Managing type 1 diabetes

DR MAXWELL ADEYEMI

Type 1 diabetes is a type of diabetes that commonly affects children, but it has been found to affect older people as well. It was formerly called juvenile diabetes or insulin-dependent diabetes. Type 1 diabetes is characterised by auto-immune destruction of the insulin-producing beta cells in the pancreas.

A similar condition, referred to as secondary diabetes, may also present like type 1 diabetes when the insulin-producing beta cells are wiped out or destroyed by other situations like diseases, injuries or surgery, rather than by the person's immune system.

CAUSES

The body uses the hormone insulin to move glucose into the cell for cellular metabolism and energy generation. Absence of insulin because of beta cell damage impairs glucose utilisation, since the glucose is unable to move into the cells it builds up in the blood and causes the cell to starve. This blood glucose accumulation in the blood, known as hyperglycemia, can lead to a cascade of events in the body physiological function.

The elevated blood sugar is toxic to body cells; in an attempt to restore equilibrium, the body starts getting rid of the excess glucose via the kidney by urination. A large amount of water goes out with the urine causing dehydration. Additionally, the glucose excretion depletes the body of calories which not only results in increased hunger but also weight loss.

As the body’s inability to utilise glucose to generate energy despite hyperglycemia continues, the body breaks down fat which produces chemicals called ketones. Also, in the absence of insulin, another hormone produced by the alpha cells of the pancreas called glucagon causes the liver to release glucose from the liver stored as glycogen. This causes more glucose to build up in the blood (since insulin is still not available to facilitate the glucose utilisation). The mix of extra glucose with acidic ketones as well as accompanying dehydration, leads to a life-threatening condition known as diabetic ketoacidosis.

SYMPTOMS OF TYPE 1 DIABETES.

The signs and symptoms can be subtle but they can develop rapidly and become severe in some patients, such symptoms may include: extreme thirst, increased hunger, dry mouth, abdominal pain, upset stomach, vomiting, frequent urination, unexplained weight loss, fatigue, blurry vision, recurrent infections of the skin, vagina or urinary tract infection, bed wetting, crankiness or mood changes.

In severe situations, shaking and confusion, heavy, laboured breathing (kussmaul respiration), rapid breathing, fruity smell to breath, loss of consciousness.

COMPLICATIONS OF TYPE 1 DIABETES.

Heart and blood vessel disease: diabetes dramatically increases the risk of various cardiovascular problems, including coronary artery disease with chest pain, heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.

Nerve damage (neuropathy): excess sugar causes injury to the tiny blood vessels that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain of the toes or fingers. This may eventually cause the loss of all sense of feeling in the affected limbs.

Kidney damage (nephropathy): nephropathy-diabetic kidney disease affects about 20-30 per cent of people with type 1 diabetes. It usually shows up about 15 to 25 years after the onset of diabetes. Diabetes can damage the kidney’s delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which requires dialysis or a kidney transplant.

Eye damage: retinopathy-eye complications affects about 80 per cent of adults who have had type 1 diabetes for more than 15 years. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially causing blindness. Diabetes also increases the risk of cataracts and glaucoma.

Foot damage: nerve damage in the feet or poor blood flow to the feet increases the risk of foot injuries, ulcers, cuts and blisters, which can lead to serious infections that may ultimately require amputation.

Skin and mouth conditions: diabetes may cause infections of the skin and mouth, including bacterial and fungal infections, gum disease and dry mouth.

Pregnancy complications: the risk of miscarriage, stillbirth and birth defects increases with diabetes.

Gastroparesis: nerve damages, if it happens around the stomach can also cause digestive problems like nausea, vomiting, constipation or diarrhea.

DIAGNOSIS AND TREATMENT.

The diagnosis of type 1 diabetes is made by random blood sugar test, fasting blood sugar test or glycated hemoglobin test.

After the diagnosis of type 1 diabetes has been made, appropriate management will be instituted which should include:

1.Life style changes involving dietary adjustments and physical activities.

2.Frequent blood sugar monitoring.

3.Education and nutritional counselling, healthy eating, carbohydrate, protein and fat counting.

4.Use of insulin: anyone diagnosed with type 1 diabetes will be on life-long insulin therapy. There are different types of insulin such as short-acting (regular) insulin, rapid acting insulin, intermediate acting (NPH) insulin and long-acting insulin.

5 Periodic blood test such as cholesterol levels, thyroid function test, liver function test and kidney function test.

Contact Dr Maxwell on 363-1807 or 757-5411.