Written by Shabir
What is Type 1 diabetes?
Type 1 diabetes (juvenile diabetes or insulin-dependent diabetes), is a chronic disorder in which the pancreas produces little or no insulin. Insulin is a hormone needed to convert sugar (glucose) into energy. Type 1 diabetes can develop at any age, but is usually first seen in childhood or adolescence. It is a very common illness in North America and estimates indicate that one in 500 children born in USA will develop type 1 diabetes. Overall it accounts for at least 5-10% of all cases of diabetes
Everything underneath the sun has been postulated to cause Type 1 diabetes but so far nothing conclusive is known. Today, we have no cure for the disease. However, great advances have been made in the home monitoring and treatment of diabetes.
To understand Type 1 diabetes, one has to understand something about glucose and its role in the body. Glucose is a major source of energy and used up by all tissues of the body. For all organs to survive, glucose must enter the cells. This requires a hormone called insulin. Insulin has the ability to drive glucose into the cell and help process the glucose for energy.
Insulin is made in the pancreas and released during times when the glucose levels are high. Insulin also controls the glucose levels in the body. In Type 1 diabetes, the body fails to make insulin and thus the glucose levels remain very high. In Type 1 diabetes, one’s own immune system destroys the insulin producing cells but this is not a universal finding. In others, the cause may be genetic or may be related to a viral infection. Although the exact cause of Type 1 diabetes is unknown, the risk of the disorder is greatly increased if one has a parent or sibling with the same condition.
Type I diabetes usually presents suddenly. The condition can present with varied symptoms and a high index of suspicion must be maintained. The diagnosis is easy if one thinks about the disease. The symptoms may include:
- high sugar levels in the blood
- high levels of sugar in the urine
- extreme thirst
- frequent urination
- extreme hunger
- loss of weight
- blurred vision
- nausea and vomiting
- abdominal pain
- weakness and fatigue
- irritability and mood changes
The diagnosis of diabetes involves a few basic tests which include:
- Randomly checking blood sugar: A blood sample is taken randomly and blood sugar levels are measured. If blood levels are greater than 200 mg/dl, regardless of the time of a meal, diabetes should be suspected
- Checking fasting blood sugar. If the above test is positive, a blood sugar is measured after an overnight fast. The normal glucose after fasting is between 70-100mg/dl. If the level of glucose is > 126 mg/dl., then a diagnosis of diabetes is made.
Additional tests may include the detection of antibodies towards insulin and the presence of ketones in the urine.
To assess how well the diabetes is controlled, a glycated hemoglobin (HbA1c) test is done. If glucose is present in the body for a long time, it will bind to hemoglobln and measuring HbA1c lets the physician know well the disorder has been controlled over the past few months. In most individuals the HbA1c levels are less than 7%.
Uncontrolled diabetes can lead to devastating complications which include:
High blood sugar: When the blood sugar is uncontrolled, one can develop extreme thirst, frequent urination, nausea, blurred vision and fatigue. Fluids and insulin are needed to reverse this transient condition.
Diabetic ketoacidosis (DKA): When insulin is not taken, the diabetes can go out of control and result in a lethal condition called DKA. The body begins to break down fat and generate ketones which are toxic. The individual may present with a fruity breath, nausea, vomiting, abdominal pain, extreme lethargy, coma, seizures and even death. This is a medical emergency which needs treatment with intravenous insulin and fluid hydration.
Low blood sugar: If insulin is taken and if you do not eat, the sugar levels in the body can drop and can serious medical problems. Symptoms of low sugar may be fevers, chills, lethargy, confusion and even coma. Thus it is essential to eat whenever insulin is injected. If hypoglycemia is suspected, one should immediately drink anything containing glucose or give an injection of glucagon (hormone which increases blood glucose).
Long-term complications of Type 1 diabetes develop if the sugar has not been controlled for long periods. The complications are serious and rarely reversible. They include:
Heart disease: diabetes blocks the coronary vessels and can cause angina and heart attacks. This is a major cause of death in diabetics.
Neuropathy (nerve damage): high sugar can damage the nervous system. All nerves are prone to damage but the most frequently affected are the nerves in the legs. The individual will complain tingling, numbness, burning or pain that usually begins in the toes and migrate upwards. When the nerve damage progresses, one can lose all sensation and the majority of these individuals end up with severe bone and joint damage to the foot.
Kidney damage (nephropathy): Diabetes eventually destroys the kidney and this is the major cause of kidney failure in North America. The majority of patients end up on dialysis or receive a kidney transplant.
Eye damage: Diabetes can damage the blood vessels of the inner eye and lead to blindness. Other complications include cataracts, glaucoma and retinal detachment.
Diabetic foot: Diabetes causes narrowing of the blood vessels in the legs and this is the most common reason for infections. The combined nerve and vessel damage is the leading cause of amputations in diabetic individuals.
Oral care: Diabetes is notorious for causing infections of the gums and teeth. Poor oral hygiene worsens the prognosis. It is essential that all diabetics regularly see an oral hygienist.
There is only one treatment for Type 1 diabetes and that is daily insulin.
There is absolutely no other substitute.
Treatment for Type 1 diabetes is a lifelong commitment of monitoring blood sugar, taking insulin, maintaining a healthy weight, eating healthy foods and exercising regularly. The goal is to maintain blood glucose within normal limits. Tighter control of blood sugar levels can reduce the risk of diabetes-related heart attacks and strokes by more than 50 percent.
Blood sugar monitoring
No matter what type of insulin is used, monitoring of blood glucose is essential. Careful monitoring is the only way to make sure that your blood sugar level remains within your target range. Type 1 diabetes is a very fragile and unpredictable condition and blood glucose levels can be affected by:
- Other medical illness
- Menstrual cycle
Insulin and other medications
Insulin is life saving for Type 1 diabetics. Today, we have a variety of insulin products which have to be injected on a daily basis. Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options.
Inhaled insulin (Exubera) is now available as well and is rapidly acting. However, caution should be exercised since recent studies do indicate that it may cause low sugars in some patients.
Diabetes also profoundly affects the gut and causes slowing of the bowels. Many diabetics complain of constipation and feeling bloated. Thus, some individuals may require medications (like Reglan) to help move the bowels.
The only potential cure for type 1 diabetes is a pancreas transplant. However, of all the organ transplants, pancreas and islet cell transplants have had the least success. And even after a successful transplant, one has to take life long immunosuppressive drugs which are associated with numerous side effects which are worse than the diabetes itself.
Recently stem cell transplants have been accomplished in a few individuals and the short term results are excellent. However, the procedure does involve taking some high risk drugs to suppress the immune system to allow for acceptance of stem cells.
Unfortunately, Type 1 diabetes can not be prevented nor can it be cured. It is a serious chronic disease and the individual has to adapt to it. Diabetes is relatively easy to control but the complications of diabetes are devastating. To avoid the complications, the following changes in lifestyle will make one’s life a lot bearable and hassle free. These changes include:
Medical nutrition therapy is an integral component of diabetes management and of diabetes self-management education. Yet many misconceptions exist concerning nutrition and diabetes. Despite what everyone thinks there is no such thing as a diabetic diet.
One should reduce the intake to total fat, mainly saturated fat, which is known to worsen diabetes and make control of blood glucose difficult. Except for the omega 3 fatty acids, most fats have an adverse effect on insulin action. Some dieticians recommend that intake of unsaturated fatty acids are beneficial in the long term management of diabetes.
Recent studies also indicate that there is a decreased risk of diabetes with increased intake of whole grains and dietary fiber. Although few micronutrients may affect glucose and insulin metabolism, data to document their role in the development of diabetes are scant. Infact moderate amount of alcohol intake has recently been shown to increase insulin sensitivity and improve glucose control. However, recommending alcohol consumption as therapy may lead to worsening of the social problems related to alcoholism, not to mention its damaging effects on the liver.
The best way to control diabetes is being smart and selecting foods what will keep not only the sugar down, but will also help to control weight gain and decrease cholesterol. This can be approached by changing to a diet with fewer calories and less fat- this can be accomplished by eating more fresh fruit, vegetables sea food and legumes instead of daily steak.
One should try and eat a health diet which derives at least 20-20% daily calories from protein, 30% of less from fat and the rest from carbohydrates. One should become a label based shopper and check which foods are sugar and fat free. Some labels even mention which foods are good for the diabetic.
When it comes to alcohol, there is no rule on how much on should drink. Alcohol is known to lower sugar and so drink it with your meals. And do not go overboard. One should not treat the diabetes and sat the same time require treatment for alcoholism. Do be aware that brandy and some liqueurs have very high sugar content.
Because diabetes increases the risk of heart disease, one should make every attempt to control the cholesterol levels. Combination of cholesterol and diabetes is bad news. There are drugs to decrease cholesterol levels, but the first choice of therapy is exercise and this is highly recommended.
All diabetics should be involved with a nutritionist or a dietician. These individuals can help you with develop a well balanced diet and monitor your progress. They can also teach you about the foods you eat and how they affect your glucose levels and help you coordinate your diabetes and medications to eating. The dietician will work with you to create a health eating plan what will include all your favorite foods.
Diabetes does not mean not enjoying food. In moderation, almost all types of food can be eaten by the diabetic.
Physical activity: Like everyone, Type 1 diabetics should also exercise. The exercise will prevent weight gain and help control the blood sugar. For those diabetics who start to exercise, glucose levels should be measured more frequently to ensure that low sugar does not occur.
Learn about diabetes: Being knowledgeable can help one appreciate the disorder and adjust accordingly. One should regularly see an endocrinologist and a nutritionist.
Wear a bracelet: This important tag will ensure that all health care workers know your condition and will immediately identify any treat any serious complications that may arise.
Glucagon: Keep a glucagon kit nearby in case of a low blood sugar emergency. Make sure those around you know how to use it.
Doctor visits: It is very important to see a physician regularly because of the multitude of complications that can occur. Both the kidney and eyes should be frequently checked.
Immunizations: Keep updated on immunizations because the high sugar can weaken your immune system. The high sugar also makes one more prone to numerous infections.
Oral hygiene: The high sugar can destroy your gums and teeth from recurrent infections. Brush your teeth, and get regular dental exams.
Foot care: There is no other more devastating complication than the diabetic foot. When diabetes is not controlled, the majority of individuals will eventually end up with amputations of their toes or their legs. One should avoid all trauma to the feet and wear proper protective shoes. All injury or infection of the feet must be immediately seen by a physician.
Blood pressure: Most diabetics develop a high blood pressure because of the stiffening of their blood vessels. The blood pressure must be maintained within normal limits and routine checks up are a must.
Smoking; This social habit worsens and increases the risk of every type of diabetic complication. In simple, diabetics should not smoke. The majority who do smoke will have their feet/legs amputated or die from a heart attack.
Stress: Stress is bad for all disorders and diabetes is no exception. Stress can worsen blood sugar and make it difficult to control. Relax, sleep well and live an active life.
Herbs and Diabetes
There is only one treatment for Type 1 diabetes and that is insulin. There is no other agent, chemical, nutrient, element or mineral which is a replacement for insulin. Many individuals with Type 1 diabetes have died as a result of stopping insulin. Herbs may be taken as an additional supplement but these natural plants and minerals play more of a role in Type 2 diabetes. The herbs which are known to modulate sugars are:
Sweet Eze: This nutrient is a combination of herbs and is a self prescribed nutrient. Anecdotal reports from diabetics indicate that they were off the diabetic medications after taking Sweet Eze. However, recent data from the FDA indicate that there are other chemicals in Sweet Eze which are not listed on the product label and there are no controlled studies which have shown its benefits. Caution is advised.
Ginseng: Toronto, the home of the discovery of insulin has been a Mecca for herbs and nutrients in the treatment of diabetes. Research indicates that ginseng did lower blood glucose in Type 2 diabetes over a prolonged period.
However despite these encouraging results, the researchers caution that it is too early for diabetic patients to rely on ginseng. They note that that there was a wide response depending on where the ginseng was bought. Because of the lack of standardization, it is difficult to know for certain what one is buying and impossible to ensure consistent dosages. In addition, the active ingredients in ginseng have not been identified.
Fenugreek: There are a lot of reports on Fenugreek and its ability to lower blood sugar. Some studies have confirmed this finding but little is known how it controls diabetes.
At present, one should know that there is no substitute for insulin in the treatment of type 1 diabetes. For type 2 diabetes, some herbs may have a role but because of the lack of standardization and absolutely no quality control, the ADA has steered patients away from herbal therapies. Recently Chinese herbs were found to contain prescription diabetic medications as a fraudulent attempt to trick patients.
Given these uncertainties, some people are turning to mineral supplements instead of herbs. One that shows great promise chromium.
Chromium: For years, research has revealed that chromium may infact have some ability to control blood glucose. Some patients have benefited from chromium supplements, but it still is not the magic pill. Current recommended dosages for chromium are 200 micrograms taken three times daily.
Another element that has been postulated to lower blood sugar is magnesium. Individuals in the nutrition business always believe that if something is lower than normal in the body, then it must be the direct cause of a disease. Low magnesium levels have absolutely nothing to do with diabetes and the levels are low because of the excess urinary excretion.
The best advice for all diabetic individuals is that there is little evidence that most minerals or elements control diabetes. If one eats a well balanced diet with fruits and vegetables, no other supplements are necessary.
If one does decide to try herbs or minerals, discuss this with your doctor so he may adjust your medications. Many an individual has lost his life when relying on unfounded therapies. Diabetes is a disorder with very high mortality when not treated appropriately
Coping with Type 1 diabetes
Type 1 diabetes is devastating when it occurs in a young child. The child usually does not understand this life-long ailment and frequently fails to understand the need for frequent glucose monitoring and daily insulin injections. The majority of children with Type 1 diabetes go develop some type of mental anguish including:
- fear of death
The best thing for the parent is not to be over protective as this will just feed into the mental anguish. Encouragement, teaching and improving self esteem and independence are the corner stone to coping with the illness.
Type 1 diabetes is a difficult illness and controlling it requires a lot of Don’ts and patience. The prognosis is fine for those who keep control of the blood sugar: and for those who do not, life can be very unpleasant- one can end up losing limbs, eyes, heart, kidney and even life.
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