Type 1 Diabetes

Type 1 diabetes – the basics

Type 1 diabetes used to be called insulin dependent diabetes or juvenile diabetes. Over the years this has become confusing as many people with type 2 diabetes eventually need insulin to manage their diabetes and as well, adults can also get type 1 diabetes. Type 2 diabetes never turns into type 1 diabetes – they are very different diseases. In Type 1 diabetes, the pancreas cannot produce insulin because the cells that actually make the insulin have been destroyed by the body’s own immune system. The Islets of Langerhans is the area in which the endocrine,( hormone-producing) cells of the pancreas are grouped. Discovered in 1869 by the famous German pathological anatomist Paul Langerhans, the islets of Langerhans constitute approximately 1 to 2% of the mass of the pancreas. There are about one million islets in a healthy adult human pancreas, which are distributed evenly throughout the organ; their combined mass is 1 to 1.5 grams. Insulin acts as a key to open the blood cells and release the glucose into the body where it is needed. This insulin must be replaced. People with Type 1 diabetes must have insulin every day to live. At this stage that means insulin injection via an insulin syringe or pen, or an insulin pump. Read more here at Diabetes Australia

What age is it diagnosed?

While Type 1 diabetes can and does occur at any age, it usually starts in childhood, the teen years and in young adults, with the peak age being 11 years old. It is most common under 40 years of age. People diagnosed as adults can find it tough going as it can be assumed they have type 2 diabetes due to their age. There is an adult onset autoimmune diabetes (LADA) which is basically type 1 diabetes in adults – it has a slow onset, not quick like the usual type 1 diabetes and is also often misdiganosed initially, as type 2 diabetes. A simple blood test can tell you have type 1 or autoimmune diabetes. You can read more on the “other types” of diabetes page. Type 1 diabetes is the least common form of diabetes, with just 10-15% of all people with diabetes having Type 1 diabetes. Some people with type 1 diabetes feel this makes them unique and special! Others feel that there is not enough focus on type 1 diabetes and it is certainly the case that confusion reigns when it comes to the types of diabetes, causes and consequences.

Who is most likely to get Type 1 diabetes?

We still don’t know what actually causes Type 1 diabetes in the first place. We are getting closer to understanding more each day as researchers invest a lot of time seeking answers. It seems that new type 1 diabetes cases are increasing in developed countries and Australia is high on the list. We do know it has a family link, but this is not as strongly linked as it is in type 2 diabetes. We also know there are some envrionmental factors involved in the “tipping” over or trigger, which starts the process of autoimmunity in type 1 diabetes – and there are a range of ideas here such as exposure to wheat or cow’s milk. However nothing has yet been confirmed in relation to any of these ideas.

Is it genetic?

Some people say they got type 1 diabetes and nobody else in the family had it, others can pinpoint relatives scattered throughout their family trees. We do know that some people are born with the predisposition to develop type 1 diabetes and research is looking at the markers for type 1 diabetes in those at higher risk and then seeking possible ways to prevent it developing. A trigger is needed for the immune system to start damaging the pancreas. These triggers are thought to be factors in the environment, which are still not fully understood and it is suggested that the trigger might be different for different people. We know Type 1 diabetes occurs when something triggers the immune system to destroy the insulin-making cells in the pancreas, such as a virus. This is called an autoimmune reaction. While the cause of Type 1 diabetes has nothing to do with lifestyle, a healthy lifestyle is very important in managing the condition. In reality this sort of lifestyle is one that all people would benefit from and forms the basis of a healthy and long life. Once the body’s immune system, whose job it is to protect us from infection, starts to attack the insulin producing cells (beta cells) of the pancreas, it can take from a few weeks to many years for all of the beta cells to be destroyed. The pancreas has many beta cells to spare, so symptoms of diabetes do not occur until more than 90% of the cells have been destroyed. In adults diagnosed with the slower form of type 1 diabetes (Lada), this can take many years. In children the process is usually quicker and onset of diabetes symptoms are acute and significant.

Signs and symptoms

When type 1 diabetes develops blood glucose levels may rise up to five to ten times the normal level! Normal levels sit about 3.5 mmol – 8 mmol. Excess glucose then spills over into the urine, taking water with it which leads to frequent urination and dehydration. Thirst increases as the body tries to compensate and that unquenchable thirst results. Excessive tiredness, infections and mood changes are also common. The body is unable to use glucose from food for energy and starts to break down fat and muscle leading to weight loss over weeks or months. The breakdown of fat causes chemicals, known as ketones, to accumulate in the blood, resulting in abdominal pain, nausea and vomiting. If undetected, glucose and ketone levels become very high in the blood stream with severe dehydration and loss of salts from the body. This is called diabetic ketoacidosis (DKA) and coma may occur.

Common Signs and Symptoms of type 1 diabetes

• Going to the toilet frequently to pass urine
• Excessive thirst and drinking a lot of fluids
• Weight Loss
• Tiredness
• Mood changes

Other Signs and Symptoms

***In babies and young infants, signs and symptoms may be less easily detected.

Can Type 1 diabetes be prevented or cured?

While a great deal of research is being done, at this stage nothing can be done to prevent or cure Type 1 diabetes. There is a lot of work being done on prevention trials. The Type 1 Diabetes Prevention Trial (Intranasal Insulin Trial INITII) is recruiting relatives of people with type 1 diabetes. Relatives have an increased risk of developing diabetes, which can be assessed by a simple blood test. Only 2% of the people tested will be considered at high risk of developing diabetes and be eligible to enter the trial. The remaining 98% of people tested will be reassured their risk is low. If relatives are at high risk they have the opportunity to participate in a prevention trial of a nasal insulin vaccine. Relatives are vitally important in research to prevent and eventually cure type 1 diabetes. Please encourage your relatives to think of themselves and future generations by having the free blood test. To find our more call 1300 138 712, visit the trial website http://www.stopdiabetes.com.au or find the trial on facebook (Type 1 Diabetes Prevention Trial – initii). There is also a lot of work being done on development of a “closed loop” system of management, essentially an “artificial pancreas”. You can find out about some of the current advances in the prevention, detection and management of type 1 diabetes at:

• JDRF
• Diabetes Australia
• International Diabetes Federation
• http://www.stopdiabetes.com.au/

Is there any risk of other family members developing type 1 diabetes?

Although other family members may carry the same ‘at risk’ genes for developing type 1 diabetes, the overall risk is generally low. The risks for family members are estimated as follows:

• Mother who has type 1 diabetes – 1-2% risk for child
• Father who has type 1 diabetes – 4-6% risk for child
• Identical twin who has type 1 diabetes – at least 35%
• Brother or sister who has type 1 diabetes – 3-6%

The Rollercoaster that can happen with type 1

If you have type 1 you know that on a regular basis your blood glucose levels can go up, down, up, down – just like a yo-yo on a string you can feel at the mercy of your diabetes and the blood glucose monitor at times. This up and down is a normal pattern – all people’s blood glucose goes up and down over a 24 hour period and is affected by hormones, stress, food, sleep and so on. However without diabetes, this up and down is within a small range. For those with type 1 diabetes, these ups and downs might range from 2.0 mmol to 21 mmol (or less/more) and it can be frustrating and disheartening if this happens. Once you start to feel out of control with your diabetes it can really impact on your wellbeing and sense of hope. It is important to regain this control, so that you can move on and continue your life in a happy way. We are all different, our management regimes are different, each day is different and injecting insulin can never totally mimic what the body does when not having to cope with diabetes. Add to this the fact that every aspect of life affects blood glucose, from the injection site, to the time of day, to the time of month, to what you eat, how active you are, your mood, stress levels and the day of the week – and it can be a recipe for a rollercoaster ride. HOWEVER – with the tools we have now, it is entirely possible to have a more balanced ride with your type 1 diabetes. Regular blood glucose checks, keeping informed about the latest technology, tools and insulins – enable you to take control of your diabetes as much as you can. Sometimes there will be unexplained swings, but it is possible to maintain things on a smoother level as much as possible. Getting good support is vital. You also need to practise regular relaxation, find time out from diabetes, learn how to manage the more tricky aspects of type 1 and connect with other people who understand. Some people we have spoken to worry about the long term impact of high blood glucose levels and work very hard to keep the levels in a “normal” range. This often means more hypos, as when you run your levels at a “normal” rate with type 1 diabetes, there are going to be times when there is a little too much insulin floating around. Pumps make this easier for many people and the new long acting insulins such as Lantus and Levemir also help reduce hypos. Often times this means an unforgiving regime of many blood glucose checks each day and close monitoring of food intake, exercise etc – people can end up worn out, burnt out and giving up. It is important to find a balance of what suits you, so that you can stay healthy without burning out.

Hypo Anxiety

Some people develop a real fear and even anxiety about hypoglycemia. This can result in them keeping their blood glucose levels high, to prevent a hypo happening. This is particularly the case for people in positions of control, such as a new parent, a person who cares for others in their work, or who has to make regular public presentations, for example. Once you have had a hypo, you understand what it feels like – the loss of control, mood swings, physical sensations and sometimes even a feeling of anxiety and panic – can in themselves bring on anxiety and panic. This can then become entwined with the hypo and lead to people not being sure if they are suffering with a hypo or a panic attack. In the end it can seem easier to stay at a higher level, so that a hypo can not eventuate. What can help is to make sure you check your levels when you feel “funny” so you can see if you are low or not – you can record this and see how accurate you are at picking up a hypo. Along with the rollercoaster can come a sense of “why can’t I get it right?” “What is wrong with me?” And this can equal “I am a hopeless loser”. No matter how long you have had diabetes and how much you know, this can still happen. The “should’s” can creep in – I should have had less insulin, I should have known this would happen etc etc This way of thinking is unhelpful and whilst we are not always able to do this, it is important to try and be aware of this thinking and stop it. A trick is to start to recognise this thinking and when you notice it, turn it around to saying something like “I did the best I could at the time, I made the decision I thought would be ok – it is just a high/low reading and now I will deal with it”. In this way you are being rational about the reading on the blood glucose monitor and doing something about it, rather than beating yourself up.