Episode #31 of the Charged podcast
Type 1 Diabetes
In type 1 diabetes, the body can’t make insulin. Insulin is needed to help sugar (glucose) enter cells for energy. Read on to learn more about this condition that often develops in children or young adults.
We provide comprehensive care to children and adolescents with both type 1 (juvenile-onset; insulin-dependent) and type 2 (adult-onset; non-insulin-dependent) diabetes mellitus.
The Division of Pediatric Endocrinology and Diabetes Center at MassGeneral Hospital for Children is an international referral center for the management of pediatric diabetes and endocrine disorders in children and adolescents.
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Massachusetts General Hospital’s Preventive Genomics Clinic empowers patients to better understand, predict and prevent disease using genetic information.
Type 1 Diabetes
What is type 1 diabetes?
In type 1 diabetes, the body can’t make insulin. Insulin is needed to help sugar (glucose) enter cells for energy. Without insulin, glucose builds up in the blood. This causes high blood glucose or high blood sugar. In the past, type 1 diabetes was also called:
Insulin-dependent diabetes mellitus (IDDM)
Type 1 diabetes accounts for between 5 out of 100 to 10 out of 100 diagnosed cases of diabetes in the U.S. Type 1 diabetes most often develops in children or young adults. But it can start at any age.
What causes type 1 diabetes?
Experts don't know what causes type 1 diabetes. Genetic and environmental factors may play a role.
The body's immune system attacks and destroys the cells in the pancreas that make insulin. Insulin lets glucose enter the cells for energy. When glucose can’t enter the cells, it builds up in the blood. Then the cells don't get enough nutrition. It also causes high blood sugar. People with type 1 diabetes must take daily insulin shots and regularly check their blood sugar levels.
What are the symptoms of type 1 diabetes?
Type 1 diabetes often appears suddenly. Symptoms may include:
Frequent and increased urination
Extreme hunger but loss of weight
Nausea and vomiting
Extreme weakness and lack of energy (fatigue)
Irritability and mood changes
Fungal (yeast) skin infections in the groin area
In children, symptoms may seem like the flu.
These symptoms may be caused by other conditions or health problems. Always see your healthcare provider for a diagnosis.
How is type 1 diabetes diagnosed?
There are several ways to diagnose diabetes. It's best for the tests to be repeated on a second day to make sure of the diagnosis.
Fasting plasma glucose (FPG). This test checks your blood glucose levels after fasting overnight. You may have water before this test is done, but nothing else. Diabetes is diagnosed at a fasting blood glucose of 126 mg/dL or higher.
Oral glucose tolerance test (OGTT). This is a 2-hour test that checks your blood glucose levels before and 2 hours after you drink a sugary drink. This test tells your healthcare provider how your body processes glucose. Diabetes is diagnosed at a 2-hour blood glucose of 200 mg/dL or higher.
A1C. The hemoglobin A1C test measures your average blood glucose for the past 2 to 3 months. Diabetes is diagnosed at an A1C of 6.5% or higher.
Random glucose test. This blood test is done at any time of the day. Diabetes is diagnosed at blood glucose of 200 mg/dL or higher with the symptoms of hyperglycemia or hyperglycemic crisis.
Insulin and c-peptide levels. Levels of these will be low or normal with type 1 diabetes, but high with type 2 diabetes.
Antibody levels. People with newly diagnosed type 1 diabetes will often have high levels of antibodies against certain proteins found in the pancreas.
How is type 1 diabetes treated?
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
If you have type 1 diabetes, you will need daily shots of insulin to keep your blood sugar level in normal ranges. Other parts of treatment may include:
Eating a diet to help manage blood sugar levels
Exercising to help the body use blood sugar efficiently
Monitoring blood sugar levels several times a day, as directed by your healthcare provider, and learning how to adjust your meals and insulin dose as needed.
Having regular hemoglobin A1C testing. This is advised at least 2 times a year. You may need to do this more often if your blood sugar level stays too high.
Research is being done to find better ways to manage diabetes. This includes looking for other ways to take insulin such as through pens, inhalers, pills, or pumps. Researchers have also found some genetic markers for type 1 diabetes. Pancreas and islet cell transplants are considered experimental treatments.
What are possible complications of type 1 diabetes?
Type 1 diabetes may cause:
Hypoglycemia. This is low blood sugar, sometimes called an insulin reaction. It occurs when blood sugar drops below 70 mg/dL. This can happen if the last insulin dose was too high.
Hyperglycemia. This is high blood sugar that occurs when the body has too little insulin. It can be a sign that diabetes is not well controlled.
Ketoacidosis. When your body doesn't have enough insulin to use glucose for energy, the liver creates ketones out of fat. These ketones are then sent out in the bloodstream to muscles and other tissues to be used for energy. This can be part of the normal body function. But with diabetes, ketones can build up to high levels, and become a life-threatening condition, leading to coma or death.
Long-term complications of uncontrolled type 1 diabetes include:
Key points about type 1 diabetes
In type 1 diabetes, the body can’t make insulin.
It is an immune system disorder. The body's immune system destroys, or tries to destroy, the cells in the pancreas that make insulin.
It most often develops in children or young adults. But it can start at any age.
It often appears suddenly. Symptoms include abnormal thirst, frequent urination, blurred vision, nausea, and vomiting.
For type 1 diabetes, you need daily insulin injections. You also need to regularly check your blood sugar levels.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.
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