Type 1 Diabetes

Why is Type 1 Diabetes an emerging public health issue?

Diabetes has been and is an emerging public health issue, as it affects around 16 million Americans and contributes to around 200,000 deaths a year. Diabetes is the seventh leading cause of death in the United States and the leading cause of blindness, kidney failure, leg and foot amputations, pregnancy complications, and deaths related to flu and pneumonia. Of all of these affected Americans, 5-10% of diagnosed cases are Type 1 diabetes, but it is believed that as many as 10% of people diagnosed with Type 2 diabetes (adult-onset, non-insulin dependent diabetes) actually have Type 1 diabetes. This translates to someone getting diagnosed with Type 1 diabetes every hour of every day. The direct and indirect costs of diabetes (all types) are nearly $100 billion a year with average health care costs per individual with diabetes estimated at $10, 071 a year in 1997 ($2,699 is average for individuals without diabetes).

Type 1 diabetes is an autoimmune disease that is diagnosed mainly in children and young adults, which is why it has commonly been referred to as juvenile diabetes. This disease causes abnormally high levels of sugar to accumulate in the blood leading to the deterioration of some organs and a decreased life span of around 15 years. However, with careful management most diabetics lead healthy and active lives.

Type 1 diabetes affects both males and females equally, however, it does affect whites more than non-whites. This type of the disease is rare in most African, American Indian, and Asian populations. In contrast, the rate of Type 1 diabetes is higher in European countries such as Finland and Sweden.

What is Type 1 Diabetes?

Type 1 diabetes is an autoimmune disease. This means that the immune system, which normally uses cells to attack bad things that invade the body, such as germs from colds or infections, mistakenly starts to attack things that are supposed to be present in the body. For Type 1 diabetics this means that the immune system starts to attack special cells, called beta cells, that are located in the pancreas (an organ near the stomach). These beta cells play an important role in the pancreas and, as they are destroyed, the body is unable to make a hormone (chemical that instructs cells to do certain jobs) called insulin. Without the help of insulin, cells in the body cannot take up sufficient amounts of sugar to complete their everyday jobs. Since there is nothing around to take up the sugar consumed, it builds up in the blood, therefore, causing diabetes.

Since Type 1 diabetics have few, or no, beta cells, they need help distributing the extra sugar in their bodies. The lack of insulin can be treated by injecting insulin, obtained from a doctor, into the body using a variety of techniques. For this reason, Type 1 diabetes is often referred to as insulin-dependent diabetes. Diabetics need to use insulin to keep their sugar levels near the normal range of 70-120. Blood glucose, the sugar present in blood, levels below 70 or over 240 is a warning sign that an individual needs to more carefully manage their sugar levels. These measurements are all ranges an individual wants to have either before eating a meal or 4-5 hours after a meal. Blood glucose levels vary from individual to individual, so it is important for the doctor to determine the specific range that is appropriate for each person.

What are the symptoms of Type 1 diabetes?

In children, type 1 diabetes strikes very fast. Therefore, it is important to know the symptoms, so the disease can be managed as quickly as possible.

Common Symptoms of Type 1 Diabetes
Extreme thirst
Frequent urination
Drowsiness or lethargy
Increased appetite
Sudden and unexplainable weight loss
Sudden vision changes
Sugar in urine
Sweet, almost fruity, odor to the breath
Heavy or labored breathing
Stupor or unconsciousness
Tingling or loss of feeling in the feet
Sores that are slow to heal

It is very important that these symptoms are recognized early because if left untreated a person can lapse into a diabetic coma called diabetic ketoacidosis. If an individual suspects that he/she may have Type 1 diabetes, they should contact a doctor so that he can perform a fasting plasma (blood) glucose test. A plasma glucose level of 126mg/dL, after 8 hours of fasting, will alert the doctor that an individual may have diabetes. This initial test will be followed up by a repeat of the test or another similar glucose test. If both test results show high levels of glucose in the blood, it gives the doctor a good indication that the individual has diabetes and insulin injection methods can be discussed to help lower the amount of glucose in the bloodstream.

What causes Type 1 diabetes?

Diabetes is not contagious, like a cold or the flu. This means that it is not something that can be passed from one person to the other. Scientists have only an understanding of what might cause the disease and are currently working to better understand Type 1 diabetes. They believe that both genetics and the environment play a role. This is known as multifactorial inheritance.

Figure 1:Genetic and environmental factors contribute to Type 1 diabetes

A genetic role in the disease means that if someone in a family is affected by diabetes, other family members may have an increased chance of developing the disease. At this point scientists have discovered approximately 20 genes that can affect an individual’s risk of developing type 1 diabetes. Differences, called mutations, can occur on any one of these 20 genes. Scientists are still trying to understand which mutations make a person more likely to develop type 1 diabetes. It is known that problems in two particular genes, the HLA region and the insulin gene, play a more central role in the development of the disease. Therefore, current research efforts are focused on these two genes. For now, since there is no cure for diabetes, the Diabetes Association of America only recommends that children who have a parent or sibling with Type 1 diabetes be screened. To screen these individuals doctors look for increased amounts of antibodies to insulin or beta cells. These antibodies attach to the insulin or beta cells to tell the body to destroy them. This destruction, known as an immune response, causes the loss of insulin and/or beta cells that leads to type 1 diabetes. Knowing that the child will develop diabetes is currently not very helpful to doctors because there is no method that can be used to prevent the disease. For this reason, the test is usually only given to a family that is going to participate in a scientific study of type 1 diabetes prevention.

In terms of the environmental factors associated with developing type 1 diabetes, scientists are examining various environmental triggers. These triggers may cause the body to attack beta cells in the pancreas, which consequently causes a decrease in insulin levels.

How is Type 1 diabetes treated?

Insulin

It is important for the doctor to review the different methods of insulin intake so each person can decide on a method that works best for his/her diabetes and life style. The doctor should also explain how to calculate the right dose of insulin to deliver to the body. These calculations will help prevent blood glucose levels from getting too low (causing dizziness, fatigue, short temper and confusion) or too high. Below are listed a summary of different methods of taking insulin:

· Injection: This is one of the most common ways to take insulin and is accomplished using a needle and syringe. This method delivers insulin just under the surface of the skin so it can enter the bloodstream. There are several places on the body that are recommended for the injection of insulin, so it is able to enter the body as fast as possible (Figure 2). It is also helpful to make sure a friend or family member knows how to administer an insulin shot in the event that the individual is in need of insulin, but unable to give the shot.

Figure 2: Common places for injection of insulin into the body.

External insulin pump: A needle connected to plastic tubing is inserted just under the skin near the abdomen (mid-section of the body at the same level as the belly button). This piece of tubing is connected to an insulin pump, which is about the size of a pager or deck of cards, attached to your belt or placed in a pocket. Each patient programs the insulin pump according to his/her needs so there is a continual base line amount (small continuous amount) of insulin entering the body. This amount of insulin can be increased during meals or when blood sugar is too high.

Implantable insulin pumps: These pumps have an advantage in that they deliver the insulin directly to the pancreas, which helps decrease the amount of work and stress on the liver. Small disc shaped pumps are surgically implanted, usually on the left side of the abdomen, and deliver a base line amount of insulin throughout the day. A remote control gives the user the ability to administer the base amount or an increased quantity depending on the level of glucose in the blood.

Insulin pens: These devices look just like pens, but contain little cartridges (containers within the pen) that hold insulin. Users select the desired dose of insulin by turning a dial on the pen. After setting the correct dose, a plunger is pressed that causes a small needle to enter the skin and deliver insulin to the user (See Figure 2 for injection sites).

Insulin Injectors: This method is a good option for patients that like the injection method but do not want to use needles. A high-pressure air mechanism delivers the insulin through the skin (see Figure 2 for injection sites).

Inhaled insulin delivery system: This is an aerosol delivery system that delivers rapid acting insulin directly into the lungs, from where it will flow into the bloodstream. The insulin powder, which is inhaled into the mouth, shoots out of a device that is about the size of a pocket flashlight.

The insulin patch: This device is a patch that is worn on the skin to deliver the base line of insulin needed throughout the day. To increase the amount of insulin in the body before meals a tab is pulled off of the patch. This method is not as widely recommended because it is hard for the insulin to make it through the skin and into the bloodstream effectively.

In addition to this wide variety of methods for insulin intake there are even more methods currently being developed through various diabetes research organizations and centers.

For more information on various devices for taking insulin contact the National Diabetes Information Clearinghouse .

Diet and Exercise

In addition to taking insulin, there are a variety of ways one can manage his/her diabetes to you minimize health concerns throughout life. Working with a person that can help plan meals is very helpful. This type of person is called a dietician and a doctor should be able to make a recommendation. Even without a dietician one can manage his/her diet by making sure not to eat foods high in fat, salt or sugar. Instead, choose foods like fruits and vegetables, beans and grains (cereal, rice noodles or bread), milk and milk products (cheese or yogurt) and meat, chicken or another poultry food (this means fish, cheese and eggs).

Exercise is another important way to stay healthy and keep diabetes under control. Exercising helps insulin work even better to decrease levels of sugar in the blood, however, exercise should only be done after a meal. It is important to wear a medical alert badge, bracelet or necklace at all times; this is especially important while exercising. In the event of injury, this badge will alert medical professionals that the individual is diabetic, so they can take care of any special medical needs that may be required.

According to a 10 year study by the University of Pittsburgh Graduate School of Public Health (Arizona Daily Star: May 5, 2001), keeping blood pressure levels under 120/80 and cholesterol under 100 milligrams per deciliter (HDL cholesterol higher than 45md/dL) can avoid or delay complications of type 1 diabetes on the body. It is important to keep this in mind and ask a doctor if medication is necessary to reach these levels, or if they can be achieved through diet and exercise.

Is there a cure for Type 1 diabetes?

There is no known cure for diabetes however several approaches to a cure for are being examined. They include:

· Pancreas transplantation

· Islet cell transplantation (these are the cells that produce insulin)

· Artificial pancreas development

· Genetic manipulation: this involves insertion of the human insulin gene into areas, like fat or muscle, that do not normally produce insulin in order to get them to work as artificial insulin producers. This will decrease or eliminate the need for insulin injection.

In addition to these approaches, researchers at the Joslin Diabetes Center have shown that small daily injections of insulin, into patients who are at risk for developing type 1 diabetes, will delay the onset of the disease for up to eight years. Centers like the Joslin Diabetes Center are working on these and other treatments, so it is important to ask a doctor about any current research methods that might be useful.

Additional information on Type 1 diabetes:

The American Diabetes Association (ADA) National Service Center

The National Diabetes Information Clearinghouse

The Centers for Disease Control's Diabetes Program

Juvenile Diabetes Research Foundation International

The March of Dimes Foundation