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Type 1 diabetes

Published by Bupa's health information team, July 2009.

This factsheet is for people who have type 1 diabetes, or who would like information about it.

Type 1 diabetes is a lifelong condition in which the body can't control the amount of glucose in the blood. This is because the body can't produce the natural hormone insulin. If left untreated, symptoms include excessive thirst, passing excessive urine and weight loss.

About type 1 diabetes

Type 1 diabetes is also known as insulin-dependent diabetes mellitus.

Glucose and insulin

Glucose is a simple form of sugar found in foods and sugary drinks - it's absorbed as a natural part of digestion.

One function of your blood is to carry glucose around your body. When glucose reaches body tissues, such as muscle cells, it's absorbed and converted into energy. The glucose concentration in your blood is automatically regulated and insulin is crucial for this.

Insulin helps cells absorb glucose, where it's then converted into energy. A shortage of insulin therefore causes glucose to build up in your blood.

Insulin is secreted into the blood by your pancreas - a gland found behind your stomach. Type 1 diabetes develops when the cells in your pancreas that make insulin - called beta cells - are destroyed by your body's own immune system. Because of this, type 1 diabetes is known as an autoimmune disease.

Structure of the pancreas
Structure of the pancreas

Types of diabetes

There are two main types of diabetes: type 1 and type 2. About two million people in the UK have diabetes. Type 1 diabetes is the rarer form, affecting between five and 10 of every 100 people with diabetes.

Symptoms of type 1 diabetes

The initial symptoms include:

  • weight loss
  • excessive passing of urine
  • constant thirst
  • tiredness
  • blurred vision
  • itchy skin around your genitals or regular infections, such as thrush

The symptoms can develop quickly - usually over a few weeks. In particular, marked weight loss, often over a short period of two to eight weeks is the main distinguishing symptom between type 1 and type 2 diabetes. The other symptoms listed above can occur in either type.

Complications of type 1 diabetes

If type 1 diabetes isn't diagnosed or controlled properly, you can develop high blood glucose levels (hyperglycaemia). Sometimes the treatment itself can cause low blood glucose levels (hypoglycaemia). Both of these conditions can lead to complications.

Low blood glucose

Low blood glucose can occur if you exert yourself or don't eat enough foods that contain glucose while taking insulin. It can also happen if you take too much insulin, which leads to your cells taking up more glucose and therefore blood glucose levels falling.

If you have low blood glucose, generally defined as under 4mmol/litre, you may feel faint, sweat and feel your heart pounding. If you don't treat this by eating or drinking something sugary, it can lead to confusion, collapse and even coma. This is often called a 'hypo'.

High blood glucose

Most patients will develop high blood glucose levels from time to time. These will settle either of their own accord or in response to a change in the dose of insulin you're taking. Rarely, glucose can build up in your blood and reach dangerous levels if you don't have enough insulin in your bloodstream. This condition is called diabetic ketoacidosis. Diabetic ketoacidosis causes additional symptoms, including:

  • vomiting
  • stomach pain
  • rapid breathing
  • breath that smells of ketones - like pear drops or nail varnish

Diabetic ketoacidosis needs immediate medical treatment in hospital. Without this, the condition can lead to coma and even death.

Long-term, poorly controlled high blood glucose can be very damaging to your health and can increase your risk of heart disease, stroke, kidney failure, nerve damage and blindness. The risk of blindness has been greatly reduced in the last 20 years because of advances in specialist eye treatment and better insulin products. There is also better understanding now of how the body's functions are affected by diabetes.

Causes of type 1 diabetes

The exact cause of type 1 diabetes isn't known. However, it's possible that is may be triggered by a virus or other autoimmune diseases, or it may run in your family.

Diagnosis of type 1 diabetes

If you think you may be developing diabetes, visit your GP. It's important to seek help early so you can get the treatment you need.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may ask for a sample of urine so he or she can test for glucose. Urine doesn't usually contain glucose, but it can be detected if you have diabetes. Alternatively, your GP may test a sample of blood taken from your finger - this tends to give a more accurate result.

You may also be asked to have a blood test to measure the level of glucose in your blood. This might be a fasting glucose test, which is taken after you haven't eaten for at least eight hours, or a random glucose test done at any time.

If your GP can't make a definite diagnosis after these tests, you may have a glucose tolerance test. This measures how your blood glucose level changes over time after you swallow a sugary drink. You will need to fast overnight before having this test.

If you're diagnosed with type 1 diabetes, you will usually be referred to a hospital clinic that has nurses and doctors who specialise in diabetes.

Treatment of type 1 diabetes

There isn't a cure for type 1 diabetes but it can be controlled.

Medicines

Type 1 diabetes can be controlled by giving your body insulin. This allows glucose to be absorbed into cells and converted into energy, stopping it building up in the blood.

There are different kinds of insulin that work at different rates and act for different lengths of time. Each can have varying rates of success in different people - ask your doctor or diabetes specialist nurse for advice on which type is best for you.

There are two main methods of taking insulin.

  • Insulin injections are the most common form of treatment, where insulin is injected under the skin. You will usually give these to yourself two to four times a day, using either a small hypodermic needle or a pen-type syringe with refillable cartridges.
  • Portable insulin pumps may be appropriate for you if you find it difficult to control your blood glucose with regular injections despite careful monitoring of its level. These are about the size of a pack of cards and can be attached to your waist. Insulin pumps can be programmed to inject you with insulin at a rate that you can control. However, these aren't appropriate for most people with diabetes.

Your doctor will advise you on the most appropriate method for you.

Self-help

Controlling your blood glucose

If you have diabetes, it's very important to carefully control your blood glucose level in order to stay as healthy as possible. However, you will probably have a 'hypo', or near hypo, from time to time - it's a good idea to keep some sugary food or glucose tablets with you to control it. You can also buy glucose gels that rapidly increase your blood glucose level.

It's vital that friends and relatives know what to do should you have a hypo.

You can monitor your blood glucose levels with a home test kit. It involves taking a pinprick of blood from the side of your finger and putting a drop on a testing strip. A meter will read the result automatically.

You can adjust both your diet and insulin to keep your blood glucose level within the normal range. Your 'normal' range will be specific to you but a general guide for adults is:

  • before meals: 4 to 7mmols/litre
  • after meals: less than 9mmols/litre

Your GP or specialist nurse in a hospital clinic can guide you on how to monitor and manage your blood glucose and will give you continuing support.

A healthy lifestyle

In addition to controlling blood glucose, your lifestyle is key to ensuring that diabetes has as little impact as possible on your health.

A healthy diet is essential if you have diabetes and it's important to eat regularly three times a day.

Special diabetic foods aren't necessary for a healthy diet; you just need to eat a balanced diet that is low in saturated fat, sugar and salt and high in fibre, vegetables and fruit. Include carbohydrates, such as pasta, potatoes or sugary foods such as fruit in each meal.

Ask a dietitian at your hospital clinic for more information.

Exercise promotes a healthy circulation and will help you to stay a healthy weight. The Department of Health recommends that you do at least half an hour of moderate activity on at least five days a week.

If you have diabetes, there's no need to give up alcohol completely, but it's important to drink sensibly. However, don't drink on an empty stomach - eat food containing carbohydrate before and after drinking and monitor your blood glucose levels regularly.

Smoking is unhealthy for everyone, but it's especially important for people with diabetes to quit. This is because you already have an increased risk of developing cardiovascular disease or circulatory problems. Smoking makes the chance of developing these diseases even greater.

It's also important to keep your blood pressure and the level of cholesterol in your blood well controlled. High blood pressure and high cholesterol levels have been linked to heart attack and stroke - you're more at risk if you have diabetes.

You can control your blood pressure by following the tips above, but you may also need to take medication. Similarly the best way to control the level of cholesterol in your blood is to reduce the amount of fat in your diet.

Related topics

Further information

Sources

  • IDDM (type 1diabetes). GP Notebook. www.gpnotebook.co.uk, accessed 10 February 2009
  • Diabetes. World Health Organization. www.who.int, accessed 11 February 2009
  • National Collaborating Centre for Chronic Conditions. Type 2 diabetes: National clinical guideline for management in primary and secondary care (update). Royal College of Physicians, 2008. www.rcplondon.ac.uk
  • What is diabetes? Diabetes UK. www.diabetes.org.uk, accessed 10 February 2009
  • Diabetes symptoms. Diabetes UK. www.diabetes.org.uk, accessed 10 February 2009
  • Canadian Diabetes Association. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008; 32(Supplement 1). www.diabetes.ca
  • Diabetic ketoacidosis. Diabetes UK. www.diabetes.org.uk, accessed 10 February 2009
  • Types of diabetes. World Health Organization. www.who.int, accessed 11 February 2009
  • Drugs used in diabetes. Joint Formulary Committee, British National Formulary. 56th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
  • Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: report of a WHO/IDF consultation. World Health Organization, 2006. www.who.int
  • Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk July 2008.
  • Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. National Institute for Health and Clinical Excellence (NICE), www.nice.org.uk, July 2004
  • Cardiovascular disease. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • Blood glucose. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • 'Diabetic foods' and food labelling: Joint statement on 'diabetic foods' from the Food Standards Agency and Diabetes UK. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • 10 steps to healthy eating. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • Be active, be healthy: a plan for getting the nation moving. Department of Health. www.dh.gov.uk, 2009
  • Smoking and diabetes. Diabetes UK. www.diabetes.org.uk, accessed 11 February 2009
  • Know your diabetes health numbers. Diabetes.co.uk www.diabetes.co.uk, accessed 8 May 2009
  • Diabetes and cholesterol. Diabetes.co.uk www.diabetes.co.uk, accessed 8 May 2009
  • Type 2 diabetes. The management of type 2 diabetes. National Institute for Health and Clinical Excellence (NICE). www.nice.org.uk, May 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed 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 2009

 

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