Diabetes Mellitus (DM) is a complicated metabolic problem that is characterized by persistently high levels of sugar in the body. This situation is also known as hyperglycemia.
When food is eaten, the body during the process of digestion breaks down carbohydrates to glucose and sends it to the bloodstream. Insulin (a hormone) then controls the sugar levels in the blood by signaling the liver, muscle, and fat cells to take in glucose from the blood and store it up as glycogen. In a diabetic patient, there is a dysfunction of insulin, hence leading to high blood glucose levels.
There are different types of DM, type 1 DM, type 2 DM, and a temporary condition in pregnant women known as gestational DM
Causes of Type 1 Diabetes Mellitus.
Type 1 DM, also known as juvenile diabetes or insulin-dependent diabetes is an autoimmune disease. It is mostly diagnosed in kids first but can occur at any age.
The pancreas is an organ responsible for the secretion of insulin in the body. In type 1 DM, the immune system (body’s natural defense mechanism) attacks healthy pancreatic cells and destroys them. The immune system mistakes pancreatic cells as foreign and damages them. As a result, the secretion of insulin by beta cells of the pancreas is impaired. Self-destruction of pancreatic cells can happen over a few weeks, months, or years. When the beta cells of the pancreas are destroyed, your pancreas secrets little or no insulin. Thus glucose regulation in the body fails, leading to hyperglycemia which is an abnormal rise in blood glucose levels.
The causes of this destructive process (autoimmune reaction) are not fully understood but a likely explanation is that the combination of genetic susceptibility (conferred by a large number of genes) and an environmental trigger, such as a viral infection, initiate the autoimmune reaction. Toxins or some dietary factors have also been implicated.
Signs and symptoms of type 1DM include;
- Excessive thirst (polydipsia)
- Excessive urination(polyuria)
- Excessive hunger
- Excessive weight loss
- Blurred vision
- Slow healing of cuts
Diagnosis of type 1 DM
In the case of suspected type 1 DM, one of the following tests will be carried out
- The random blood sugar test which is the elementary test for Type 1DM. A capillary blood sample is collected from the patient and tested for glucose levels using a glucometer. A blood glucose level of 200mg/dl or more suggests diabetes.
- The fasted blood sugar test is done after an overnight fast. Fasting blood sugar level of 126mg/dl suggests diabetes
- The glycated hemoglobin (A1C) test depicts the average blood sugar level for 3 months past. AC1 level of 6.5% or more suggests diabetes
Other recommended tests for diabetes type 1 include blood or urine tests to check for the presence of ketones which result from the breakdown of fats to provide energy. Also, antibodies specific for type 1 DM can be checked in blood.
Treatment of type 1 DM.
At the moment, type one diabetes can only be controlled and not cured. However, some scientific studies propose that a pancreas transplant can reverse the situation.
Since the pancreas does not make insulin in type 1 DM, there is a need for insulin replacement. As such type 1 DM patients take insulin by injection with a syringe or an insulin pump. Dietary control to regulate carbohydrate intake and exercise routines also play a major role in diabetes management. The American Diabetes Association suggests people with type 1 DM to consume low glycemic index foods like citrus, berries, tomatoes, guavas, salmon, beans, whole grains, nuts, fat-free yogurt, and milk.
Complications of Type1 DM.
Insulin deficit, if left unchecked over the long term, can cause damage to many of the body’s organs, leading to disabling and life-threatening health complications such as cardiovascular diseases (CVD), nerve damage (neuropathy), kidney damage (nephropathy) and eye disease (leading to retinopathy, visual loss, and even blindness).
Heart and blood vessel disease.
Diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis), and high blood pressure. These conditions arise when high blood sugar over time causes damage to blood vessels and the nerves that control the heart. There are deposits of cholesterol (plaques) in the walls of the coronary arteries (the blood vessels that supply oxygen and blood to the heart) which make the inside of the arteries narrow and decrease blood flow. This decreased blood flow to the heart can cause a heart attack while a decreased blood flow to the brain can cause a stroke.
Nerve damage (neuropathy).
Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish nerves, especially in the legs. This can cause tingling, numbness, burning, or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar could cause one to eventually lose all sense of feeling in the affected limbs.
Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea, or constipation. For men, erectile dysfunction may be an issue.
Kidney damage (nephropathy).
The kidneys contain millions of tiny blood vessel clusters that filter waste from the blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which requires dialysis or a kidney transplant.
Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially causing blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections that may ultimately require toe, foot, or leg amputation.
Skin and mouth conditions.
Diabetes may cause one to be more susceptible to infections of the skin and mouth, including bacterial and fungal infections. Gum disease and dry mouth also are more likely to occur.
High blood sugar levels can be dangerous for both the mother and the baby. The risk of miscarriage, stillbirth, and birth defects increases when diabetes is not well controlled. For the mother, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure, and preeclampsia.
These complications can be avoided by;
- Keeping your blood sugar within the target range (Diet and physical activity)
- Avoiding smoking
- Getting preconception counselling
- Management of weight
- Keeping cholesterol and fat levels within the target range
- Keeping your blood pressure within the target range
• Taking care of your feet
- Making regular visits to your doctor and diabetes team (dietician, sports instructor, eye specialist, etc.)
Although type one diabetes is an autoimmune disease that does not have a cure at the moment, it is not a death sentence when properly managed. If patients follow a healthy eating plan, stay physically active, control insulin dosages, and monitor diabetes, they will keep blood glucose levels at a target range. Once diagnosed with diabetes, patients should start making necessary health adjustments until it becomes a lifestyle. Diabetics are advised to stay happy, healthy, and strong.
Justin M Gregory., Daniel Jensen Moore., Jill H Simmons (2013). Type 1 Diabetes Mellitus. Pediatrics in review / American Academy of Pediatrics. 34. 203-15. 10.1542/pir.34-5-203.
Safia Kousar. (2019). Type 1 Diabetes: Causes, Symptoms, and Treatments, Review with Personal Experience. Curr Res Diabetes Obes J. 2019; 11(3): 555817. DOI: 10.19080/CRDOJ.2019.11.555817