Type 1 Diabetes

Reviewed by Professor Ian Campbell, consultant physician and Dr Soon Song, consultant physician In Type 1 diabetes, blood sugar is controlled by insulin. The pancreas lies at the back of the abdomen and has two main functions: to produce a juice that flows into the digestive system to help us digest food to produce the hormone called insulin. Insulin is the key hormone that controls the flow of glucose (sugar) in and out of the cells of the body. Type 1 diabetes is caused by a lack of insulin output because of damage to the pancreas gland.

Type 1 Diabetes

Reviewed by Professor Ian Campbell, consultant physician and Dr Soon Song, consultant physician
 

 
© PhotoDisc
In Type 1 diabetes, blood sugar is controlled by insulin.
The pancreas lies at the back of the abdomen and has two main functions:

 
  • to produce a juice that flows into the digestive system to help us digest food

     
  • to produce the hormone called insulin.

     
Insulin is the key hormone that controls the flow of glucose (sugar) in and out of the cells of the body.

Type 1 diabetes is caused by a lack of insulin output because of damage to the pancreas gland.

 
Term watch
 
Type 1 diabetes used to be called 'insulin dependent diabetes’.
This is because this type of diabetes always requires insulin treatment.
As some people with Type 2 diabetes now also require insulin, the term Type 1 is preferred.
Damage to the pancreas can occur for a many reasons, eg a viral infection. But the most common cause in Type 1 diabetes is the body’s own immune system.

Insulin-producing cells in the pancreas of people with Type 1 diabetes are destroyed by cells that normally defend us from invading organisms.

This is called an ‘auto-immune’ process, referring to the fact the body appears to turn against itself.

 
    Auto-immune diseases

    There are other auto-immune diseases, for example of the thyroid gland.

    They are more frequent in people who have Type 1 diabetes.

    This may reflect an inherited tendency to developing auto-immune disease that is triggered by some other factor in the environment.

    Exactly what that trigger can be is still unclear, but there is some evidence to suggest that a virus infection could start the process off.

     
What are the symptoms of Type 1 diabetes?

Glucose is one of the key fuels used by the cells of the body for its energy needs.

The brain and nervous system use only glucose, while most other cells can also utilise fat for energy.

As a result of the lack of insulin output in Type 1 diabetes, the blood sugar level climbs and glucose starts to appear in urine.

Because glucose use becomes very inefficient, a person with untreated Type 1 diabetes develops symptoms such as:

 
Good advice
 
If you experience any of these symptoms on a regular basis, you should see your GP and be tested for diabetes.
  • increased thirst

     
  • tiredness

     
  • frequent urination

     
  • weight loss (although appetite often increases)

     
  • itchiness, especially around the genitals, caused by overgrowth of yeast on the skin (thrush)

     
  • other infections on the skin (yeast infections and boils).

     
A family history of diabetes makes it more likely that you will get diabetes too. Type 1 diabetes is much less common than Type 2 diabetes.

How is Type 1 diabetes treated?

Diabetes is treated by:

 
  • regular injections of insulin. These are given daily or several times a day, depending on the type of insulin used. Insulin is now also available as an inhaler, but it's likely that most people for who this is suitable will still need insulin injections as well.

     
  • staying physically active and getting plenty of exercise

     
  • maintaining a steady weight

     
  • eating a proper diet containing a controlled amount of carbohydrates.

     
The goal of insulin treatment is to control the amount of insulin in the bloodstream so glucose levels are normal, or near normal.

Treatment for diabetes depends on the individual. It starts the first time you give yourself an insulin injection, and continues through starting an exercise programme and eating the right types and amounts of food.

Your healthcare team dietician, GP and diabetes nurse are all on hand to give advice and guidance.

Ways to help yourself

 
  • Keep an eye on any signs indicating either high or low glucose levels.

     
  • Learn how to measure glucose levels and do it regularly. The most important piece of equipment is the home blood glucose meter, which enables you to measure your blood sugar levels and control your insulin dose.

     
  • Try to follow your diet as carefully as possible.

     
  • Learn how to give yourself insulin injections.

     
  • Always carry glucose for the treatment of hypoglycaemia (low blood glucose). Occasionally, a glucagon injection (GlucaGen) may be necessary for severe hypoglycaemia.

     
  • See your doctor on a regular basis to evaluate your blood glucose levels, carry out check-ups on your eyes, kidneys and feet, and check for any late stage diabetic symptoms.

     
  • See your doctor early on if you become ill because it may cause your diabetes to become unstable.

     
  • Note down glucose levels in a 'diabetes diary', which you can then discuss with your doctor.

     
Physical activity

Physical activity will help reduce the associated risks of diabetes such as heart disease and cholesterol, as well as improve your general wellbeing.

But you may need to adjust your insulin dose according to the amount of exercise you do. Too much insulin and exercise may lower your blood sugar level and lead to hypoglycaemia.

A healthy diet

Eat a healthy, well-balanced diet that is low in fat and high in fibre and carbohydrates (eg pasta, rice, potatoes).

Try to eat the same amount of carbohydrates each day. You should also try to eat three main meals and two to three snacks daily.

You can get specific dietary advice from the dietician attached to your diabetes clinic.

What can I do to avoid Type 1 diabetes?

At present, you cannot prevent this type of diabetes.

But there are many scientific studies underway to investigate the cause, treatment and prevention of the disease.

 Possible complications

  In the long term

There is no cure for this type of diabetes.

But with proper treatment, there is a significant reduction in the risk of developing late-stage diabetic complications. This means keeping your blood sugar level as close to normal as possible.

People with diabetes who also have high blood pressure suffer fewer complications if their blood pressure is kept under good control.

Diabetes makes hardening of the arteries more likely, and this risk is increased if you smoke as well. To reduce your risk, you should stop smoking.

 
Based on a text by Dr Jan Erik Henriksen, Dr Ole Hother Nielsen and Professor Henning  Beck-Nielsen
 

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