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Type 1 diabetesPublished by BUPA's health information team, healthinfo@bupa.com, July 2007. This factsheet is for people with type 1 diabetes or for those who want to know more about it. Diabetes mellitus is a long-term condition where the body can't control the amount of glucose in the blood. There are two types of diabetes. Type 1 diabetes develops when the body can't produce the natural hormone insulin. If left untreated, symptoms include excessive thirst, passing excessive urine and weight loss. In the long-term, poorly controlled blood sugar is a major threat to health, increasing the risk of heart disease, stroke, kidney failure, nerve damage and blindness. There are two types of diabetes - type 1 and type 2. For more information on type 2 diabetes, see Related topics.
There are about 2 million people in the UK who are known to have diabetes - and another 750,000 people who have the condition but don't know it. Type 1 diabetes is the rarer form, affecting between 5 and 15 percent of all people who have the disease. Glucose and insulinGlucose is a simple form of sugar which enters the blood from the intestines. It's absorbed from food and sugary drink as a natural part of digestion. One of the many functions of your blood is to carry glucose around the body. When it reaches body tissues, like muscle cells, it is absorbed and converted into energy. Glucose concentration in the blood is automatically regulated. The hormone insulin is crucial for this. Insulin is secreted into the blood by the pancreas - a gland found behind the stomach which also produces digestive juices. The body needs insulin to help cells absorb glucose, where it is then converted into energy. A shortage of insulin causes glucose to build up in the blood, leading to diabetes. SymptomsType 1 diabetes only takes a few weeks to develop. The initial symptoms include:
If type 1 diabetes isn't treated at this stage, the body begins to produce chemicals called ketones. This is because it tries to use energy sources other than glucose. The ketones build up in the bloodstream, leading to a condition called diabetic ketoacidosis. Diabetic ketoacidosis causes additional symptoms, including:
Without treatment, diabetic ketoacidosis can lead to coma and, eventually, death. CausesType 1 diabetes develops when the cells in the pancreas which make insulin - called the islets of Langerhans - are destroyed by the body's own immune system. Because of this, type 1 diabetes is known as an autoimmune disorder. Without insulin, glucose builds up in the blood stream, and can reach dangerous levels if left untreated. DiagnosisNo one knows exactly what causes type 1 diabetes develops. It might be triggered by a virus or other autoimmune diseases, or it may be due to inheriting certain genes. Type 1 diabetes is most common in people under the age of 30, although it can develop at any age. TreatmentType 1 diabetes can be detected with a blood test to measure the level of glucose in the blood. This might be a fasting glucose test, which is taken after fasting for at least eight hours, or a random glucose test, which can be carried out at any time. You may have another type of blood sugar test called a glucose tolerance test. This measures how your blood sugar changes over time after you swallow a sugary drink. You need to fast overnight before having this test. Controlling your blood sugarAt the moment there's no cure for type 1 diabetes. However, it can be controlled by giving the body insulin. This allows glucose to be absorbed into cells and converted into energy, stopping it building up in the blood. Insulin can't be taken orally because it is destroyed by acid in the stomach - instead, you need to inject it. Insulin injections are usually self-administered two to four times a day, using either a small hypodermic needle or a pen type syringe with refillable cartridges. There are different kinds of insulin that work at different rates and act for different lengths of time. They can be used to try and get the best control of blood sugar levels. Recently, devices that let you inhale an insulin powder have been designed. Alternatively, portable insulin pumps, which are attached to your waist, can be programmed to inject you with insulin. These newer methods are only used if a good level of blood sugar control isn't reached with other methods. How you take insulin varies between individuals, and your GP will advise you on the most appropriate method for you. Carefully controlling blood sugar is the key to maintaining good health if you have diabetes. If you don't, you can develop either low blood glucose levels (hypoglycaemia), or high blood sugar levels (hyperglycaemia). Low blood glucoseLow blood glucose happens if you don't eat enough - so not enough sugar from food is absorbed into the blood - or if you take too much insulin - which causes too much glucose in the blood stream to be absorbed into cells and used up. It causes faintness, sweating and a pounding heart. If it isn't treated by eating or drinking something sugary, it can lead to confusion, collapse and even coma. You will probably experience a "hypo", or near hypo, from time to time, and should consider keeping some sugary food or glucose tablets at hand to control it. If "hypo" attacks are too frequent, you may not notice the warning signs. High blood glucoseUncontrolled high blood sugar can lead to a number of long-term complications. Over time, very small blood vessels become damaged. This can cause irreversible damage to the eyes and kidneys, leading to blindness and kidney failure, if left unchecked. Nerves can also be damaged, which can affect your ability to feel sensations and pain. Badly controlled blood sugar can also damage larger blood vessels. It makes the lining of arteries more likely to fur up and become narrower (atherosclerosis). This makes heart disease and stroke more likely. Damage to your circulation can also increase the risk of leg or foot ulcers, which can lead to gangrene and even amputation. Monitoring your blood sugarYou can monitor your blood sugar levels with a home test kit. This can be useful for your doctor when assessing your treatment. It involves taking a pin prick of blood and analysing it with either colour-coded strips of paper (which give a blood sugar reading based on the colour they turn) or, more recently, an electronic monitor. Diet and insulin can be adjusted to keep the level within the normal range. Hospital clinics, run by diabetologists (doctors with a special interest in the disease) and specialist nurses can provide you with initial guidance and support to do this. After you have learnt how to manage your blood sugar, you can get support from your GP or specialist nurses at local diabetic clinics. A healthy lifestyleIn addition to controlling blood sugar, lifestyle is a key part of ensuring that diabetes has the minimum impact on your health. DietA healthy diet is essential for people with type 1 diabetes. So called "diabetic foods" aren't necessary for a healthy diet; you just need to watch what you eat. This is the same as the normal, balanced diet that's recommended for good health - low in saturated fat, sugar and salt; high in fibre, vegetables and fruit. Carbohydrates should be spread throughout the day to prevent high blood sugar levels after a meal. Carbohydrates include starchy food such as pasta, potatoes, bread and cereals and sugary foods including fruit, sweets and biscuits. It's important to keep your weight under control. This will help keep your risk of getting cardiovascular disease to a minimum. Talk to a state registered dietitian for more information. ExercisePhysical activity promotes a healthy circulation and helps you maintain a healthy weight. Many successful sports people have diabetes: well-controlled diabetes need not prevent an active life. To stay healthy the government recommends that you do at least half an hour of moderate activity, at least five days a week. AlcoholIf you have diabetes, there's no need to give up alcohol. However, women should limit themselves to two to three units of alcohol a day, and men shouldn't drink more than three to four units a day. You should also avoid drinking on an empty stomach. SmokingSmoking also damages the circulation and, like diabetes, increases the risk of cardiovascular disease. Smoking is unhealthy for everyone, but it's especially important for smokers with diabetes to give up because of the damage to does to circulation. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and by BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: July 2007. Expected review date: July 2009.
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