Overview
Type 1 diabetes is one of the most common chronic diseases in childhood. It’s characterized by the body’s inability to produce insulin. Insulin is the main hormone of glucose metabolism. It takes glucose molecules to all of the body’s cells and lowers blood glucose levels. Type 1 diabetes is an autoimmune disease: the immune system destroys the body’s own cells, particularly insulin producing pancreatic cells.
Epidemiology and causes
Type 1 diabetes is also called insulin-dependent diabetes or juvenile diabetes. The latter means that usually it affects children and adolescents, but in adults it also can develop. In 2017 there were 9 million people with type 1 diabetes. Every year, there is an increase of 3%–5% in the incidence, with younger children experiencing the greatest rise.
The exact cause of type 1 DM is unknown. The main mechanism is autoimmune. Genetics and environmental factors also play a role.
There are several factors that could predispose to type 1 DM development.
Risk factors
Family history: a risk of having type 1 diabetes is higher if you have a sibling with this condition
- Age: type 1 diabetes occurs at any age, but the peak incidence is 4-7 and 10-14 years old
- Lifestyle factors: traditionally non healthy lifestyle is linked to type 2 diabetes mellitus, but recent studies show the correlation between high BMI and high blood cholesterol levels and type 1 DM development
- Early life factors: children who were delivered by cesarean section are at more risk of type 1 DM development. The risk is also increased in children that were not breastfed.
- Air pollution: pollutants increase the risk of autoimmune diseases
Signs and symptoms
Signs and symptoms of DM type 1 are
- Polyuria (frequent urination)
- Nocturnal enuresis (bed-wetting) in children who never wet the bed during the night
- Polydipsia (excessive thirst)
- Polyphagia (extreme hunger)
- Unexplained weight loss
- Unexplained mood changes
- Nonspecific malaise
- Symptoms of ketoacidosis (high ketones in blood)
Talk to your GP if you notice any of these symptoms.
Diagnosis
Diagnosis can be made preclinically (before the onset of dysglycemia or hyperglycemia) or after development of symptoms. Preclinically, it’s diagnosed by screening with type 1 DM antibodies (proteins that the body’s immune system produces against cells that produce insulin).
Diagnostic criteria by the American Diabetes Association (ADA) include the following:
- Hemoglobin A1c ≥ 6.5% (≥48 mmol/mol)
- A fasting plasma glucose level ≥126 mg/dL (7.0 mmol/L), or
- A 2-hour plasma glucose level ≥200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test (OGTT), or
- A random plasma glucose ≥200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
Treatment
The goal of treatment is to keep blood glucose as close to the normal range as possible. Generally, the fasting glucose goal is 80 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.
All patients with type 1 DM need lifelong daily insulin therapy. Later can be with either multiple daily dosing (MDD) of subcutaneous injections or continuous insulin infusion/insulin pump.
There are 3 main types of insulin classified by their action time:
| Insulin type | Onset | Duration |
| Short-acting | 15-30 minutes | 3-8 hours |
| Intermediate-acting | 1-2 hours | more than 14 hours |
| Long-acting | 3-4 hours | 12-24 hours |
- MDD therapy consists of basal insulin (long-acting) + premeal insulin (short-acting) + insulin that is given to correct hyperglycemia as needed (short-acting)
- An insulin pump is a small device that delivers rapid-acting insulin underneath your skin. It mimics the natural work of our pancreas. The ADA recommends offering this device to all children with Type 1 DM who want and can use these pumps.
Diet and physical activity
There is no strict diet for patients with diabetes. But if you have diabetes, you should avoid processed food and refined carbohydrates, like bread and sweets. Add more low-fat, high-fiber food, like fruits, vegetables and whole grains.You’ll need to learn how to count carbohydrates for choosing the right dose of insulin. Registered dietitians could help you to create a meal plan that fits you the best.
Physical activity lowers blood glucose. It’s recommended to have moderate aerobic activity at least 150 minutes a week. If you start a new physical activity, you should check your blood glucose more frequently to know how it affects your blood glucose level.
