Type 1 diabetes

Type 1 diabetes accounts for over 80% of diabetes cases diagnosed before 19 years of age. It is caused by an autoimmune process that destroys the insulin- producing cells in the pancreas known as beta cells. Besides producing insulin, beta cells are able to sense how much sugar is entering the blood and control how much insulin is released at all times to maintain blood sugars levels within a very tight range.

A nearly complete loss of beta cells results in severe insulin deficiency and the inability to regulate blood sugar levels. Since insulin is needed to transport of sugar into the body’s cells, the body becomes severely starved. Starvation causes the body break down the fat energy reserves and release ketones to provide an alternative supply of fuel to the brain. However, when the body can’t transport enough sugar into the cells, ketones are produced in very large amounts causing diabetic ketoacidosis (DKA). DKA can be fatal if not caught on time but fortunately, that rarely happens. People with untreated type 1 diabetes frequently experience very rapid weight loss due to starvation.

Type 1 diabetes may also be known by a variety of other names, including:

• Insulin-dependent diabetes mellitus (IDDM)
• Juvenile diabetes
• Brittle diabetes
• Sugar diabetes

There are two forms of type 1 diabetes:

• Idiopathic type 1 - refers to rare forms of the disease with no known cause.
• Immune-mediated diabetes - is an autoimmune disorder in which the body's immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin.

Immune-mediated diabetes is the most common form of type 1 diabetes and is generally referred to as type 1 diabetes. The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood. Peak incidence occurs during puberty, around 10 to 12 years of age in girls, and around 12 to 14 years of age in boys. The symptoms for type 1 diabetes can resemble the flu in children. Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10 percent chance of developing the disease by age 50. The identical twin of a person with type 1 diabetes has a 25 to 50 percent chance of developing type 1 diabetes.

What causes type 1 diabetes?
The cause of type 1 diabetes is unknown. However, it is believed that people inherit a tendency to develop diabetes, and that some outside trigger may be involved. Type 1 diabetes is the result of the body's failure to produce insulin, the hormone that allows glucose to enter the cells of the body to provide fuel. This is the result of an autoimmune process in which the body's immune system attacks and destroys the insulin producing cells of the pancreas.

When glucose cannot enter the cells, it builds up in the blood causing the body's cells to starve to death. People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels.

What are the symptoms of type 1 diabetes?
Type 1 diabetes often appears suddenly. In children, type 1 diabetes symptoms may resemble flu symptoms. The following are the most common symptoms for type 1 diabetes. However, each child may experience symptoms differently. According to the American Academy of Pediatrics, common symptoms may include:

• High levels of sugar in the blood when tested
• High levels of sugar in the urine when tested
• Unusual thirst
• Dehydration
• Frequent urination; a baby may need more frequent diaper changes; a previously toilet-trained child may start wetting his or her pants
• Extreme hunger but loss of weight; loss of appetite may be seen in younger children
• Blurred vision
• Nausea and vomiting
• Abdominal pain
• Extreme weakness and fatigue
• Irritability and mood changes
• Serious diaper rash that does not respond to treatment

The symptoms of type 1 diabetes may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

What complications may be associated with type 1 diabetes?
Although type 1 diabetes can cause many different problems, there are several key complications, including the following:

• Hypoglycemia (low blood sugar, sometimes called an insulin reaction) - occurs when blood sugar drops too low
• Hyperglycemia (high blood sugar) - occurs when blood sugar is too high, and can be a sign that diabetes is not well controlled
• Ketoacidosis (diabetic coma) - loss of consciousness due to untreated or under-treated diabetes

Complications that may result from type 1 diabetes include:

• Heart disease
• Kidney disease
• Eye problems
• Neuropathy (nerve problems)
• Foot problems

Treatment for type 1 diabetes:
The only treatment for type 1 diabetes is to replace the missing insulin to restore energy balance in the body. The person must also balance their diet and check blood sugar levels frequently to determine how much insulin to take to keep blood sugar levels within a safe target range. Insulin can be replaced with injections or with an insulin pump. Insulin cannot be given in a pill.

Children with type 1 diabetes must have daily injections of insulin to keep the blood sugar level within normal ranges. Specific treatment for type 1 diabetes will be determined by your child's physician based on:

• Your child's age, overall health, and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Treatment may include:

• Appropriate foods (to manage blood sugar level)
• Exercise (to lower and help the body use blood sugar)
• Regular blood testing (to check blood-sugar levels), as directed by your child's physician
• Regular urine testing (to check ketone levels), as directed by your child's physician

Helping your child cope with type 1 diabetes:
Depending on your child's age, a type 1 diabetes diagnosis can be devastating. The younger child may not quite understand all the life changes that may occur because of the diagnosis, such as glucose monitoring and insulin injections. After being diagnosed with type 1 diabetes, children may feel:

• As if they are being punished
• Guilty
• Fearful of death
• Hostility toward the parent

Although a child who is diagnosed with type 1 diabetes requires supervised medical care, a parent should avoid being overprotective. Through parental encouragement, self-care of the diabetes by the child, starting at the appropriate age, will foster improved self-esteem and independence.