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This might be a good place to start if you are new to diabetes; someone you know has just been diagnosed; you are thinking about supporting someone who has type 1 diabetes…
Type 1 diabetes occurs when the immune system destroys the beta cells in the pancreas, stopping insulin production and leaving the body unable to use glucose for energy. Insulin is a hormone which allows the body to use glucose from the food we eat for energy. When there is a lack of insulin the blood glucose level rises and the person gets symptoms which may include thirst, going to the toilet a lot, weight loss and dehydration. To stay alive and maintain good health, daily management involves balancing, simultaneously, injections of insulin with carbohydrate intake and exercise.
WHY DOES IT OCCUR?
Some people carry the genes that can make it more likely that they get diabetes. Some environmental trigger causes the immune system to start attacking the pancreas and eventually the person will start having symptoms, once more than 90% of health beta cells have been destroyed. This process may take weeks, months or years. So far, there is nothing that can be done to stop this auto-immune destruction.
There are still lots of things not fully understood about why Type 1 diabetes develops. A lot of research is going on into different aspects of diabetes. The triggers are not fully understood but may be common things in our environment like viruses or foods which are harmless to most people but may cause diabetes to develop in other people. If there is a family history of type 1 diabetes then there is a slightly increased risk of developing diabetes. For many families, however, the development of type 1 diabetes is a random event.
Diabetes cannot be caught from another person and it is not caused by eating too much sugar or not getting enough exercise. There is nothing parents can do to stop type 1 diabetes developing.
TREATMENT OF DIABETES
Young adults with diabetes will have a multidisciplinary team looking after them which includes an endocrinologist or diabetes specialist doctor, diabetes nurse specialists, dietitian, psychologist and others as required.
The main aspects of diabetes care are:
- Replacement of insulin by insulin injections
- Health eating with carbohydrates at every meal
- Testing blood glucose levels and dealing with highs and lows
- Regular exercise
- Regular appointments at the diabetes clinic and with members of the team as required
THE PANCREAS, INSULIN AND DIABETES
INSULIN AND THE PANCREAS
The pancreas is a gland situated behind the stomach. It has 2 jobs – it makes enzymes to help digest food and produced insulin to move glucose into the cells for energy. Diabetes does not affect enzyme production.
In Type 1 diabetes the pancreas can’t make enough insulin to keep the blood glucose level normal. Young adults with type 1 always need treatment with insulin injections.
INSULIN, FOOD AND ENERGY
When we eat food the food goes down into our stomach so it can be digested. The carbohydrates (sugars and starches) in our food are broken down into glucose. When this process starts happening, insulin is released by the beta cells and enters the blood stream along with the glucose.
Insulin is like a key that unlocks the cell door and moves the glucose from the blood into the cells where it can be used for energy.
Glucose is the unit of energy your body needs to do its work. Most of the glucose we eat is used by the brain to keep us thinking and a little bit each time is stored in the liver as glycogen. This can be released when your blood glucose level is dropping. The remaining glucose is used for energy or stored as fat.
As you haven’t been making much insulin lately you have had a lot of glucose in your blood so none of the glucose has been used for energy. You may have been feeling more tired than usual and lacking energy, and that’s because your glucose (fuel for energy) has been unable to get into the cells.
Ketones are another source of energy that the body can use if it can’t get glucose. In people with diabetes ketones mean that there is a lack of insulin and glucose in the blood that cannot be used for energy. Ketones can make you feel sick and give you stomach ache. If your body has been using alternative sources of energy (energy stored in muscles, fat and the liver) you may have lost some weight.
One of the ways the body gets rid of the extra glucose is to send it out in the urine. Glucose is not usually present in urine and when it is it draws a lot of water out with it. So you may have been in a cycle of being very thirsty and going to the toilet a lot. Once you start getting insulin this cycle will stop and you will start replacing the stores of energy and fluids that you have been using. You can be very hungry for a few weeks! This is all part of your normal recovery.
Signs and Symptoms
- Frequent passing of urine
- Increased thirst
- Weight loss
- Mood changes
SOMETIMES YOU CAN ALSO HAVE
- Skin infections or thrush
- Stomach pains
- Decreased energy and ability to concentrate
- Excessive hunger
When diabetes comes on quickly or is found late,you can become very ill. You will have high levels of glucose and ketones in your blood, severe dehydration, rapid breathing, a smell of acetone on your breath and coma may occur. This called diabetic ketoacidosis or DKA.
In most cases this is straight forward. The doctor will test your blood (and maybe your urine) for glucose and ketones. Then you are usually referred to the hospital as diabetes in young adults is usually managed by the diabetes team at the hospital.
Once insulin treatment starts and the extra glucose is cleared away, some of the pancreatic cells may recover for a short time and produce some insulin. This is known as the ‘honeymoon’ phase and occurs in most people, but not everyone. Often only small doses of insulin are needed during this time. Unfortunately the pancreas cannot recover from the auto-immune damage that has already occurred. Eventually these cells will stop producing insulin and all the body’s needs will have to be met by injections.
Acknowledgement: Children and Adolescents with Diabetes in Australia and New Zealand