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diabetes mellitus type 1 (Juvenile diabetes) : Symptoms, Causes, Diagnosis and Treatment

What is diabetes mellitus type 1?

Type 1 diabetes is a disease in which the body does not make enough insulin to control blood sugar levels. Diabetes of type 1 was previously called insulin-dependent diabetes or diabetes juvenile.

During digestion, food is broken down into basic components. Carbohydrates are broken down into simple sugars, primarily glucose. Glucose is a critically important source of energy for the body's cells. To provide energy to the cells, glucose needs to leave the blood and get inside the cells.

Type 1 diabetes is not caused by the amount of sugar in a person's diet before the disease develops.

Type 1 diabetes is a chronic disease. It is diagnosed most commonly between ages 10 and 16. Type 1 diabetes equally affects males and females.

Type 1 diabetes is an autoimmune disease. This means it begins when the body's immune system attacks cells in the body. In type 1 diabetes, the immune system destroys insulin-producing cells (beta cells) in the pancreas.

Why the immune system attacks the beta cells remains a mystery. Some people are genetically predisposed to the disease. That does not mean they will necessarily get the disease. It just means that they are more likely to do so. Something in the environment, such as particular viral infections or something about the diet, may trigger this autoimmune disease in people with a genetic predisposition.

Insulin traveling in the blood signals the cells to take up glucose. Insulin is a hormone produced by the pancreas. When levels of glucose in the blood rise, like following a meal, the pancreas normally produces more insulin.

Type 1 diabetes occurs when some or all of the insulin-producing cells in the pancreas are destroyed. This leaves the patient with little or no insulin. Without insulin, sugar accumulates in the bloodstream rather than entering the cells. As a result, the body cannot use this glucose for energy. In addition, the high levels of glucose that remain in the blood cause excessive urination and dehydration, and damage tissues of the body.

diabetes mellitus type 1 is also known as Juvenile diabetes. diabetes mellitus type 1 belongs under the category of Sugar disease. Generally Male, Female are the victim of the diabetes mellitus type 1. Seriousness of this disease is Medium.

Symptoms of diabetes mellitus type 1 are :

  • Extreme thirst
  • hunger
  • Dry mouth
  • upset stomach
  • Vomiting
  • Vomiting, or throwing up, is a forceful discharge of stomach contents. It can be a one-time event linked to something that doesn?t settle right in the stomach. Recurrent vomiting may be caused by underlying medical conditions.

    Frequent vomiting may also lead to dehydration, which can be life-threatening if left untreated.

  • Frequent urination
  • Weight loss
  • Sudden, noticeable weight loss can happen after a stressful event, although it can also be a sign of a serious illness.

    It's normal to lose a noticeable amount of weight after the stress of changing jobs, divorce, redundancy or bereavement.

    Weight often returns to normal when you start to feel happier, after you've had time to grieve or get used to the change. Counselling and support may be needed to help you get to this stage.

    Significant weight loss can also be the result of an eating disorder, such as anorexia or bulimia. If you think you have an eating disorder, talk to someone you trust and consider speaking to your GP. There are also several organisations that can provide you with information and advice, such as the eating disorders charity Beat.

    If your weight loss wasn't due to one of the causes mentioned, and you didn't lose weight through dieting or exercising, see your GP, as you may have an illness that needs treating.

  • Fatigue/weakness
  • Weakness

    Weakness is when strength is decreased and extra effort is needed to move a certain part of the body or the entire body. Weakness is due to loss of muscle strength. Weakness can be a big part of why cancer patients feel fatigue.

    Fatigue

    Fatigue is an extreme feeling of tiredness or lack of energy, often described as being exhausted. Fatigue is something that lasts even when a person seems to be getting enough sleep. It can have many causes, including working too much, having disturbed sleep, stress and worry, not having enough physical activity, and going through an illness and its treatment.

  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Double vision is the perception of two images of a single object seen adjacent to each other (horizontally, vertically, or obliquely) or overlapping. Diplopia is the medical term for double vision. Polyplopia is the perception of three or more images of a single object overlapping each other.

    Double vision is called "monocular" when the double image is perceived by an eye that is tested alone. In "binocular" double vision, each eye sees a single image when tested alone, but a double image is present when both eyes are open.

  • Difficulty in breathing
  • Experiencing breathing difficulty describes discomfort when breathing and feeling as if you can?t draw a complete breath. This can develop gradually or come on suddenly. Mild breathing problems, such as fatigue after an aerobics class, don?t fall into this category.

    Breathing difficulties can be caused by many different conditions. They can also develop as a result of stress and anxiety.

    It?s important to note that frequent episodes of shortness of breath or sudden, intense breathing difficulty may be signs of a serious health issue that needs medical attention. You should discuss any breathing concerns with your doctor.

  • mood swings
  • Skin rash
  • Itchy skin, also known as pruritus, is an irritating and uncontrollable sensation that makes you want to scratch to relieve the feeling. The possible causes for itchiness include internal illnesses and skin conditions.

    It?s important to see a doctor for itchiness if the cause isn?t obvious. A doctor can find the underlying cause and provide treatments for relief. Several home remedies such as over-the-counter creams and moisturizers work well for itching.

  • Trembling or shaking
  • Belly Pain
  • Causes

    diabetes mellitus type 1 can be caused due to:

    The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system ? which normally fights harmful bacteria and viruses ? mistakenly destroys the insulin-producing (islet, or islets of Langerhans) cells in the pancreas. Other possible causes include:

    • Genetics
    • Exposure to viruses and other environmental factors

    The role of insulin

    Once a significant number of islet cells are destroyed, you'll produce little or no insulin. Insulin is a hormone that comes from a gland situated behind and below the stomach (pancreas).

    • The pancreas secretes insulin into the bloodstream.
    • Insulin circulates, allowing sugar to enter your cells.
    • Insulin lowers the amount of sugar in your bloodstream.
    • As your blood sugar level drops, so does the secretion of insulin from your pancreas.

    The role of glucose

    Glucose ? a sugar ? is a main source of energy for the cells that make up muscles and other tissues.

    • Glucose comes from two major sources: food and your liver.
    • Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
    • Your liver stores glucose as glycogen.
    • When your glucose levels are low, such as when you haven't eaten in a while, the liver breaks down the stored glycogen into glucose to keep your glucose levels within a normal range of sugar.

    In type 1 diabetes, there's no insulin to let glucose into the cells, so sugar builds up in your bloodstream. This can cause life-threatening complications.

    What kind of precaution should be taken in diabetes mellitus type 1?

    Type 1 diabetes is not currently preventable. Some researchers believe it might be prevented at the latent autoimmune stage, before it starts destroying beta cells.

    Immunosuppressive drugs

    Cyclosporine A, an immunosuppressive agent, has apparently halted destruction of beta cells (on the basis of reduced insulin usage), but its kidney toxicity and other side effects make it highly inappropriate for long-term use.

    Anti-CD3 "CD3 (immunology)") antibodies, including teplizumab and otelixizumab, had suggested evidence of preserving insulin production (as evidenced by sustained C-peptide production) in newly diagnosed type 1 diabetes patients. A probable mechanism of this effect was believed to be preservation of regulatory T cells that suppress activation of the immune system and thereby maintain immune system homeostasis and tolerance to self-antigens. The duration of the effect is still unknown, however. In 2011, Phase III studies with otelixizumab and teplizumab both failed to show clinical efficacy, potentially due to an insufficient dosing schedule. antibody, rituximab, inhibits B cells and has been shown to provoke C-peptide responses three months after diagnosis of type 1 diabetes, but long-term effects of this have not been reported.

    Diet

    Some research has suggested breastfeeding decreases the risk in later life and early introduction of gluten-containing cereals in the diet increases the risk of developing islet cell autoantibodies; various other nutritional risk factors are being studied, but no firm evidence has been found. Giving children 2000 IU of vitamin D daily during their first year of life is associated with reduced risk of type 1 diabetes, though the causal relationship is obscure.
    Children with antibodies to beta cell proteins (i.e. at early stages of an immune reaction to them) but no overt diabetes, and treated with niacinamide (vitamin B3), had less than half the diabetes onset incidence in a seven-year time span than did the general population, and an even lower incidence relative to those with antibodies as above, but who received no niacinamide.
    People with type 1 diabetes and undiagnosed celiac disease have worse glycaemic control and a higher prevalence of nephropathy and retinopathy. Gluten-free diet, when performed strictly, improves diabetes symptoms and appears to have a protective effect against developing long-term complications. Nevertheless, dietary management of both these diseases is challenging and these patients have poor compliance of the diet.

    How it can be spread?

    Type 1 diabetes is inherited, which means a group of genes that can lead to type 1 diabetes is passed down from mothers and fathers to their children. A person with a parent, brother, or sister with type 1 diabetes has a greater chance of also developing type 1 diabetes.

    Genes play an important role in determining who gets type 1 diabetes and who doesn't. But they might not be the only influence. Environmental factors, including viruses and allergies, appear to trigger type 1 diabetes in some people who have inherited the genes.

    Treatment for the diabetes mellitus type 1

    Diagnosis of diabetes of type 1:

    Diabetes can be diagnosed using different kind of diagnostic tests as follows :

    • Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

    If the A1C test isn't available, or if you have certain conditions that can make the A1C test inaccurate ? such as pregnancy or an uncommon form of hemoglobin (hemoglobin variant) ? your doctor may use these tests:

    • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.

    • Random blood sugar test. A blood sample will be taken at a random time and may be confirmed by repeat testing. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst.

    If you're diagnosed with diabetes, your doctor may also run blood tests to check for autoantibodies that are common in type 1 diabetes. These tests help your doctor distinguish between type 1 and type 2 diabetes when the diagnosis is uncertain. The presence of ketones ? byproducts from the breakdown of fat ? in your urine also suggests type 1 diabetes, rather than type 2.

    After the diagnosis

    You'll regularly visit your doctor to discuss diabetes management. During these visits, the doctor will check your A1C levels. Your target A1C goal may vary depending on your age and various other factors, but the American Diabetes Association generally recommends that A1C levels be below 7 percent, which translates to an estimated average glucose of 154 mg/dL (8.5 mmol/L).

    Compared with repeated daily blood sugar tests, A1C testing better indicates how well your diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your insulin regimen, meal plan or both.

    In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your cholesterol levels, thyroid function, liver function and kidney function. The doctor will also examine you to assess your blood pressure and will check the sites where you test your blood sugar and deliver insulin.

    Treatment of diabetes of type 1:

    The goal is to keep your blood sugar level as close to normal as possible to delay or prevent complications. Generally, the goal is to keep your daytime blood sugar levels before meals between 80 and 130 mg/dL (4.44 to 7.2 mmol/L) and your after-meal numbers no higher than 180 mg/dL (10 mmol/L) two hours after eating.

    Insulin and other medications

    Anyone who has type 1 diabetes needs lifelong insulin therapy.

    Types of insulin are many and include:

    • Short-acting (regular) insulin
    • Rapid-acting insulin
    • Intermediate-acting (NPH) insulin
    • Long-acting insulin

    Examples of short-acting (regular) insulin include Humulin R and Novolin R. Rapid-acting insulin examples are insulin glulisine (Apidra), insulin lispro (Humalog) and insulin aspart (Novolog). Long-acting insulins include insulin glargine (Lantus, Toujeo Solostar), insulin detemir (Levemir) and insulin degludec (Tresiba). Intermediate-acting insulins include insulin NPH (Novolin N, Humulin N).

    Insulin administration

    Insulin can't be taken orally to lower blood sugar because stomach enzymes will break down the insulin, preventing its action. You'll need to receive it either through injections or an insulin pump.

    • Injections. You can use a fine needle and syringe or an insulin pen to inject insulin under your skin. Insulin pens look similar to ink pens and are available in disposable or refillable varieties.

    If you choose injections, you'll likely need a mixture of insulin types to use throughout the day and night. Multiple daily injections that include a combination of a long-acting insulin combined with a rapid-acting insulin more closely mimic the body's normal use of insulin than do older insulin regimens that only required one or two shots a day. A regimen of three or more insulin injections a day has been shown to improve blood sugar levels.

    • An insulin pump. You wear this device, which is about the size of a cellphone, on the outside of your body. A tube connects a reservoir of insulin to a catheter that's inserted under the skin of your abdomen. This type of pump can be worn in a variety of ways, such as on your waistband, in your pocket or with specially designed pump belts.

    There's also a wireless pump option. You wear a pod that houses the insulin reservoir on your body that has a tiny catheter that's inserted under your skin. The insulin pod can be worn on your abdomen, lower back, or on a leg or an arm. The programming is done with a wireless device that communicates with the pod.

    Pumps are programmed to dispense specific amounts of rapid-acting insulin automatically. This steady dose of insulin is known as your basal rate, and it replaces whatever long-acting insulin you were using.

    When you eat, you program the pump with the amount of carbohydrates you're eating and your current blood sugar, and it will give you what's called a bolus dose of insulin to cover your meal and to correct your blood sugar if it's elevated. Some research has found that in some people an insulin pump can be more effective at controlling blood sugar levels than injections. But many people achieve good blood sugar levels with injections, too. An insulin pump combined with a continuous glucose monitoring (CGM) device may provide even tighter blood sugar control.

    Artificial pancreas

    In September 2016, the Food and Drug Administration approved the first artificial pancreas for people with type 1 diabetes who are age 14 and older. It's also called closed-loop insulin delivery. The implanted device links a continuous glucose monitor, which checks blood sugar levels every five minutes, to an insulin pump. The device automatically delivers the correct amount of insulin when the monitor indicates it's needed.

    There are more artificial pancreas (closed loop) systems currently in clinical trials.

    Other medications

    Additional medications also may be prescribed for people with type 1 diabetes, such as:

    • High blood pressure medications. Your doctor may prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to help keep your kidneys healthy. These medications are recommended for people with diabetes who have blood pressures above 140/90 millimeters of mercury (mm Hg).
    • Aspirin. Your doctor may recommend you take baby or regular aspirin daily to protect your heart.
    • Cholesterol-lowering drugs. Cholesterol guidelines tend to be more aggressive for people with diabetes because of the elevated risk of heart disease. The American Diabetes Association recommends that low-density lipoprotein (LDL, or "bad") cholesterol be below 100 mg/dL (2.6 mmol/L). Your high-density lipoprotein (HDL, or "good") cholesterol is recommended to be over 50 mg/dL (1.3 mmol/L) in women and over 40 mg/dL (1 mmol/L) in men. Triglycerides, another type of blood fat, are ideal when they're less than 150 mg/dL (1.7 mmol/L).

    Possible complication with diabetes mellitus type 1

    Over time, type 1 diabetes complications can affect major organs in your body, including heart, blood vessels, nerves, eyes and kidneys. Maintaining a normal blood sugar level can dramatically reduce the risk of many complications.

    Eventually, diabetes complications may be disabling or even life-threatening.

    • Heart and blood vessel disease. Diabetes dramatically increases your risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.

    • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and gradually spreads upward. Poorly controlled blood sugar could cause you to eventually lose all sense of feeling in the affected limbs.

      Damage to the nerves that affect the gastrointestinal tract can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

    • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, which requires dialysis or a kidney transplant.

    • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy), potentially causing blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.

    • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections that may ultimately require toe, foot or leg amputation.

    • Skin and mouth conditions. Diabetes may leave you more susceptible to infections of the skin and mouth, including bacterial and fungal infections. Gum disease and dry mouth also are more likely.

    • Pregnancy complications. High blood sugar levels can be dangerous for both the mother and the baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes isn't well-controlled. For the mother, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and preeclampsia.

    References:

    1. https://www.healthline.com/health/type-1-diabetes-causes-symtoms-treatments
    2. https://en.wikipedia.org/wiki/Type_1_diabetes
    3. https://www.endocrineweb.com/conditions/type-1-diabetes/type-1-diabetes-treatments
    4. https://www.healthline.com/health/difference-between-type-1-and-type-2-diabetes
    5. https://www.health.harvard.edu/a_to_z/type-1-diabetes-mellitus-a-to-z
    6. https://www.webmd.com/diabetes/type-1-diabetes

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