- Type 1 diabetes mellitus is one of the most common diseasesaffecting the endocrine system in children
- An estimated 97,700 children with Type 1 Diabetes mellituslive in India
- Type 1 diabetes mellitusaccounts for 5% to 10% of all diagnosed diabetes
- About 40% to 60% of people with Type 1 Diabetes mellitusare younger than 20 years of age, when they are diagnosed
What is Type 1 Diabetes mellitus?
In healthy people, the glucose levels in the blood are maintained at normal levels by a complex mechanism that leads to the release of insulin from the pancreas (an organ in the stomach) whenever the blood glucose levels rise. The liver and the fat cells in the body also play an important role in this as seen in the figure below (Figure 1)
Figure 1: Normal blood glucose level maintenance in the body.
In type 1 diabetes mellitus, the pancreas do not produce any insulin. This happens because type 1 diabetes is a chronic autoimmune condition, which means that the body attacks its own pancreas with antibodies.
Antibodies are proteins that normally attack unwanted invaders in the body such as bacteria and viruses, but in some people they attack their own body cells leading to conditions such as diabetes. The reason why this happens is not known exactly, but scientists feel that there might be a mix of genetic and environmental factors involved.Without insulin high levels of glucose remain in the blood that can damage the eyes, kidneys, nerves, and heart, if not controlled in time.
Symptoms of type 1 diabetes
- Feeling very thirsty
- Producing excessive amounts of urine
- Weight loss and muscle wasting (loss of muscle bulk)
- Flu-like symptoms
Management of Type 1 Diabetes
Unlike people with type 2 diabetes mellitus, people with type 1 diabetes mellitus can never take oral drugs for control of their diabetes. The basic elements to manage type 1 diabetes are:
- Insulin therapy
- Nutrition management
- Physical activity
- Self-monitoring of blood glucose (SMBG)
- Life style modification
In type 1 diabetes, since pancreas can no longer produce insulin, patients are required to takeexternal insulin daily, either by injection or a special insulin pump to control their blood sugar.With this insulin gets absorbed into the bloodstream where it can easily access all the cells of the body that require it for using up the glucose from the blood.
Insulin requirement is not only based on the levels of glucose in the blood but also on various other factors such as age, lifestyle, food, exercise, stress, emotions and general health.
Based on the above factors your doctor will decide the dose, number and timing of insulin injections to be taken per day.
- Your diet should include foodshigh in fibre, and low in fat, salt and sugar. It is recommended to include a lot of fruits, and vegetables
- Different foods will affect you in different ways. Try to find out what to eat and when to eat that so that you get the right amount of glucose for the insulin you are taking.
- Consult a dietician specialising in diabetes, who can help you work out a dietary plan that can be fitted to your specific needs.
- The American Diabetes Association recommends that all children with diabetes should engage in at least 60 minutes of physical activity every day.
- Adults are recommended to engage in at least 150 min/week of physical activity that would increase their heart rates by 50%–70%. These 150 minutes can be spreadover at least 3 days/week.
- There should not be more than 2 continuous days without exercise.
- Aerobic activity, strength building and flexibility training on most days of the week will help you better control your blood glucose and improve your heart health.
- You also need to be aware of the possible side effects of physical activity while on insulin.
- Exercise may affect your blood glucose level, either increasing or decreasing it in different people. You may have to adjust your insulin treatment accordingly
Self-monitoring of blood glucose (SMBG):
SMBG isextremely effective for the constant monitoring and management of diabetes.
- Use blood glucose monitors to check the level of glucose on a regular basis
- People with diabetes can use these results and correct any deviations if required by changing their diet, exercise, or insulin dose.
- Most experts say patients with type 1 diabetes should monitor blood glucose at least four
times a day, most commonly fasting (morning before breakfast), before meals(lunch & dinner), and before bed. (7)
Life style modification
Diabetes may increase risk of developing a cardiovasculardisease, such as a heart attack or stroke and by smoking, you are further increasingthis risk. Thus, it is important to quit if you do smoke.
- Drinking alcohol
Alcohol can cause either high or low blood glucose levels and also affect your ability to carry out your insulin treatment. Thus, it is important to avoid excessive alcohol consumption.
Self- care tipsLook after your feet
Diabetes patients are more prone to foot infections including foot ulcers.To prevent this:
- Keep your nails short and wash your feet with warm water every day.
- Wear shoes that fit properly.
- Check your feet often for any cuts, blisters or grazes because you may not be able to feel them if there is damage to the nerves in your feet.
- Visit your doctor if any minor injury to your foot does not heal within a few days.
Have regular eye tests
- Go for regular eye check-up at least once a year to check for retinopathy(an eye condition where the small blood vessels in your eyes become damaged due tohigh blood glucose levels for a long period of time)
Other preventive care
- Get your blood pressure checked regularly
- Have regular dental check ups
- Get your urine checked for microalbumin. This urine test helps detect very small levels of a blood protein (albumin) in your urine and helps detect early signs of kidney damage as people with diabetes are at an increased risk for kidney damage due to high blood glucose levels.
- Remember to get your blood cholesterol/lipid levels checked at least once a year
- Familiarise yourself with what the above tests measure, how often you should measure them, what the normal levels are and what steps you would need to take if any of the results are abnormal.
Above all, it is important to remain motivated and actively engaged in the effective management of your diabetes. Avoid giving this disease the power to dictate your life, all your life!