Diabetes mellitus (DM) type 1 is a genetic condition in which there is alteration of the immune system, characterised by an absolute deficiency of insulin in the body.
It occurs when the body’s own immune system destroys the insulin-producing pancreatic cells. This deprives the body of insulin that aids in the conversion of food into energy.
Children and young adults are usually diagnosed with this because it is hereditary and runs in the family. Previously, DM type 1 was referred to as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes.
Signs and symptoms
There are 3Ps that serve as identifiers for DM type 1:Polyuria (frequent urination, particularly at night) with chances of bedwetting, polydipsia (frequent thirst) and polyphagia (frequent feeling of hunger).
Several other identifiers also exist, including:
- Weakness or fatigue
- Unexplained weight loss and muscle mass loss
- Itching all over the body, especially around the genitals
- Frequent episodes of thrush — a fungal infection in the mouth, throat or other parts
- Slow healing of cuts and wounds
- Blurred vision
- Pain, numbness or tingling in lower legs or sudden onset of a wound (gangrene)
- Dry skin
Causes of type-1 diabetes
The exact cause of DM type 1 is not known yet. However, it is thought to be caused by autoimmune reactions that destroy the insulin-producing pancreatic cells. Autoimmune reactions are those in which the body’s immune system attacks its own healthy cells, mistaking them as foreign objects.
However, individuals with a family history are at increased risk of getting DM type-1 and high blood pressure, sedentary lifestyle, and higher sugar and carbohydrate intakes just add a star to the genetic risk.
Diagnosis
A doctor can rule out the type and severity of the DM based on the collaborating inferences from physical examinations, signs and symptoms, and a series of laboratory tests. Early detection can help in better treatment outcomes. Pre-diabetics, those who are at risk of developing DM, should be more proactive when it comes to detection and therapy.
| Diagnosis | HbA1c (Glycosylated hemoglobin) | Fasting Plasma Glucose Test (FPG) in mg/dl | Random Plasma Glucose Test (RBG) in mg/dl | Oral Glucose Tolerance Test (OGTT) in mg/dl |
| Normal | Less than 5.7 % | Less than 100 | – | Less than 140 |
| Pre-diabetes | 5.7 – 6.4 | 100 – 125 | – | 140 – 199 |
| Diabetes Mellitus | Higher than 6.5% | 126 or higher | 200 or above | 200 or higher |
Key:
mg/dl: Milligram per deciliter
HbA1c: Attachment of glucose in red blood cells after increased levels of blood glucose for more than five months
FPG: Evaluation of glucose levels in the blood after eight hours of fastin
RBG: Evaluation of blood glucose any time of that day
OGTT: Evaluation of blood glucose two hours before and after giving 75grams of glucose in 100 ml of water
Source: https://www.diabetes.org/diabetes/a1c/diagnosis
Treatment
In DM type 1, insulin is not produced by the pancreas. So, insulin should be injected to cope with the requirements in the body. Your doctor will decide the best insulin based on several factors such as activity levels, food habits, ability to manage the blood glucose levels, age, time taken by the body to absorb insulin and how long it stays active.
Your doctor will decide the preference of insulin based on three factors:
- Onset (time taken by insulin to begin its action)
- Peak time (the maximum strength of the insulin)
- Duration (how long the insulin stays active in the body)
| Insulin type | Onset | Peak time | Duration | Preference |
| Rapid-acting | 15 minutes | 1 hour | 2 – 4 hours | Taken right before a meal |
| Regular/short acting | 30 minutes | 2 – 3 hours | 3 – 6 hours | Usually taken 30–60 minutes before a meal |
| Intermediate-acting | 2 – 4 hours | 4 – 12 hours | 12 – 18 hours | Taken for half a day or overnight |
| Long acting | 2 hours | Does not peak | Up to 24 hours | Covers insulin needs for almost a full day |
| Ultra-long acting | 6 hours | Does not peak | 36 hours or longer | Covers steady insulin for long periods; often used when needed |
| Premixed | 5 – 60 minutes | Varies | 10 – 16 hours | Taken 10–30 minutes before breakfast and dinner |
Sources: https://www.cdc.gov/diabetes/basics/type-1-types-of-insulin.html ; https://www.diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics
Moreover, physical activity and a balanced diet along with medications can help in better treatment outcomes.
