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Type 1 Diabetes

Diabetes means your blood glucose, or blood sugar, is too high. With Type 1 diabetes, your pancreas does not make insulin. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, and gums and teeth.

Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Despite active research, type 1 diabetes has no cure. But advances in blood sugar monitoring and insulin delivery have simplified the daily routine of managing type 1 diabetes. With proper treatment, people who have type 1 diabetes can expect to live long, healthy lives.

Signs and Symptoms

Type 1 diabetes symptoms may seem harmless at first. Look for,

  • Increased thirst and frequent urination. As excess sugar builds up in your bloodstream, fluid is pulled from your tissues. This may leave you thirsty. As a result, you may drink and urinate more than usual.

  • Extreme hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger that may persist even after you eat. Without insulin, the sugar in your food never reaches your energy starved tissues.

  • Weight loss. Despite eating more than usual to relieve hunger, you may lose weight  sometimes rapidly. Without the energy sugar supplies, your muscle tissues and fat stores may simply shrink.

  • Fatigue. If your cells are deprived of sugar, you may become tired and irritable.

  • Blurred vision. If your blood sugar level is too high, fluid may be pulled from your tissues including the lenses of your eyes. This may affect your ability to focus clearly.

Causes

To understand type 1 diabetes, first you must understand how glucose is normally processed in the body.

Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing center. When your insulin levels are low when you haven't eaten in a while, for example your liver releases the stored glucose to keep your glucose level within a normal range.

In type 1 diabetes, your immune system which normally fights harmful bacteria or viruses attacks and destroys the insulin-producing cells in the pancreas. This leaves you with little or no insulin. Instead of being transported into your cells, sugar builds up in your bloodstream.

The exact cause of type 1 diabetes is unknown. Genetics may play a role. Exposure to certain viruses may serve as a trigger as well.

Risk Factors

Although the exact cause of type 1 diabetes is unknown, family history may play a role. Your risk of developing type 1 diabetes increases if you have a parent or sibling who has type 1 diabetes.

Screening and Diagnosis

Various blood tests can be used to screen for diabetes, including:

  • Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.

  • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level between 70 and 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes, which indicates a high risk of developing diabetes. If it's 126 mg/dL or higher on two separate tests, you'll be diagnosed with diabetes.

If you're diagnosed with diabetes, your doctor may do other tests to distinguish between type 1 and type 2 diabetes — which may require different treatment strategies. Type 1 diabetes might be suspected if you have little or no ability to produce insulin, you have antibodies to insulin-producing cells in your blood, or you have toxic acids produced by the breakdown of fat (ketones) in your urine.

If you're diagnosed with diabetes, your doctor may also recommend a glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. Generally, a target A1C result is 7 percent or less.

Prevention

Type 1 diabetes can't be prevented. Researchers are studying various options for prevention, however. For example, although oral insulin can't be used to lower blood sugar, researchers are testing whether an insulin capsule taken by mouth once a day can prevent or delay type 1 diabetes in people who have antibodies to insulin in their blood. In other studies, researchers are testing ways to slow the development of type 1 diabetes and preserve insulin production in people recently diagnosed with type 1 diabetes.

Complications

Type 1 diabetes can affect many major organs in your body, including your heart, blood vessels, nerves, eyes and kidneys. Keeping your blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Short-term Complications

Short-term complications of type 1 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

  • High blood sugar (hyperglycemia). Your blood sugar level can rise for many reasons, including eating too much, being sick or not taking enough insulin. Check your blood sugar level often, and watch for signs and symptoms of high blood sugar — frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you have hyperglycemia, you'll need to adjust your meal plan, medications or both. If your blood sugar level is persistently above 250 mg/dL, consult your doctor right away or seek emergency care. You might have diabetic hyperosmolar syndrome, a life-threatening condition in which sky-high blood sugar causes blood to become thick and syrupy.

  • Increased ketones in your urine (diabetic ketoacidosis). If your cells are starved for energy, your body may begin to break down fat. This produces toxic acids known as ketones. Watch for loss of appetite, nausea, vomiting, fever, stomach pain and a sweet, fruity smell on your breath especially if your blood sugar level has been consistently higher than 250 mg/dL. You can check your urine for excess ketones with an over-the-counter ketones test kit. If you have excess ketones in your urine, consult your doctor right away or seek emergency care.

  • Low blood sugar (hypoglycemia). If your blood sugar level drops below your target range, it's known as low blood sugar. Your blood sugar level can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Check your blood sugar regularly, and watch for early signs and symptoms of low blood sugar — sweating, shakiness, weakness, hunger, dizziness and nausea. Later signs and symptoms include slurred speech, drowsiness and confusion.

  • If you develop hypoglycemia during the night, you might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

  • If you have signs or symptoms of low blood sugar, eat or drink something that will quickly raise your blood sugar level — fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. If you lose consciousness, a family member or close contact may need to give you an emergency injection of glucagon, a hormone that stimulates the release of sugar into the blood.

Long-term Complications

Long-term complications of type 1 diabetes develop gradually. The earlier you develop diabetes and the less controlled your blood sugar the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

  • Heart and blood vessel disease. Diabetes dramatically increases your risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure. In fact, about 75 percent of people who have diabetes die of some type of heart or blood vessel disease, according to the American Heart Association.

  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, you could lose all sense of feeling in the affected limbs. Damage to the nerves that control digestion can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.

  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections. Severe damage might require toe, foot or even leg amputation.

  • Skin and mouth conditions. Diabetes may leave you more susceptible to skin problems, including bacterial infections, fungal infections and itching. Gum infections also may be a concern, especially if you have a history of poor dental hygiene.

  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your risk of osteoporosis.

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