Type 1 diabetes is a chronic autoimmune condition that affects how the body processes blood sugar. Unlike other forms of diabetes, it is not linked to lifestyle choices or diet. The pancreas, located behind the stomach, normally produces insulin, a hormone that regulates blood glucose levels.
After food is digested, glucose enters the bloodstream, signaling the pancreas to release insulin. Insulin acts like a key, allowing glucose to enter cells for energy or storage. With Type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This destruction leads to a lack of insulin, making it impossible for glucose to enter cells and resulting in high blood sugar levels. Insulin therapy is a lifelong necessity for survival.
Causes and Risk Factors of Type 1 Diabetes
The development of Type 1 diabetes involves a combination of genetic predisposition and environmental factors. Individuals with certain genetic markers, particularly specific HLA genes, have an increased susceptibility to the condition. While these genes raise the risk, their presence alone does not guarantee that someone will develop Type 1 diabetes.
Environmental triggers initiate the autoimmune attack in genetically susceptible individuals. Exposure to certain viruses, such as enteroviruses, or other environmental factors might trigger the immune system to mistakenly target pancreatic beta cells. The autoimmune destruction of these cells can occur over months or even years before symptoms become apparent.
Recognizing the Signs and Symptoms
Type 1 diabetes presents with acute symptoms due to high blood sugar. Excessive thirst (polydipsia) and frequent urination (polyuria) are common, as the body tries to dilute and flush out high blood glucose.
Extreme hunger (polyphagia) occurs because cells cannot access glucose for energy, leading to a feeling of starvation. Unexplained weight loss can also occur, as the body starts breaking down muscle and fat for energy in the absence of insulin. Fatigue and blurred vision are also reported, stemming from the body’s inability to utilize glucose and the effect of high sugar on eye lenses.
Diabetic Ketoacidosis (DKA) is a severe, life-threatening condition that can be the first sign of Type 1 diabetes, particularly in children. DKA develops when the body, lacking insulin, starts burning fat for energy, producing acidic byproducts called ketones. Symptoms of DKA include nausea, vomiting, stomach pain, and a distinct fruity odor on the breath. Rapid, deep breathing and dry skin and mouth are also signs of this medical emergency, requiring immediate medical attention.
Diagnosis and Daily Management
Diagnosis involves blood tests that measure glucose levels and identify autoimmune markers. A random plasma glucose test showing a blood sugar level of 200 mg/dL or higher, along with classic symptoms, can indicate diabetes. The A1C test provides an average blood sugar level over the past two to three months, reflecting long-term glucose control. Autoantibody tests confirm the autoimmune nature of Type 1 diabetes by detecting antibodies that target pancreatic beta cells.
Management centers on replacing the insulin the body no longer produces. Insulin therapy is necessary for survival and involves either multiple daily injections (MDI) or an insulin pump. MDI involves injecting insulin using syringes or pens several times a day, while insulin pumps deliver small, continuous doses of insulin through a catheter placed under the skin, offering more flexibility.
Blood glucose monitoring is a cornerstone of daily management, allowing individuals to adjust insulin doses. Traditional finger-prick tests provide a snapshot of blood sugar at a specific moment. Continuous Glucose Monitors (CGMs) offer real-time glucose readings throughout the day and night via a small sensor inserted under the skin, providing trends and alerts. Carbohydrate counting is also routine, as insulin needed often depends on carbohydrates consumed.
Long-Term Health Considerations
Diligent daily management of Type 1 diabetes, maintaining stable blood glucose levels, significantly reduces the risk of long-term complications. However, prolonged high blood sugar can affect various organs and systems.
Microvascular complications arise from damage to small blood vessels. Retinopathy involves damage to retinal blood vessels, which can lead to vision impairment or blindness. Nephropathy affects the kidneys, potentially leading to kidney disease or failure due to damage to filtering units. Neuropathy, or nerve damage, can manifest as numbness, tingling, or pain, especially in the hands and feet, and can also affect internal organs.
Macrovascular complications involve damage to larger blood vessels, increasing the risk for cardiovascular disease. Individuals with Type 1 diabetes have an elevated risk for heart disease, including heart attacks and stroke. Consistent management of blood sugar, blood pressure, and cholesterol can help prevent or slow the progression of these complications, supporting long-term health.