Type 1 diabetes happens when the pancreas is producing
insufficient insulin because its cells suffer from autoimmune destruction.
The pancreas loses the ability to produce insulin due to an
immune system defect, causing our antibodies to attack the cells that construct
this hormone.
In this scenario, the body attacks the cells that produce
insulin because they no longer recognize them as belonging to the person.
Type 1 diabetes occurs in about 5 to 10% of diabetes patients.
Type 1 diabetics require daily insulin injections to keep their blood glucose
at normal values, and it is life-threatening if the insulin doses are not given
daily.
Type 1 diabetes, although it occurs at any age, is most commonly
diagnosed in children, adolescents, or young adults.
Causes
Type 1 diabetes develops because the body's immune system
destroys the beta-pancreatic cells responsible for making insulin. Because of
this, people with type 1 diabetes cannot make their insulin in adequate
amounts.
Type 1 diabetes can happen by genetic inheritance in conjunction
with environmental factors such as viral infections. Insulin is needed to carry
blood sugar to the cells, where the glucose can be stored or used as an energy
source.
In type 1 diabetes, the beta cells produce little or no insulin.
This causes glucose not to enter the cells, accumulating in the blood, and
leading to type 1 diabetes.
Symptoms of Type 1 Diabetes
- The urge to
urinate several times a day
- Frequent hunger
- Constant thirst
- Weight loss (in
some cases, it occurs even with excessive desire)
- Weakness
- Fatigue
- Nervousness
- Mood swings
- Nausea and
vomiting
Unlike type 2 diabetes, these symptoms gradually come on in type
1 diabetes; they appear quickly, persistent urination, excessive thirst, and
weight loss.
If the diagnosis of type 1 diabetes is delayed, the body's cells
may not get the glucose they need to produce all the energy they require.
In this scenario, the body begins to break down fat and muscle
to generate energy.
When fat is used to produce energy, ketone bodies are created
and enter the bloodstream, causing an imbalance called the chemical diabetic
ketoacidosis.
The symptoms of diabetic ketoacidosis are:
- Reddened, hot,
dry skin
- Loss of
appetite, abdominal pain, and vomiting
- A strong, fruity
odor on the breath, called ketone breath
- Fast, deep
breathing
- Agitation or
drowsiness, difficulty waking up, confusion, or coma
Type 1 Diabetes Diagnosis
The diagnosis of type 1 diabetes is usually made using three
tests:
Fasting Blood Glucose
Fasting blood glucose is a test that measures the level of sugar
in your blood at that moment in time and is used to monitor your diabetes
treatment.
The reference values are between 65 and 99 milligrams of glucose
per deciliter of blood (mg/dl). What abnormal results mean:
Values above 100 mg/dl indicate further investigation with the
glycemic curve; Two fasting glucose values above 126 mg/dl are diagnostic for
type 1 diabetes. Values above 200 mg/dl are also considered diagnostic for type
1 diabetes.
Glycated Hemoglobin
Glycated hemoglobin (HbA1c) is the fraction of hemoglobin
(protein inside the red blood cell) that binds to glucose.
During the average 90-day lifespan of a red blood cell, the hemoglobin
incorporates glucose as a function of glucose concentration in the blood.
If glucose levels are high during this period or increase
occasionally, then there will be an increase in glycated hemoglobin levels.
Thus, the A1c test can show an average of the hemoglobin
concentrations in our blood over the last few months.
The A1c values will indicate whether or not you have
hyperglycemia, starting an investigation for type 1 diabetes.
Normal glycated hemoglobin levels are as follows:
- For healthy people: between 4.5% and 5.7%
- Consistent for diabetes: greater than or equal to 6.5%
- For patients already diagnosed with diabetes: below 7%
- Abnormal close
to the limit: 5.7% and 6.4%, and the patient should investigate for
pre-diabetes
Glycemic Curve
The simplified OGTT measures how fast your body absorbs glucose
after you eat it. The patient ingests 75 g of glucose, and the amounts of the
substance in his or her blood are measured two hours later. In the United
States, the simplified glycemic curve test is used for diagnosis, measured at
zero and after 120 minutes.
The reference values are:
- Fasting: below 100mg/dl
- After 2 hours: 140mg/dl
A glycemic curve greater than 200 mg/dl after two hours of
ingesting 75 g of glucose is diagnostic of type 1 diabetes.
American Diabetes Association recommends the following
conditions as diagnostic criteria for diabetes mellitus:
Glycemia greater than 200 mg/dl two hours after ingesting 75 g
of glucose.
Glycated hemoglobin greater than 6.5% confirmed on another
occasion (two altered tests).
Fasting glucose greater than or equal to 126 mg/dl on at least
two samples on different days
An A1c test combined with fasting glucose greater than 200 mg/dl
in the presence of symptoms of diabetes
Symptoms of heavy urination and thirst, weight loss despite food
intake, with out-of-fasting glucose greater than 200 mg/dl
Type 1 Diabetes Treatment
The right type 1 diabetes treatment involves maintaining a
healthy lifestyle and blood glucose control to avoid possible complications of
the disease. The main precautions for treating diabetes include:
Exercise
Physical activity is essential in the treatment of diabetes to
keep blood sugar levels under control and ward off the risks of weight gain.
Exercise should be done three to five times a week.
There are restrictions in cases of hypoglycemia, especially for
patients with type 1 diabetes. Thus, people with deficient blood glucose levels
should not start physical activity, at the risk of lowering the ranks even
further.
On the other hand, if the diabetes is out of control, with very
high blood glucose levels, exercise can cause the release of counter-regulatory
hormones, further increasing blood glucose levels. In all cases, patients with
diabetes should always discuss with their doctors which are the best options.
Remembering that the idea favors light physical activities
because when calorie expenditure is higher than the replacement of nutrients
after training, hypoglycemia may occur.
Diet Control
People with diabetes should avoid simple sugars present in
sweets and simple carbohydrates, such as pasta and bread because they have a
very high glycemic index. When a food has a low glycemic index, it slows down
the absorption of glucose. But when the index is high, this absorption is fast
and accelerates the increase of glucose rates in the blood.
The carbohydrates should constitute 50 to 60% of the total
calories ingested by the person with diabetes, preferring complex carbohydrates
(nuts, walnuts, whole grains), which will be absorbed more slowly.
When exercising, it is vital to check glycemic control before
starting the activity, choose the best food - if glycemia is too low, it is
advisable to prefer carbohydrates, just as one should avoid them if it is high.
Food choice also depends on the type of exercise: long-duration
aerobic activities (such as running and swimming) tend to lower blood glucose,
and a greater intake of food is required.
Checking Your Blood Glucose
Everyone with type 1 diabetes needs to take insulin daily.
However, it is essential to do a self-examination to check your glucose at
home. To do this, you need to have a glucometer at home, a device that can
measure the exact concentration of glucose in your blood.
There are different types of devices. Usually, the person
pierces his finger with a small needle called a lancet. A small drop of blood
appears on the tip of the finger.
The blood is placed on a reagent strip that is inserted into the
device. The results appear in about 30 to 45 seconds. Your doctor or other
diabetes professional will help you set up a home testing schedule.
Your doctor will help you set goals for your glucose levels, and
you should use the test results to alter your meals, activities, or medications
to keep your glucose levels normal. This procedure can help identify high and
low blood glucose levels before they cause problems.
Types of Insulin
* Regular insulin: This
is fast insulin and is transparent in color. It starts to work between half an
hour and an hour after it is applied, and its peak effect is within 2 to 3
hours.
*
NPH insulin: it is intermediate
insulin and is milky in color. The acronym NPH stands for Neutral Protamine
Hagedorn, Hagedorn being the surname of one of its creators. Protamine, the
name of the substance, was added to insulin to delay its action time.
After being applied, its onset of the action happens between two
and four hours, its maximum effect happens between four to 10 hours, and its
duration is 10 to 18 hours.
* Insulin analogs: modified
molecules of insulin that our body naturally produces and may have ultrafast or
slow action. There are some types of ultrafast insulin analogs available in the
market: Asparte, Lispro, and Glulisine.
After being applied, their onset of action occurs in five to 15
minutes, and their maximum effect occurs between half and two hours. There are
also two long-acting types: Glargine and Detemir.
The Glargine insulin analog has an onset of action between two
to four hours after being applied, has no peak of maximum effort, and works for
20 to 24 hours.
The Detemir analog has an onset of action between one to three
hours, a peak action of six to eight hours, and a duration of 18 to 22 hours.
* Premix: consists of special preparations that combine different
types of insulin in various proportions. They can be 90:10, i.e., 90% slow or
intermediate insulin and 10% fast or ultrafast insulin. They can also have
other ratios, like 50:50 and 70:30.
Insulin Application
Insulin must be applied directly to the subcutaneous tissue
(layer of fat cells), just under the skin. The skin thickness is around 1.9 to
2.4 millimeters (mm) at the insulin application sites.
The needles used can be 4, 5, 6, or at most 8 mm. The angle of
application varies depending on the amount of fat in the application area of
the patient with diabetes.
For example, in a thin person with little fat in the application
area, there is a greater risk of hitting the muscles when using a longer needle
and an application angle of 90° to the skin surface. One can opt for a shorter
needle in these cases, make a skin fold, and apply at a 45° angle.
Remember that the skin fold for people with diabetes is used to
prevent the needle from reaching the muscles located just below the fat tissue
because the insulin can be absorbed more quickly.
There must be a rotation between the application sites because
this conduct decreases the risk of complications in the application area, such
as hypertrophy (hardened spots under the skin) or atrophy (depressions in the
skin relief caused by fat loss).
The ideal is to wait 20 to 30 days before applying again in the
same spot. The distance between two application points should be about three
centimeters (two fingers).
Insulins can be absorbed more quickly in the abdomen than in the
arms and thighs. The choice of needles can follow the following
recommendations:
For Adults:
- 4-, 5-, or 6-mm
needles can be used by both obese and non-obese adults and generally do
not require skin folding, especially for the 4 mm needles.
- In general, when
short needles (4, 5, or 6 mm) are used, applications should be made at a
90° angle. However, when the application is performed on the limbs or thin
abdomen, a skin fold can be made to ensure no intramuscular injection,
even with 4- and 5-mm needles. In this case, injections with a 6 mm needle
should only be used with a skin fold or at a 45° angle.
- There is no
medical reason to use needles longer than 8 mm.
For Children and Adolescents:
- 4-, 5- or 6-mm
needles can be used. There is no medical reason to use longer needles.
- Children and
adolescents with thin diabetes and those who inject in arms and legs may
need to make a skin fold, especially when 5- or 6-mm needles are used.
When a 6 mm needle is used, application at a 45° angle can be made in
place of the skin fold.
- For most
children, except fragile children, a 4 mm needle can be inserted at 90°
without the need for a skin fold. If only an 8 mm needle is available
(which can happen with syringe users), perform the skin fold and, in
addition, insert the needle at a 45° angle.
For Pregnant Women:
- The appearance
of purple spots is typical at the insulin application site.
- Pregnant women
can use short needles (4, 5, or 6 mm).
- When only an 8
mm needle is available, the abdomen region should be avoided and the
application performed with the skin fold and at a 45° angle.
- It is prudent to
fold the skin at all application sites.
- To avoid
complications, it is recommended to avoid applying insulin in the
abdominal region, especially around the navel, in the last trimester of
pregnancy. The gluteal region (buttocks) is recommended for thin pregnant
women. The flanks of the abdomen can also be used as long as the skin fold
is made.
The best places to apply insulin are:
- Waist region
- Abdomen (belly)
- Thigh (front and
outer side)
- Arm (back of
upper third)
- Gluteus (upper
and lateral part of the buttocks).
Step-by-step when applying insulin:
* Separate all of the material: prescribed insulin, syringe,
needle, cotton, and alcohol.
* Wash your hands thoroughly with soap and water.
* Then clean the application sites with cotton wool soaked in
alcohol. Ideally, a new syringe and needle should be used for each application.
* The NPH insulins and premixes should be gently mixed by
rolling the vial between your hands approximately 20 times, without shaking the
vial, until the liquid is milky and homogeneous. This procedure is not
necessary for clear insulins.
* Clean the rubber stopper on the top of the vials with a cotton
swab dipped in alcohol in one direction.
* Aspirate an amount of air into the syringe equal to the
prescribed amount while keeping the needle capped with its plastic cap.
* Remove the needle cap and place the vial on a flat surface.
Insert the needle through the rubber cap of the insulin vial and inject the air
inside the syringe into the vial.
* Turn the vial upside down and aspirate the prescribed amount
of insulin. If bubbles are in the syringe, inject the insulin back into the
vial and repeat the procedure.
* Remove the needle from the vial.
* Clean the chosen site bypassing the alcohol-soaked cotton over
the skin, always in one direction only.
After passing the alcohol, do not apply the insulin until the
skin is dehydrated.
* With the syringe between your fingers, as if it were a pen,
you should make a rapid movement toward the skin (like throwing a dart) at a
90º or 45º angle as instructed. Fold the skin when necessary.
The injection of insulin must be done slowly. Applying the
insulin at room temperature helps to reduce pain during application. Ideally,
take the insulin bottle out of the refrigerator 15 minutes before application.
* Remove the needle from the skin and press the site gently with
a dry cotton pad. The application area should not be massaged, as this can
increase blood flow and alter insulin absorption.
Immediately cover the needle with the cap to avoid contamination
and accidents.
* The use of the pens should be carried out by the instructions
of the manufacturer of each of them. Their use should be restricted to one
patient only. The needles must be immediately disconnected from the pen and
discarded after application, and used only once to avoid contamination and
infection. After insulin is applied, count to 10 (ten seconds) to withdraw from
the needle.
When larger doses are applied, it may be necessary to count up
to 20 seconds to prevent some of the insulin from returning to the skin surface
when the needle is withdrawn. This count is not required for syringe
applications.
Regular insulin should preferably be applied to the abdomen to
increase the absorption rate. In contrast, NPH should preferably be applied to
the thighs or buttocks to slow absorption and reduce the risk of hypoglycemia.
The appearance of purple spots is expected at the insulin
application site. These are due to the extravasation of blood when the needle
punctures blood vessels.
Restrain Alcohol Consumption
The consumption of alcohol is not forbidden, but it must be
moderate and always accompanied by food because isolated consumption can cause
hypoglycemia.
This can cause nausea, body tremors, excessive hunger,
irritability, and headaches. It is also essential to monitor your blood glucose
before and after consuming alcoholic beverages.
Beware of beers and sweet or carbohydrate-based drinks. They
have a high glycemic index and can cause problems.
Avoid Saunas and Scalding Feet
Diabetes affects microcirculation, damaging the small arteries
(arterioles) that nourish the tissues, affecting the legs and feet.
Due to this circulatory alteration, the risks of exposure to
high temperatures and thermal shocks can worsen or trigger angiopathies and
other cardiac problems.
Increase Eye Care
The corneal cells of the patient with type 1 diabetes do not
have the adherence found in most of those without diabetes.
This weakness is the gateway to a host of opportunistic
infections and diseases such as cataracts and glaucoma.
Fundus examination is required five years after diagnosis for
type 1s, on an annual frequency.
This is to help identify early changes in the retina, such as
diabetic retinopathy.
Managing Stress
People with type 1 diabetes are more likely to have anxiety and
depression. Patients may feel a sense of anxiety about controlling
hypoglycemia, applying insulin, or gaining weight.
Stop Smoking
Type 1 diabetes and smoking multiply the risk of heart attack by
up to five times. The substances in cigarettes help to create fatty deposits in
the arteries, blocking circulation.
Consequently, the blood flow gets slower and slower until the
artery gets clogged. In addition, smoking also contributes to hypertension in
the patient with diabetes.
Take Care of Your Oral Health
Oral hygiene after every meal for the type 1 diabetes patient is
crucial. This is because the blood of people with diabetes, with its high
concentration of glucose, is more prone to the development of bacteria.
As it is an entry route for food, the mouth also receives
several foreign bodies that, added to the accumulation of food debris, favor
the proliferation of bacteria—brushing well and visiting the dentist once every
six months is essential.
Medications for Type 1 Diabetes
The most commonly used medications for the treatment of type 1
diabetes are:
- Glifage
- Glyphage XR
- Metformin
Only a physician can tell you which medication is best for you,
as well as the correct dosage and duration of treatment.
Always follow your doctor's instructions to the letter and NEVER
treat yourself.
Do not stop using the medication without consulting a doctor
first, and if you take it more than once or in much more significant amounts
than prescribed, follow the instructions in the package insert.
Is Type 1 Diabetes Curable?
Type 1 diabetes is a life-long disease, and there is still no
cure. However, the condition varies from person to person.
Tight control of blood glucose levels can prevent or delay the
onset of problems in type 1 diabetes. However, complications can occur even in
people with good diabetes control.
Prevention
Type 1 diabetes cannot be prevented. Furthermore, there is no test to determine whether or not a person will have diabetes before symptoms appear.