Type 1 Diabetes
(Insulin Dependent Diabetes Mellitus; Juvenile-Onset Diabetes; Ketosis-Prone Diabetes; "Brittle" Diabetes; Diabetes Mellitus Type 1; Diabetes, Type 1)
by Debra Wood, RN
Diabetes is a higher level of glucose in the blood than is normal. Glucose travels through your body in the blood. A hormone called insulin then helps glucose move from your blood to your cells. Once glucose is in your cells it can be used for energy. A problem making or using insulin means glucose can not move into your cells. Instead the glucose will build up in your blood.
In type 1 diabetes, the body does not make insulin. This will lead to the build up of glucose in the blood, also called hyperglycemia. At the same time, your cells are not getting glucose they need to function well. Over a long period of time high blood glucose levels can also damage vital organs. The blood vessels, heart, kidneys, eyes, and nerves are most commonly affected organs.
Type 1 diabetes is often found during childhood and young adulthood.
Our immune system keeps us well by fighting off and destroying viruses and bacteria. Unfortunately, sometimes the immune system attacks healthy tissue. Most type 1 diabetes develop because the immune system attacks and destroys the cells that make insulin. These cells are in the pancreas.
It is not yet clear why the immune system attacks these cells. It is believed that some people have genes that make them prone to getting diabetes. For these people, certain triggers in the environment may make the immune system attack the pancreas. The triggers are not known but may be certain viruses, foods, or chemicals.
Type 1 diabetes may also develop as a complication of other medical conditions. It may develop in:
Risk Factors TOP
Type 1 diabetes is more common in males. It can start at age 4 years and peak between the ages of 11-13 years. Other factors that may increase your chance of type 1 diabetes include:
Type 1 diabetes may cause:
Without insulin your body will need to find new forms of energy. This will cause an imbalance in the body called ketoacidosis. It is a severe state that can lead to coma or death. Ketoacidosis may cause:
The doctor will ask about your symptoms and medical history. A physical exam will be done.
Type 1 diabetes is diagnosed based on the results of blood tests and other criteria. These include:
*mg/dL = milligrams per deciliter of blood, mmol/L = millimole per liter of blood
You may also need other blood tests to confirm diabetes is type 1 and not type 2. These may include:
Diabetes treatment goal is to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.
While diabetes makes blood glucose levels too high, treatment can make blood glucose levels go too low. This is called hypoglycemia. It can cause confusion, shakiness, anxiety, heart palpitations and more. If the levels fall too low it can cause seizures and loss of consciousness. You and your doctor will plan and adjust your medication and diet to keep the risk of hypoglycemia low.
Insulin injections replace the insulin you are missing. The amount given is based on your individual need and a blood glucose test you take before and after meals and at bedtime. You will need to have insulin shots 2 or more times daily. There is one short-acting inhaled insulin which may be available for select persons.
You may also have an insulin pump that automatically gives you small amounts of insulin through the day.
Amylin is made in the pancreas along with insulin. In people with type 1 diabetes, this hormone, like insulin, is missing. The missing amylin may be responsible for the blood glucose rise after a meal in people with diabetes. The drug pramlintide may be used when insulin therapy is not enough to control blood sugar.
Glucagon can be injected to quickly increase blood glucose level. People with type 1 diabetes should always have an emergency supply available in case of hypoglycemia.
If you are diagnosed with type 1 diabetes consider getting a medical alert ID. It will let others know you have diabetes in case you are unable to communicate.
If you have type 1 diabetes, you should meet often with a registered dietitian. Generally speaking, it is best to:
Exercise is encouraged as long as blood glucose levels are under control. Follow your doctor's advice on activity levels and changes you may need to make.
You may need to adjust your insulin dose or diet if you are having low glucose levels after exercise.
Blood Sugar Testing TOP
Regular blood glucose checks throughout the day will help you manage your diabetes. Testing is often done with a blood glucose monitor. You can also ask your doctor about continuous monitoring systems that you wear all day.
Keep a record of the results to show your doctor. Your treatment plan may change based on your test results. The HbA1c blood test is also used by your doctor to assess your overall glucose control.
Pancreatic Islet Cell Transplant TOP
This is a procedure that is still being investigated. It involves transplanting islet cells from a donor to a person with type 1 diabetes. After the transplant, these new cells are able to produce insulin. In some cases, people who receive these transplants may no longer need insulin injections.
Closed-Loop Artificial Pancreas TOP
This device is still being studied and developed. It is a continuous glucose monitoring system (CGMS). This system can automatically checks glucose levels through the day. Insulin is then delivered as needed through the day and night. The monitoring system will allow you to keep your blood sugar levels within the normal range without daily testing or injections.
Pancreatic Transplant TOP
A pancreatic transplant may be recommended if you have:
Depression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your depression and diabetes.
There are no current guidelines to prevent type 1 diabetes.
Some research is looking at the effectiveness of suppressing the immune system. This may be helpful in people who are at high risk of developing type 1 diabetes.
American Diabetes Association
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Diabetes Association
Public Health Agency of Canada
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Last reviewed September 2016 by Kim Carmichael, MD, FACP
Last Updated: 9/3/2015
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