Type 1 Diabetes

“It is estimated that about 80,000 children develop the disease each year.

“12% of people with Type 1 Diabetes have clinical  depression.”

When People are unable to produce insulin we are usually talking about Type 1 Diabetes (T1D).

This can be a fatal state since the person’s body has destroyed his/her own insulin-producing beta cells in the pancreas. Patients with Type 1 Diabetes regularly take exogenous insulin and will likely go into a coma if it is untreated.

Type 1 Diabetes is also known as Juvenile Diabetes or Childhood Diabetes. The reason for that is the fact that most of the Type 1 Diabetes patients develop the condition during childhood or teenage years. Although it can also develop after the age of 18 and before the age of 40, it is extremely rare to get Type 1 Diabetes by the age near 40.

Unlike the Type 2 Diabetes, the Type 1 Diabetes is not preventable. Approximately 10% of all people with Diabetes Mellitus have Type 1 Diabetes and the majority of people who develop Type 1 Diabetes are of normal weight and are otherwise healthy during onset. As a matter of fact unlike Type 2 Diabetes, the onset of Type 1 Diabetes is unrelated to lifestyle.

Comparison of Type 1 and Type 2 Diabetes
Type 1 Type 2
Onset Sudden Gradual
Age at onset Mostly in children Mostly in adults
Body size Thin or normal Often obese
Ketoacidosis Common Rare
Autoantibodies Usually present Absent
Endogenous insulin Low or absent Normal, decreased

or increased

Concordance in identical twins 50 % 90 %
Prevalence ~10% ~90%

The sad thing is that the exact causes of Type 1 Diabetes are unknown. It is generally agreed that Type 1 Diabetes is the result of a complex interaction between genes and environmental factors, though no specific environmental risk factors have been shown to cause a significant number of cases.

Type 1 Diabetes can be partly inherited, with multiple genes, more than 50 genes are associated to Type 1 Diabetes, including certain HLA genotypes, known to influence the risk of Diabetes.

Despite the misbeliefs, Type 1 Diabetes can not be reversed by diet and exercise. This is quite understandable since the person has lost his/her insulin-producing beta cells, which can be considered as the complete failure of their organ, the pancreas.

Patients with Type 1 Diabetes will need to take insulin injections for the rest of their life. Also for this reason some people may refer to this type as Insulin-Dependent Diabetes.

Currently there are many ongoing researches and attempts to find ways of preventing or slowing down the progress of Type 1 Diabetes, but so far with no proven success. The only success which we can mention is that some patients have had their beta cells replaced through a pancreas transplant and have managed to produce their own insulin again.

It is interesting to mention that the World Health Organization (WHO) created a study which highlighted that Type 1 Diabetes is most common in Scandinavian populations and in Sardinia and Kuwait, and much less common in Asia and Latin America.

The first signs of having Type 1 Diabetes are the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), xerostomia (dry mouth), fatigue and weight loss.

About a quarter of people with new Type 1 Diabetics are diagnosed when they present with Diabetic Ketoacidosis. The signs and symptoms of Diabetic Ketoacidosis include xeroderma (dry skin), rapid deep breathing, drowsiness, abdominal pain and vomiting.

Although the cause of Type 1 Diabetes Mellitus is unknown, it results from the autoimmune destruction of the insulin-producing beta cells in the pancreas.

Type 2 Diabetes is characterized by insulin resistance, while Type 1 Diabetes is characterized by insulin deficiency, generally without insulin resistance. The subsequent lack of insulin leads to increased glucose in blood and urine and administration of insulin is becoming essential for survival. Insulin therapy must be continued indefinitely and typically does not impair normal daily activities.

The devastating effect of Type 1 Diabetes on the body can be perfectly clearly presented with the shocking fact that about 12% of people with Type 1 Diabetes have clinical depression.

Globally, the exact number of people with Type 1 Diabetes is unknown, it accounts approximately 10% of all Diabetes cases.

It is estimated that about 80,000 children develop the disease each year. The development of new cases vary by country and region; the lowest rates appear to be in Japan and China with approximately 1 person per 100,000 per year; the highest rates are found in Scandinavia where it is closer to 35 new cases per 100,000 per year. The United States and other countries in northern Europe fall somewhere in between with 8-17 new cases per 100,000 per year.

The cause of Type 1 Diabetes is unknown however number of explanatory theories have been put forward, and the cause may be one or more of the following:

  • genetic susceptibility,
  • a diabetogenic trigger, and/or
  • exposure to an antigen.

Talking about genetic susceptibility, the risk of a child developing Type 1 Diabetes is about 10% if the father has it, about 10% if a sibling has it, about 4% if the mother has Type 1 Diabetes and was aged 25 or younger when the child was born, and about 1% if the mother was over 25 years old when the child was born.

Some research has suggested breastfeeding decreases the risk in later life.

Environmental factors can influence expression of Type 1 Diabetes. For identical twins, when one twin has Type 1 Diabetes, the other twin only has it 30%–50% of the time. Thus for 50%-70% of identical twins where one has the disease, the other will not, despite having exactly the same genome; this suggests environmental factors, in addition to genetic factors, can influence the disease’s prevalence.

Other indications of environmental influence include the presence of a 10-fold difference in occurrence among Caucasians living in different areas of Europe, and that people tend to acquire the rate of disease of their particular destination country.

Also unforeseen circumstances or increased stress can trigger the Type 1 Diabetes in the patients. It is not unusual that the body is answering to extreme stress with a dramatic and lasting physical response such as Diabetes.

Trauma can affect our genes, even a simplest psychological stress may have a negative effect on Type 1 Diabetics.

Anxiety due to stress, causes many changes in the body because when there is physical or emotional stress the adrenal glands produce more of the hormones adrenaline and cortisol.

Adrenaline also raises blood sugar and tries to free up the energy we may need and in extreme circumstances our body can react with developing Diabetes.

Of course there are other theories as well taking away the responsibility from our environments.

One theory proposes that Type 1 Diabetes is a virus-triggered autoimmune response in which the immune system attacks virus-infected cells along with the beta cells in the pancreas. The Coxsackie virus family or Rubella is implicated, although the evidence is inconclusive.

This vulnerability is not shared by everyone, since not everyone infected by the suspected virus develops Type 1 Diabetes. This has suggested presence of a genetic vulnerability and there is indeed an observed inherited tendency to develop Type 1 Diabetes. It has been traced to particular HLA genotypes, though the connection between them and the triggering of an autoimmune reaction remains poorly understood.

Other theories suggest that pancreatic problems, including trauma, pancreatitis, or tumors (either malignant or benign) can also lead to loss of insulin production.

It is a more likely scenario especially since many drugs and chemicals can influence the reaction of the body. For example some chemicals and drugs selectively destroy pancreatic cells.

Just to ensure an example there is (was) Pyrinuron (Vacor), a rodenticide introduced drug in the United States in 1976, that selectively destroys pancreatic beta cells, resulting in Type 1 Diabetes after ingestion. Pyrinuron was withdrawn from the U.S. market in 1979 but is still used in some countries.

Or there is Streptozotocin (Zanosar), an antibiotic and antineoplastic agent used in chemotherapy for pancreatic cancer, which also kills beta cells resulting in loss of insulin production.

So let’s face the facts that part of the Type 1 Diabetics are victims of the drugs and chemicals, however this is just the minority of the Type 1 patients.

We still do not know what triggers the disease in the children who probably never tasted these drugs and chemicals. And this is scary, leaving us with a disease which is not currently preventable.

So how is life with Type 1 Diabetes?

Diet with Type 1 Diabetes is relatively not bad.

Since Type 1 Diabetes is not related to your lifestyle, almost every food is welcomed until you measure and control the carbohydrates.

Luckily you do not need to restrict yourself to boring bland foods. Even sugary foods are acceptable if you include them in your food plan.

Generally speaking foods that are low in fat, salt and have no or very little added sugar are ideal. Just as for every healthy human being a diet that controls the person’s blood sugar level as well as his/her blood pressure and cholesterol levels will help achieve the best possible health.

It is suggested to consume plenty of fruits, vegetables and whole grains – foods that are highly nutritious, low in fat, and low in calories. A low-carbohydrate diet, in addition to medications, is useful in Type 1 Diabetes.

The most important thing is that before every meal the Type 1 Diabetes patient needs to calculate the carbohydrates and adjust their insulin, so that the food and insulin can work together to control blood glucose levels.

Therefore the biggest change is that a person with Type 1 Diabetes always will have to watch what he/she eats.

Although it is not a mandatory thing a dietitian can help you create a food plan that suits you. Most dietitians agree that you should aim to consume the same quantity of food, with equal portions of carbs, proteins and fats at the same time each day.

Physical activity is highly recommended, Type 1 Diabetes patients must try to make physical activity part of their daily life routine. However there is a big difference between exercise and exercise. For this reason it is always good to consult with a doctor who can explain before starting exercising, whether that routine is really good or not.

For example climbing a mountain can increase your stress level which can influence your physical and mental balance. In general the physical activity or exercise for people with Type 1 Diabetes means aerobic exercise.

Many Type 1 Diabetes patients did not have any exercise before they were diagnosed, but still it is always good to build up gradually. Physical activity helps lower your blood sugar and make you fit and looks nice for your loved ones. Therefore its benefits are enormous for your physical and mental health.

Before any kind of physical activity it is highly important to understand that a person with Type 1 Diabetes has to manually adjust his/her insulin doses – the body will not respond automatically.

Remember to check your blood sugar level more frequently during your first few weeks of exercise so that you may adapt your meal plans and/or insulin doses accordingly.

Exercise will also help your circulation – helping to make sure your lower legs and feet are healthy, which is a very important thing for people with Diabetes.

Complications can be very serious with Type 1 Diabetes. A person with Type 1 Diabetes has four times higher risk of developing heart disease, stroke, high blood pressure, blindness, kidney failure, damage to the eyes, gum disease and nerve damage, compared to a person who does not have any type of Diabetes.

Talking about circulation in the body, a person with Type 1 Diabetes is more likely to have poor blood circulation through his/her legs and feet. If left untreated the problem may become such that a foot has to be amputated. Unfortunately it is a very likely issue with many people (not)fighting with Type 1 Diabetes.

People are usually trained to independently manage their Diabetes however for some this can be challenging, and untreated Diabetes can cause many complications.

Poorly managed Type 1 Diabetes can cause acute complications include Diabetic Ketoacidosis (too high blood sugar level) and Non-Ketotic Hyperosmolar Coma which can be fatal if untreated. Diabetic ketoacidosis can cause accumulation of liquid in the brain (cerebral edema).

This is a life-threatening issue and children are at a higher risk for cerebral edema than adults, causing Ketoacidosis to be the most common cause of death in pediatric Diabetes.

The good news is that treatment is available and it is effective and can help prevent these complications from happening.

Here are some tips for the preventions of the problems:

  • Keep your blood pressure under 130/85 mm Hg.
  • Keep your cholesterol level below 200 mg.
  • Check your feet every day for signs of infection.
  • Get your eyes checked once a year.
  • Get your dentist to check your teeth and gums twice a year.

And it might sound way too vulgar, but poorly treated Type 1 Diabetes can cause sexual dysfunction. In Diabetics sexual dysfunction is often a result of physical factors such as nerve damage and/or poor circulation, and psychological factors such as stress and/or depression caused by the demands of the disease. The most common sexual issues in Diabetic males are problems with erections and ejaculation.

While there is less material on the correlation between Diabetes and female sexual dysfunction than male sexual dysfunction, studies have shown there to be a significant prevalence of sexual problems in diabetic women. Common problems include reduced sensation in the genitals, dryness, difficulty/inability to orgasm, pain during sex, and decreased libido.

Women with Type 1 Diabetes show a higher than normal rate of polycystic ovarian syndrome (PCOS).

Researched, collected and written by Zsolt Szemerszky

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