Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

Type-1 diabetes is also known as insulin-dependent diabetes or juvenile diabetes. Juvenile or Type 1 Diabetes is a medical condition in which the insulin production from the pancreas is decreased to almost nothing or pancreas completely stops insulin secretions. This is a chronic condition. Insulin is a hormone, which promotes cellular transport of glucose or sugar from blood in to the individual cells. Intracellular glucose metabolism generates energy. There are many causative factors causing pancreatic cell mutations, which results in type-1 diabetes. Insulin secreting pancreatic cells are damaged by viral infection and genetic malfunction. Type-1 Diabetes usually occurs in childhood or adolescence. Type 1 Diabetes is rarely seen in adult population.

Type 1 Diabetes or Juvenile Diabetes

Type 2 Diabetes is common among adult and elderly population. Type 2 diabetes is observed when the body becomes resistant to the insulin or when the insulin production decreases.

At the present, no cure has been identified for type -1diabetes. Research data suggest medications or interventional procedure is yet not available to improve or initiate insulin secretion by pancreas. Type 1 diabetes is managed by providing external insulin as an injection to supplement insulin deficiency.

Causes of Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

The exact cause or causes of Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes) are not known.

  • Autoimmune Disease- The common reason why this condition occurs is when the body's own immune system mistakenly or unintentionally destroys the islet cells, which are the insulin-producing cells in the pancreas.
  • Genetic Disease- Genetic factor and exposure to specific viruses is thought to trigger this disease.

Risk Factors for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Family History- Having a family history of type-1 diabetes increases the risk of developing it.
  • Genetic Mutation- Genetic mutation or inherited certain mutant gene may predispose destruction or malfunction of insulin secreting cells in pancreas resulting in type-1 diabetes.
  • Cold Temperature- Type-1 diabetes commonly is seen in those people who live farther the equator such as individuals living in Sardinia and Finland have the highest number of patients having type-1 diabetes than other regions.
  • Viral Infection- Exposure to certain viruses such as mumps virus, Epstein-Barr virus, etc. can trigger the autoimmune dysfunction in the islet cells and cause type-1 diabetes.
  • Vitamin D- People who have started drinking cow's milk or other sources of vitamin D early on in their life, are at an increased risk of this disease.
  • Nitrates Pollute- Consumption of water or dairy product which contains nitrates increases a child's risk of developing Type 1 diabetes.
  • Diseases That Triggers Cellular Malfunction-Following disease causes alteration or damage of the insulin producing cells.
    • Neonatal jaundice
    • Preeclampsia in pregnancy
    • Respiratory infections immediately after birth.

Signs and Symptoms of Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Increase in thirst.
  • Frequent urination.
  • Feeling hungry all the time.
  • Weakness, tiredness.
  • Losing weight.
  • Blurry vision.

Investigations for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Glycated Hemoglobin (A1C) Test is done for finding out the average blood sugars in the last 2 to 3 months.
  • Fasting Blood Sugar (FBS) Test is done after fasting for the night and sample is taken first thing in the morning. A normal level of blood sugar is lesser than 100 mg/dL. If it is in the range of 100-125 mg/dL, then it is considered pre-diabetes. If the level of fasting blood sugar is more than 126 mg/dL on two different tests, than it means that the patient has diabetes.
  • Random Blood Sugar (RBS) Test is done at any time and a blood sugar level of 200 mg/dL or more indicates diabetes.
  • Blood tests to look for autoantibodies which are present in type-1 diabetes.
  • Blood and urine tests to check the cholesterol levels, liver, thyroid and kidney function.

Treatment for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

The aim of treatment is to maintain the blood sugar levels as much normal as possible and prevent complications. Pancreas of Type 1 diabetes patient does not respond to tablets or medication, which would increase insulin secretions. Insulin is needed for maintaining blood sugar levels.

Treatment to Lower Blood Sugar-

  • Take daily insulin as prescribed.
  • Follow a healthy diet to maintain lower intake of carbohydrate and sugar.
  • Regular exercise to burn excessive blood glucose
  • Maintain healthy weight
  • Closely monitor his/her blood sugar for his/her entire life.

Insulin Therapy for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • There are different types of insulin such as:
    • Regular Insulin (Insulin Isophane, Insulin Lispro, Insulin Aspart),
    • Rapid-Acting Insulin and
    • Long-Acting Insulin (Glargine, Detemir).
  • The type of insulin prescribed depends on the patient's needs.
  • The physician may also prescribe a combination of different insulin types to use at day and at nighttime.

Method Insulin Administration-

  • Using a fine needle and syringe
  • Insulin pen
  • Insulin pump.

Insulin cannot be administered orally as the stomach enzymes interfere with the action of insulin.

Adjuvant Medications for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

Other oral medications, which are prescribed include:

  • Antihypertensive Medications- Prophylactic treatment for hypertension and heart diseases are considered since Type 1 diabetes is associated with high blood pressure and heart diseases. Medications prescribed are as follows-
    • Angiotensin II receptor blockers (ARBs),
    • Angiotensin-converting enzyme (ACE) inhibitors to keep the kidneys healthy
  • Blood Thinning Medications- Aspirin (regular or baby) to protect the heart.
  • Cholesterol-Lowering Drugs- Prescribed to prevent heart disease.
  • Healthy Diet- Patient should consult dietitian to evaluate glucose and carbohydrate daily intake. Insulin requirement depends on carbohydrate intake and residual blood sugar level.
  • Daily Exercise- It is very important to follow a regular aerobic exercise program. It could be anything like walking, biking, swimming etc. Strength training and flexibility exercises are also important and should also be included.

How Often Should I Check My Blood Sugar?

You should check your blood sugar levels at least four times a day to ensure that the blood sugar level remains within the target range. Always wash your hands before testing your blood sugar levels.

Are There Any Surgical Treatments To Cure Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)?

Treatment for type 1 diabetes is extensively studied in lab and clinical surroundings. Following surgical procedures are tried and recommended.

Pancreas Transplant for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Insulin Requirements- Following successful transplant surgery patient would never need to take insulin.
  • Risks- Risk of failure and rejection is much higher. However, transplantation of pancreas is not always successful and this procedure has some serious risks.
  • Immunosuppressant Therapy- After this surgery, patient would require potent immune-suppressing drugs for prevention of organ rejection for the entire life; and these medicines have potentially grave side effects such as increased risk of infection and injury to the organs. As the side effects are more serious than diabetes itself, this procedure is usually kept for those patients who have diabetes, which is extremely difficult to control and manage.

Islet Cell Transplantation for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Research Procedure- This procedure is still under research.
  • Donor Pancreas Match- Selection of donor is extremely important and time consuming. Surgery involves removal of new insulin producing cells from donor and transplanted into the patient suffering with Type 1 diabetes.
  • Immunosuppressant Therapy- This procedure also requires immune-suppressing medications, as the body can destroy the transplanted islet cells.

Stem Cell Transplant for Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

  • Immune System- This procedure comprises of closing down the immune system and then starting it again while the stem cells are made from the patient's own blood and transplanted.
  • Risks- This is a risky procedure; however, it has a lot of potential to be a good additional treatment for people suffering from type-1 diabetes.

Complications Involving Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

Seizures-

  • Despite taking treatment and following a healthy diet and exercise regime, there will be times when the patient will have short-term complications from type-1 diabetes.
  • If these are not treated immediately, then they can cause seizures and result in the patient going into a coma.

Hypoglycemia-

  • Signs and symptoms of hypoglycemia (low blood sugar) are observed following increased physical activity, taking excessive insulin or skipping a meal.
  • Always test your levels of blood sugar whenever you are in doubt.

Signs and Symptoms of Hypoglycemia are:

  • Shakiness
  • Sweating
  • Weakness
  • Hunger
  • Dizziness
  • Anxiety
  • Pallor
  • Rapid/ irregular heart rate
  • Headache
  • Irritability
  • Blurred Vision.

Treatment of Hypoglycemia-

If you find out that you have low blood sugar levels, then you can do the following things:

  • Drink or eat sources of sugar such as fruit juice, regular soda, candy and glucose tablets.
  • Recheck your blood sugar after 15 minutes to see whether your sugar levels are normal or not. If they are not, then drink more juice or have more candy or other such sources of sugar; and again recheck your sugar levels after 15 minutes. Repeat doing this till you get a normal reading.

Hyperglycemia (High Blood Sugar)

Hyperglycemia can occur as a result of overeating, eating certain food groups, sickness and not taking sufficient insulin.

Signs and Symptoms of Hyperglycemia are:

  • Increased thirst
  • Frequent urination
  • Fatigue
  • Blurred vision
  • Nausea
  • Irritability
  • Increased hunger
  • Difficulty in concentrating.

If you experience the above symptoms, then test your blood sugar and if it's high, then you need to adjust your diet plan or medications.

  • If you have two successive blood sugar readings, which are greater than 250 mg/dL, then you need to test for ketones in your urine with a urine test stick. If ketones are present and your blood sugar level is high, then do not exercise. If the ketones are present only in trace amounts, then drink lots of fluids so that the ketones are flushed out.
  • If your blood sugar levels are persistently high or above 300 mg/dL, then seek emergency care without further delay.

Diabetic Ketoacidosis

  • Diabetic Ketoacidosis is a grave condition where there are increased ketones in the urine.
  • Diabetic ketoacidosis happens when the cells are deprived of energy and the body begins to break down fat to produce energy, resulting in production of toxic acids, which are ketones.

Signs and Symptoms of Diabetic Ketoacidosis:

Life Style Modifications For Type 1 Diabetes or Juvenile Diabetes (Insulin-Dependent Diabetes)

Follow Doctor's Instructions-

  • Always follow your doctor's instructions and make a lifelong commitment toward managing your diabetes.
  • Always go for yearly physical exam and eye exams, so any diabetes-related complications can be detected early.

Diet-

  • Follow a healthy diet and make sure you are exercising daily.

Wear Bracelet or Tag-

  • Always wear a bracelet or tag which says that you have diabetes so you can always be identified.

Glucagon Kit-

  • Always keep a glucagon kit with you in case of emergencies, like low blood sugar.
  • Always keep your cholesterol and blood pressure in the normal range.

Yearly Immunization-

  • Always be up to date on your immunizations, as diabetes weakens your immune system.

Personal Hygiene-

  • Teeth and Gum- Take good care of your teeth, as diabetes increases the risk of gum infections.
  • Regular Wash: Hand and Feet- Pay careful attention to your feet and wash then daily with lukewarm water and dry them gently afterwards, particularly in the regions between the toes. Moisturize your feet and check them daily for cuts, blisters, sores, swelling or redness.
  • Discontinue Smoking- If you are a smoker, then try to quit, as smoking increases the risk of diabetes related complications, such as heart attack, nerve damage, stroke and kidney damage.
  • Alcohol Consumption- Drink alcohol in moderation or better yet, stop drinking entirely, as depending on the quantity you drink and what you eat along with alcohol can result in either high or low blood sugar.
  • Prevent Being Overweight- If you are overweight, then lose weight and always maintain healthy body weight for good control and management of your diabetes.
  • Avoid Stress- Meditate, do relaxation techniques like listening to music and get enough sleep.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: December 17, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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