the kidneys are unable to remove waste products and excess fluid from the blood. End-Stage Renal Disease (ESRD) is the general outcome for this problem. Patients who develop ESRD secondary to diabetic nephropathy are managed through hemodialysis or peritoneal diaylsis.

OTHER COMPLICATIONS

Nerve Function. Neuropathy, which is damage to nerves as a result of chronic hyperglycemia. It can cause:

  • numbness and pain in the extremities
  • erectile dysfunction (impotence) in males
  • sexual dysfunction in women
  • gastroparesis (delayed stomach emptying)

Foot Problems. Impaired blood circulation to the lower extremities plus neuropathy can predispose the person with diabetes to develop foot complications. The decreased sensation felt in the feet pose a high risk of not knowing there are foreign objects that the person has already stepped into. Since there is the existing problem of poor blood circulation, healing process maybe delayed and we are now looking into the risk of infection. Diabetic patients are often admitted in the hospital because of unhealed wound in the foot. in some severe cases, this could lead to necrosis and gangrene formation which can result to amputation of the affected extremity.

How is Type 1 diabetes mellitus managed?

INSULIN SHOTS. For Type 1 diabetes mellitus, the management protocol centers on insulin injection (remember, the cause of this type of diabetes is lacking or absent insulin production). The dosage of insulin is determined by the healthcare provider with emphasis on teaching the client how to adjust the dosage or amount of insulin depending on the result of the blood glucose monitoring, the client’s lifestyle and willingness to spend time on injections. Persons with Type 1 diabetes mellitus will require multiple shots per day. With this, the client is taught how to inject the medication all by himself.

Insulin is generally given subcutaneously, although fast-acting insulin may be ordered via the intramuscular or intravenous route in urgent situations, or sometimes inhaled. There are several types of insulin and schedules by which it may be given. For persons who are always on the go and prefers a tighter control of blood glucose levels, the use of insulin pumps are recommended. This is a small device that delivers subcutaneous insulin continuously in small (basal) amounts. The patient can then add a bolus of insulin with the push of a button before meals or snacks. This provides insulin levels that are more normal, like a person without diabetes.

Some Important Details about Insulin Administration:

STORAGE: Insulin in use should be stored at room temperature, away from direct sunlight, and should be replaced after 4 weeks; administration of cold insulin causes subcutaneous  atrophy (lipoatrophy) or hypertrophy (lipodystrophy), which alters insulin absorption; extra vials of insulin not in use should be stored in refrigerator.

PREPARATION: Note date of expiration; discard vial and use a new one if regular insulin appears cloudy; do not shake to avoid inactivation and/or formation of bubbles that lead to storage errors; roll non-regular insulin gently between the palms of the hands to evenly disperse suspended particles’ draw regular (clear content) insulin first when mixing it with other types of insulin; only mix insulins of the same concentration and from the same source.

INJECTION: In order to prevent lipoatrophy and lipodystrophy, rotation of injection sites should be practiced. Do not inject insulin in an area that will be involved in strenuous activity/exercise, as it will increase the rate of absorption, onset and peak action of insulin.

ALCOHOL INTAKE: Avoid alcohol intake while taking insulin because it lowers blood glucose levels and can cause hypoglycemia.

EXERCISE. Exercise plan is indicated for every diabetic patients. Daily cardiovascular exercise decreases the risk for insulin resistance, reduces risk of complications, and improves glucose management. Persons with Type 1 diabetes mellitus are advised to check blood glucose before undergoing exercise or any other strenuous activity. Some patients are knowledgeable in checking their urine for any presence of ketones. Ketones are spilled into the blood if the blood glucose is very high (at 250 mg/dL). If ketones are present, call the practioner and avoid exercise. Monitor for signs of hypoglycemia for up to 24 hours after extensive exercise.

NUTRITION. There is a misconception among persons diagnosed with Type 1 diabetes mellitus that they can no longer eat the foods they want. As a matter of fact, food intake is only modified according to what is recommended in the My Pyramid food guidance system that is individualized for each person. Caloric intake is based on individual needs, including possible weight loss needs. Diet should consist of complex carbohydrate (CHO) in amounts tailored to individual  need, avoiding simple sugars; protein at 10 to 20% of caloric intake; saturated fat less than 10% of calories with cholesterol intake equal to or less than 300 mg/day; sodium intake 2,400 to 3,000 mg.day (same as for general population); dietary fiber 20 to 35 mg/day. Cultural preferences are also taken into consideration in order to increase adherence to the treatment plan.

MORE HEALTH CARE TIPS FOR DIABETES MELLITUS!!!

Self-awareness about the condition is essential in order to make steps or ways in managing it. Health teachings are provided to every person with diabetes mellitus so that they are knowledgeable in handling their well being. This will include:

  • Information about type of diabetes mellitus
  • Symptoms to report
  • Self-administration of medication
  • Fingerstick glucose monitoring
  • Plan for regular exam by physician
  • Need to wear Medic-Alert bracelet indicating diabetes mellitus and medication preparation
  • Need for lifelong medication management and lifestyle adjustments

Foot care is also important to prevent foot complications in the future.

  • Keep feet clean and dry.
  • Inspect feet daily using mirror to see soles.
  • Protect feet by wearing shoes (allow ½ to 3/4 –inch toe room) or slippers at all times.
  • Avoid snug-fitting socks and stockings.
  • Use cotton socks because they wick perspiration away from the skin

CONCLUSION

Type 1 diabetes mellitus is a lifelong condition. Individuals who are diagnosed with the disease gets to change a lot in terms of lifestyle, health behaviors, and outlook in life. A healthy diet that is supervised by the physician, medication adherence, and exercise regimen are all essential components of the treatment plan for Type 1 diabetes mellitus.

We will be expanding on this important topic in future articles. While I recommend you to register to download an e-book: “Adult Prevention Guide” for better health, a FREE

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The Team Manager Web Diseases

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