Type 1 diabetes

Type 1 diabetes: short overview

• Reason: Autoimmune disease (antibodies destroy the insulin-producing beta cells in the pancreas); Genetic and other factors (such as infections) are thought to be involved in disease development
• Age of onset: mostly childhood or youth
• Common symptoms: severe thirst, increased urinary urgency, weight loss, dizziness, nausea, weakness, in extreme cases disturbances of consciousness up to unconsciousness
• Important investigations: Measurement of blood glucose and HbA1c, oral glucose tolerance test (oGTT), autoantibody screening test
• Treatment: insulin therapy

Type 1 diabetes: causes and risk factors

Type 1 diabetes is also called juvenile (adolescent) diabetes because it is usually already in the Childhood and adolescence, sometimes in early adulthood. The body’s own antibodies destroy the insulin-producing beta cells of the pancreas. Once these autoantibodies have destroyed about 80 percent of beta cells, type 1 diabetes becomes noticeable due to greatly increased blood glucose levels:

The destruction of the beta cells creates a lack of insulin. This hormone normally causes circulating sugar (glucose) in the blood to reach the cells of the body, where it serves as an energy source. Insulin deficiency causes the sugar in the blood to accumulate.

Why the immune system in people with diabetes mellitus type 1 attacks the beta cells of the pancreas, is not yet clear. Scientists suspect that genes and other influencing factors play a role in the development of type 1 diabetes.

Type 1 diabetes: Genetic causes

About 10 to 15 percent of diabetes type 1 patients under the age of 15 have a first-degree relative (father, sister, etc.) who also has diabetes. That speaks for a genetic predisposition. Researchers already have multiple gene changes identified as associated with the development of type 1 diabetes. As a rule, there are several gene changes that together lead to diabetes mellitus type 1.

A group of genes that are located almost exclusively on chromosome 6 seems to be particularly influential: The so-called human leukocyte antigen system (HLA system) has a significant influence on the control of the immune system. Certain HLA constellations such as HLA-DR3 and HLA-DR4 are associated with an increased risk of diabetes 1.

Generally, however, diabetes type 1 is apparent less inheritable as a type 2. Thus, in identical twins, almost always both develop diabetes type 2 diabetes. In type 1 diabetes, this is observed only in about every third identical twins.

Type 1 diabetes: other influencing factors

The emergence of type 1 diabetes could also be different external factors to be influenced. In this context, researchers discuss:

• too short a lactation after birth
• too early a dose of cow’s milk to children
• too early use of gluten-containing foods
• Toxins like Nitrosamine

You might as well infectious diseases contribute to, or at least promote, the dysregulation of the immune system in type 1 diabetes. Mumps, measles, rubella and Coxsackie virus infections are suspected.

It is also striking that diabetes mellitus type 1 often along with other autoimmune diseases occurs. These include, for example, Hashimoto’s thyroiditis, gluten intolerance (celiac disease), Addison’s disease and autoimmune gastritis (type A gastritis).

Finally, there are also hints that damaged nerve cells could be involved in the onset of type 1 diabetes in the pancreas.

Between type 1 and type 2: LADA diabetes

LADA (latent autoimmune diabetes in adults) is a rare form of diabetes that is sometimes considered to be late-onset type 1 diabetes. However, there are also overlaps with type 2 diabetes:

As with “classic” type 1 diabetes, LADA can also detect diabetes-specific autoantibodies in the blood – but only one type (GADA), while type 1 diabetics have at least two different types of diabetes antibodies.

Another common feature of type 1 diabetes is that LADA patients tend to be rather lean.

While type 1 diabetes almost always occurs in childhood and adolescence, LADA patients are usually older than 35 years at diagnosis. This is similar to the type 2 diabetes (the age of onset is usually after the 40th year of life).

The slow disease development of LADA is also more comparable to type 2 diabetes. In many LADA patients, a change in diet and treatment with hypoglycemic tablets (oral antidiabetic agents) will initially be sufficient to lower the elevated blood glucose levels. This is how the therapy looks in many type 2 diabetics. As the disease progresses, LADA patients usually need insulin injections – in type 1 diabetes, these are vital to life right from the start.

Because of the variety of overlaps, LADA patients are often diagnosed as Type 1 or Type 2 diabetics. Sometimes the LADA is also considered simply as a hybrid of both major types of diabetes. In the meantime, however, it is more likely that both diseases are present at the same time as LADA and develop in parallel.

Type 1 diabetes: symptoms

People with type 1 diabetes are usually slim (as opposed to type 2 diabetics). They typically show severe thirst (polydipsia) and increased urine output (polyuria). The trigger for these two symptoms is the high blood sugar level.

Many sufferers also suffer from weight loss, fatigue and lack of drive. In addition, dizziness and nausea may occur.

When blood sugar levels are greatly increased, Type 1 diabetes patients develop disorders of consciousness. Sometimes they even fall into a coma.

To read more about the signs and symptoms of type 1 diabetes, read Diabetes Mellitus Symptoms.

Type 1 diabetes: examinations and diagnosis

If you suspect diabetes mellitus type 1, the right contact person is your family doctor (pediatrician, if applicable) or a specialist in internal medicine and endocrinology / diabetology.

First, the doctor will conduct a detailed conversation with you or your child to record the medical history (anamnese). It can describe the symptoms exactly and asks for any pre- or concomitant diseases. Possible questions in this conversation are:

• Is there an unusually strong feeling of thirst?
• Does the bladder have to be emptied unusually often?
• Do you or your child often feel weak and shaky?
• Did you or your child accidentally lose weight?
• Is someone diabetic type 1 in your family?

Diabetes Test

Following the interview, a physical examination follows. In addition, the doctor asks for a urine sample and makes an appointment with you for a blood sample. This must be done soberly. This means that in the eight hours of (morning) blood collection, the patient must not eat anything and at most consume unsweetened, calorie-free drinks (such as water).

Based on the blood and urine sample, a diabetes test can be performed. An oral glucose tolerance test (oGTT) also helps diagnose diabetes.

Read all about the necessary tests for the diagnosis of diabetes mellitus in the article Diabetes Test.

Type 1 diabetes: treatment

Type 1 diabetes is based on an absolute insulin deficiency, which is why patients need to inject insulin for life. For children, human insulin and insulin analogues are recommended. They are administered with a syringe or (usually) a so-called insulin pen. The latter is an injection device that resembles a pen. Some patients also receive an insulin pump that continuously delivers insulin to the body.

For diabetes type 1 patients, it is extremely important to have a thorough understanding of the condition and insulin use. Therefore, every patient should attend special diabetes training immediately after diagnosis.

Diabetes education

In diabetes education, patients learn more about the causes, symptoms, consequences, and treatment of type 1 diabetes. They learn how to properly measure blood sugar and self-administer insulin. In addition, patients get tips for life with type 1 diabetes, for example, in terms of sports and nutrition. For example, patients learn how much insulin the body needs for which foods. Crucial here is the proportion of usable carbohydrates in a food. It influences the amount of insulin that has to be injected:

A Carbohydrate unit (KE or KHE) equals ten grams of carbohydrate, which raises blood sugar levels by 30 to 40 milligrams per deciliter (mg / dl). In general, an insulin unit (IU) can lower this blood sugar increase by 30 to 40 milligrams per deciliter. However, the insulin sensitivity of the body cells varies at different times of the day. So in the morning, people need twice as much insulin for a carbohydrate unit as at noon. The daily requirement for insulin at a standard level is 40 insulin units on average.

Instead of the carbohydrate unit was especially the earlier Bread unit (BE) used. One BE equals 12 grams of carbohydrates.

By the way: Participation in diabetes education is also recommended to caregivers in facilities attended by Type 1 diabetics. These are, for example, teachers or educators of a children’s shorts.

Conventional insulin therapy

In conventional (conventional) insulin therapy, patients inject insulin according to a defined schedule: insulin injection is administered two or three times daily at fixed times and at fixed dosages.

An advantage of this fixed scheme is that it easily applicable and especially suitable for patients with limited learning or memory ability. Another advantage is that to that no constant blood glucose measurements must take place.

On the other hand, this fixed scheme leaves the patient relatively little creative freedomFor example, if you want to change the meal plan spontaneously. So it’s a relative one rigid lifestyle required. In addition, the blood sugar can not be adjusted as uniformly with the conventional insulin therapy, as is possible with the intensified insulin therapy (s.u.). consequential damages of diabetes mellitus are therefore to be expected in this scheme rather than in the intensified insulin therapy.

Intensified insulin therapy (basic bolus principle)

As part of intensified insulin therapy, a long-acting insulin is usually injected once or twice a day. It covers the fasting need for insulin and is also basic insulin (basal) called. Immediately before a meal, the patient measures his current blood glucose value and then injects a normal insulin or a short-acting insulin (bolus). Its dose depends on the previously measured blood glucose level, the carbohydrate content of the planned meal and planned activities.

The basic bolus principle requires one good cooperation of the patient (Compliance). The blood sugar must be measured several times a day to avoid over- or under-sugar.

A big advantage of intensified insulin therapy is that the patient free in the choice of food as well as the range of movement is. The dose of bolus insulin is in fact adapted to it. If the blood sugar levels are permanently well-adjusted, the risk of secondary diseases decreases considerably.

By the way: A new development is a small glucose sensor that is inserted into the subcutaneous fatty tissue (such as the abdomen). It measures tissue sugar every one to five minutes (continuous glucose monitoring, CGM). The measurement results are transmitted by radio to a small monitor where the patient can read it. This may support Intensified Insulin Therapy (Sensor assisted insulin therapy, SuT), Various alarm options alert the patient in case of hypoglycaemia or hypoglycaemia. The blood glucose measurements are still necessary, because there is a physiological difference between tissue and blood sugar.

insulin Pump

Especially in young diabetics (type 1) is often a diabetes pump used. This is a programmable, battery-operated small insulin dosing device, which the patient constantly carries in a small bag, such as a belt. Via a thin tube (catheter), the insulin pump is connected to a fine needle inserted in the subcutaneous fatty tissue on the abdomen.

The pump delivers small amounts of insulin to the body throughout the day, as programmed. They cover the basic daily requirement (fasting requirement) of insulin. At meals, you can also inject a random amount of bolus insulin at the touch of a button. These must be calculated by the patient beforehand. He takes into account, for example, the current blood sugar value (he must measure), the planned meal and the time of day.

The pump should be adjusted and adjusted at a specialized diabetes practice or clinic. The patient must be trained intensively before use. The insulin cartridges in the pump are replaced or refilled regularly.

Especially children will be helped by the insulin pump a lot of freedom given. If necessary, you can disconnect the diabetes pump for a short time (for example, for a shower). During sports, however, the pump should be worn. Many patients report that thanks to the insulin pump their Quality of life significantly improved Has.

However, the pump must be worn constantly, even at night. If, unnoticed, the catheter clogs or kinks or the device fails, insulin delivery will be interrupted. Then a dangerous hypoglycaemia can quickly develop (diabetic ketoacidosis) develop. In addition, insulin pump therapy is more expensive than intensive insulin therapy.

By the way: The above mentioned Continuous glucose monitoring (CGM) can also be combined with an insulin pump. The glucose sensor inserted in the subcutaneous fatty tissue transmits the measured values ​​of the tissue sugar directly to the pump and possibly warns against possible hypoglycaemia or hypoglycaemia. Doctors speak of Sensor-assisted insulin pump therapy (SuP), Regular blood glucose measurements are still necessary here.

Type 1 diabetes: disease progression and prognosis

Unfortunately, type 1 diabetes is an autoimmune disease that lasts a lifetime. However, some researchers believe that diabetes type 1 could be curable at some point in the future. The hope lies in the BCG vaccine. It was previously used to prevent tuberculosis. Several years ago, it was discovered that it could kill the immune cells responsible for type 1 diabetes. However, this potential therapeutic approach needs further research. No breakthrough has been achieved so far, however, diabetes-type 1 cure does not seem to be completely excluded in the future.

Life expectancy

Diabetes-type 1 life expectancy has increased dramatically in recent decades due to advances in treatment (intensified insulin therapy). Nevertheless, type 1 diabetics have a reduced life expectancy compared to the healthy population. For example, a study from Scotland found that 20-year-olds with type 1 diabetes had a life expectancy of about 11 years (men) and 13 years (women), respectively, compared to non-diabetics.

complications

In the context of diabetes type 1, various complications may occur. These include acute life-threatening conditions (hypoglycaemia, ketoacidotic coma) and long-term consequences of diabetes. The better the blood glucose levels of a patient are, the sooner they can be avoided.

Low blood sugar (hypoglycemia)

The most common complication of type 1 diabetes is low blood sugar (hypoglycaemia) due to incorrect insulin calculation. It usually manifests itself through symptoms such as dizziness, weakness, nausea and shaking of the hands. Avoiding a meal or exercising extensively may also result in low blood sugar if therapy is not adequately adjusted.

Ketoacidotic coma

One of the most feared complications of type 1 diabetes is ketoacidotic coma. In some cases, diabetes mellitus is discovered only when this condition occurs. The ketoacidotic coma arises as follows:

Due to the absolute insulin deficiency in type 1 diabetes, the body cells do not have enough sugar (energy). In response, the body increasingly degrades fatty acids from adipose tissue and proteins from muscle tissue to extract energy from them.

During their metabolism, acidic degradation products (ketone bodies) are produced. They lower the pH of the body and cause a Acidification of the blood (Acidosis). The body can exhale a certain amount of acid in the form of carbon dioxide through the lungs. The affected diabetes type 1 patients therefore show extremely deep breathing, the so-called Kussmaul breathing, The breath often smells after vinegar or nail polish remover and is a crucial diagnostic indicator.

Due to insulin deficiency, type 1 diabetes can increase blood sugar levels to levels up to 700 mg / dL. The body responds with one increased urine output: He excretes the excess glucose with large amounts of fluid from the blood through the kidneys. As a result, it begins to dry out and the blood salts concentrate. Possible consequences are Arrhythmia.

The strong fluid loss and hyperacidity of the blood go with one Loss of consciousness associated. This makes the ketoacidotic coma an absolute one Emergency!The patients must be treated immediately intensive care.

Consequences of type 1 diabetes

The complications of diabetes type 1 (and type 2) are usually based on a permanently poorly adjusted blood sugar levels. It damages the vessels over time. Physicians refer to this vascular damage as diabetic angiopathy. It can occur in all blood vessels of the body. In the area of ​​the kidneys, the vascular damage causes one diabetic nephropathy from (diabetes-related kidney damage). If the retinal vessels are damaged, lies one diabetic retinopathy in front. Other possible consequences of diabetes-related vascular damage include, for example Coronary heart disease (CHD), stroke and peripheral arterial disease (PAD).

The high blood sugar levels in poorly adjusted Type 1 diabetes (or 2) can also damage nerves over time (Diabetic polyneuropathy) and lead to serious functional disorders.