Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.
Type 1 diabetes can occur at any age. It is most often diagnosed in children, adolescents, or young adults.
Insulin is a hormone produced in the pancreas by special cells called beta cells. The pancreas is below and behind the stomach. Insulin is needed to move blood sugar (glucose) into cells. Inside the cells, glucose is stored and later used for energy. With type 1 diabetes, beta cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead of going into the cells. This buildup of glucose in the blood is called hyperglycemia. The body is unable to use the glucose for energy. This leads to the symptoms of type 1 diabetes.
The exact cause of type 1 diabetes is unknown. Most likely it is an autoimmune disorder . This is a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1 diabetes, an infection or another trigger causes the body to mistakenly attack the cells in the pancreas that make insulin. The tendency to develop autoimmune diseases, including type 1 diabetes, can be passed down through families.
Because type 1 diabetes can start quickly and the symptoms can be severe, people who have just been diagnosed may need to stay in the hospital.
If you have just been diagnosed with type 1 diabetes, you may need to have a checkup each week until you have good control over your blood sugar. Your doctor will review the results of your home blood sugar monitoring and urine testing. Your doctor will also look at your diary of meals, snacks, and insulin injections. It may take a few weeks to match the insulin doses to your meal and activity schedules.
As your diabetes becomes more stable, you will have fewer follow-up visits. Visiting your doctor is very important so you can monitor any long-term problems from diabetes.
You are the most important person in managing your diabetes. You should know the basic steps of diabetes management, including:
- How to recognize and treat low blood sugar (hypoglycemia)
- How to recognize and treat high blood sugar (hyperglycemia)
- How to plan meals, including carbohydrate (carb) counting
- How to give insulin
- How to check blood glucose and urine ketones
- How to adjust insulin and food when you exercise
- How to handle sick days
- Where to buy diabetes supplies and how to store them
Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone with type 1 diabetes must take insulin every day.
Insulin must be injected under the skin using a syringe, insulin pen, or insulin pump. It cannot be taken by mouth because the acid in the stomach destroys insulin.
Insulin types differ in how fast they start to work and how long they last. Your doctor will choose the best type of insulin for you and will tell you at what time of day to use it. Some types of insulin may be mixed together in an injection to get the best blood glucose control. Other types of insulin should never be mixed. You may need insulin shots 1 to 4 times a day.
Your doctor or diabetes nurse educator will teach you how to give insulin injections. At first, a child's injections may be given by a parent or another adult. By age 14, most children can give themselves their own injections.
People with diabetes need to know how to adjust the amount of insulin they are taking:
- When they exercise
- When they are sick
- When they will be eating more or less food and calories
- When they are traveling
HEALTHY EATING AND EXERCISE
By testing your blood sugar level, you can learn which foods and activities raise or lower your blood sugar level the most. This helps you adjust your insulin doses to specific meals or activities to prevent blood sugar from becoming too high or too low.
The American Diabetes Association and the American Dietetic Association have information for planning healthy, balanced meals. It also helps to talk to a registered dietitian or nutrition counselor.
Regular exercise helps control the amount of sugar in the blood. It also helps burn extra calories and fat to reach and maintain a healthy weight.
Talk to your doctor before starting any exercise program. People with type 1 diabetes must take special steps before, during, and after physical activity or exercise.
MANAGING YOUR BLOOD SUGAR
Checking your blood sugar level yourself and writing down the results tells you how well you are managing your diabetes. Talk to your doctor and diabetes educator about how often to check.
To check your blood sugar level, you use a device called a glucose meter. Usually, you prick your finger with a small needle called a lancet to get a tiny drop of blood. You place the blood on a test strip and put the strip into the meter. The meter gives you a reading that tells you the level of your blood sugar.
Keep a record of your blood sugar for yourself and your health care team. These numbers will help if you have problems managing your diabetes. You and your doctor should set a target goal for your blood sugar level at different times during the day. You should also plan what to do when your blood sugar is too low or high.
Talk to your doctor about your target for the A1C test. This lab test shows your average blood sugar level over the past 3 months. It shows how well you are controlling your diabetes. For most persons with type 1 diabetes, the A1C target should be 7.5% or lower.
Low blood sugar is called hypoglycemia. A blood sugar level below 70 mg/dL is too low and can harm you.
People with diabetes are more likely than those without diabetes to have foot problems . Diabetes damages the nerves. This can make you less able to feel pressure on the foot. You may not notice a foot injury until you get a severe infection.
Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores (ulcers). The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper, or infected.
To prevent problems with your feet:
Stop smoking if you smoke.
- Improve control of your blood sugar.
- Get a foot exam at least twice a year with your doctor, and learn whether you have nerve damage .
- Check and care for your feet every day. This is very important when you already have nerve or blood vessel damage or foot problems.
- Treat minor infections, such as athlete's foot, right away.
- Use moisturizing lotion on dry skin.
- Make sure you wear the right kind of shoes. Ask your doctor what kind is right for you.
Your doctor may prescribe medicines or other treatments to reduce your chances of developing common complications of diabetes , including:
With type 1 diabetes, you are also at risk of developing conditions such as hearing loss, gum disease, or yeast infections (in women). Keeping your blood sugar under good control can help prevent these conditions.
Talk with your health care team about other things you can do to lower your chances of developing diabetes.
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American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37:S14-S80. http://www.ncbi.nlm.nih.gov/pubmed/24357209.
Eisenbarth GS, Buse JB. Type 1 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 32.