Type 1 Diabetes - Symptoms, Diagnosis, and Management
According to the American Diabetes Association, over 2 million Americans have type 1 diabetes, including over 300,000 children and adolescents. Untreated, type 1 diabetes can lead to heart disease, kidney damage, vision loss, damage to blood vessels in the feet, and in extreme cases, death.
What is Type 1 Diabetes?
Type 1 diabetes is a lifelong condition in which the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas.
Insulin allows consumed sugar, or glucose, to pass from the bloodstream into the cells of the body, where it is used for energy. Without insulin, glucose builds up in the bloodstream. Over time, increased levels can damage blood vessels, nerves, tissue, and organs.
The cause of type 1 diabetes isn’t fully understood, but it’s due to an autoimmune attack of the body’s insulin producing cells or the beta cells of the pancreas. An autoimmune condition is when the body’s immune system attacks our own tissue. The immune system is supposed to attack foreign invaders like bacteria, viruses and fungi. When the immune system attacks our own body’s cells, that an autoimmune attack.
Type 1 diabetes is most often diagnosed in children and adolescents. However, we are seeing more type 1 diabetes diagnosed in adulthood. Insulin is a necessary hormone so unlike other types of diabetes that can sometimes be reversed with lifestyle changes, type 1 requires taking insulin every day to manage glucose levels.
Symptoms of type 1 diabetes may include:
- Fatigue
- Increased urination and thirst
- Increased hunger
- Weight loss
- Blurry vision
- Numbness or tingling
- An increased number of skin tags
- Slow-healing sores or infections
- Bedwetting in children who were previously sleeping dry
- Increased irritability in children
However, some people with type 1 diabetes may experience no symptoms or signs, which is why formal testing is necessary to confirm a diagnosis.
Very often, type 1 diabetes is first detected by a urine test that reveals high glucose levels. However, a blood test is required to confirm the diagnosis.
Blood test options include:
- A1C test to determine your average blood sugar levels over the past two to three months
- Fasting blood sugar test to measure your blood sugar levels after not eating overnight
- Non-timed blood sugar test to check glucose levels in a non-fasting state
In type 1 diabetes, your pancreas stops making insulin due to an autoimmune attack.
Some common ways to investigate this incude:
- Antibody level test to detect proteins in your immune system that attack the cells in your pancreas that make insulin
- C-peptide level test to see if your body is naturally producing insulin
Diabetes looks different in every individual, meaning care plans can vary dramatically from person to person. That said, the goal of every management plan is to provide insulin back to your body in a way that copies the normal, healthy release of insulin from the pancreas and keep blood glucose levels as close to the normal range as possible.
First and foremost, this requires self-administering insulin every day. Insulin can be injected, inhaled, or automatically delivered by a pump. Your doctor will advise you on the option most appropriate for your condition.
Other efforts include:
- Self-monitoring glucose levels using a glucose meter or continuous glucose monitor
- Eating a diet to help manage glucose levels
- Exercising to use glucose efficiently
- Getting your A1C tested as advised by your doctor
Complications
Type 1 diabetes can lead to serious—and even life-threatening—health problems. Recognizing and reporting changes to your health to your doctor is key to managing the disease and lowering your risk of diabetes-related complications.
Common complications of type 1 diabetes include:
Cardiovascular disease - People with diabetes are twice as likely to have heart disease or a stroke than people without diabetes. You can reduce your risk through good disease management, including regular exercise and eating well.
Chronic kidney disease - Diabetes is the leading cause of chronic kidney disease. Managing your diabetes and blood pressure can both work to reduce your risk.
Diabetic ketoacidosis (DKA) - When the body doesn’t have enough insulin to use glucose, it burns fat for energy, which produces and releases ketones (a breakdown product of fat) into the bloodstream. When the ketone level gets too high, it makes the blood acidic. Unchecked, it can lead to diabetic coma or even death.
Diabetes-related eye disease - Diabetes affects blood vessels in the retina, the light-sensitive layer of tissue in the back of the eye, and can lead to poor vision and blindness. Regular comprehensive eye exams, including dilation, can detect problems early and help prevent or delay vision loss.
Foot problems - Diabetes frequently damages nerves and blood vessels in the feet.
Nerve damage in the foot (diabetic neuropathy) can cause tingling, burning or stinging pain, weakness, and loss of feeling in the feet. The latter is particularly concerning as it makes it hard to notice wounds, blisters, and ulcers, making them prone to infection.
Poor circulation brought on by diabetes further complicates things as reduced blood flow makes it hard for the body to fight infections and slows wound healing. This can lead to gangrene. In severe cases that don’t improve with treatment, amputation of the toe, foot, or part of the leg may be required.
Skin complications - Skin problems are sometimes the first sign that a person has diabetes. People with diabetes often experience more itching and bacterial and fungal infections than people without diabetes. Other conditions unique to diabetes can lead to changes in the appearance and texture of the skin. These include light brown, scaly patches (diabetic dermopathy); firm, yellow, pea-like enlargements in the skin (eruptive xanthomatosis); thick, waxy skin on the backs of the hands, toes, and forehead (digital sclerosis); and more.
Most conditions can be managed by practicing good hygiene and skin care or with the help of a dermatologist.
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