What is type 1 diabetes?
Type 1 diabetes is characterized by a high level of sugar in the blood caused by a lack of insulin. Insulin is a hormone (a special messenger compound) made in cells (called beta cells) in an organ located behind the stomach called the pancreas.
Nutrients in food are broken down into a simple sugar called glucose, which is an important source of energy for the body. Insulin permits this glucose to move from the bloodstream into cells to produce energy.
People with type 1 diabetes cannot produce insulin. Without insulin, glucose gets “stuck” in the bloodstream, causing high blood glucose levels. Type 1 diabetes affects about 1 in 400 children, adolescents, and young adults.
What causes type 1 diabetes?
Type 1 diabetes happens when a person’s immune system “misbehaves.” The immune system produces special proteins called antibodies. Normally, antibodies protect the body against infections.
However, in type 1 diabetes, the immune system produces antibodies that attack the beta cells in the pancreas. This process may occur rapidly or over a period of years.
When 90% to 95% of beta cells are destroyed, the body cannot produce enough insulin to bring down the sugar hence blood sugar levels rise.
What are the symptoms of type 1 diabetes?
The symptoms of type 1 diabetes are largely caused by the body’s inability to use sugars from food to make energy. High sugar levels in the bloodstream cause sugar and water to spill into the urine.
Symptoms include- increased hunger, weight loss, increased thirst and urine production (waking up at night to pass urine/new onset bed wetting in younger toilet-trained children)
How is type 1 diabetes diagnosed?
Normal blood sugar is 80 to 120mg/dl.
The diagnosis is made when a person has symptoms of diabetes with high levels of sugar in the blood or urine. In extreme cases there can be severe abdominal pain, vomiting, poor feeding, poor activity and dehydration.
If you are worried that your child may have symptoms of type 1 diabetes, bring your child to a doctor right away.
Your child’s doctor can check for sugar in the urine or obtain a drop of blood from your child’s finger to check the blood sugar level with a glucose meter (a small portable machine).
Tests done to differentiate Type 1 from Type 2 Diabetes
| Test | Normal Value | How does it help? |
|---|---|---|
| Insulin Auto-Antibody (IAA) | <30 IU/ml | Elevated levels of IAA confirm a diagnosis and Predict the risk for developing type-I Diabetes |
| GAD – 65 Antibody | <30 IU/ml | The presence of GAD-65 autoantibody (most common autoantibody) also Confirms the autoimmune nature of Diabetes, i.e., type-I Diabetes |
| C-Peptide | 0.81 - 3.85 (ng/ml) | C-Peptide test is used to monitor insulin production; It helps to determine how much insulin is still produced in the pancreas. |
Presence of antibodies help in the diagnosis of Type 1 but absence does not rule out Type 1 diabetes.
How is type 1 diabetes treated?
Type 1 Diabetes is treated by giving the missing insulin. Insulin is often given as several daily injections using syringes or pens with very thin and short needles that make the injections almost pain free.
Ideally insulin in type 1 needs to be given 3-4 times before meals as it is required to digest the food. The injections are most commonly given in the lateral thigh area, belly and upper-outer buttock areas.
The latest method of giving insulin is through Insulin Pump where Insulin is delivered continuously thereby repeated pricks are avoided. But Pumps are a bit expensive!
What is the goal of sugar control in type 1 diabetes?
The goal of treatment is to normalize blood sugar levels in the range of 70-140 mg/dl. Patients need to check their blood sugar premeals and one at bedtime.
To measure blood sugar, a small drop of blood is obtained using a very fine lancet device and then put on a strip, which is then inserted into a home glucose meter.
What are the outcomes of inappropriate insulin administration?
When children with diabetes do not get enough insulin, their blood sugar levels will rise. (hyperglycemia). When they get too much insulin relative to food intake and activity level, their blood sugar levels can run low (hypoglycemia).
When hypoglycemia is unrecognized or untreated- headache, irritability, hunger, tiredness and if severe hypo – loss of consciousness, and/or fits can occur.
What are the key factors to have a good diabetes control ?
There are 4 key factors for keeping a good glycaemic control in your child with diabetes
- Regular meal timings with a healthy diet – No direct sugars and more of complex carbohydrates.
- Regular and adequate insulin dose administration using the correct technique.
- Maintaining a blood glucose monitoring and a diet intake log book.
- Daily physical activity like jogging/running/shuttle/badminton for at least one hour.
Can type 1 diabetes be prevented?
Thus far, a strategy for preventing the development of type 1 diabetes is not available. Relatives of people with type 1 diabetes are at higher risk of developing type 1 diabetes.
The development of diabetes in family members cannot be predicted with certainty, although blood tests that measure diabetes-related antibodies are available to assess the risk of diabetes in unaffected relatives of a type 1 diabetes children.
How do you take care of sick days in children with diabetes?
Do learn how to manage your child on the sick days by giving plenty of non sugary drinks. More frequent monitoring of blood sugar and continuing insulin as per blood glucose levels is very important.
Contact your diabetes care provider in case of any doubts. Never stop insulin without discussing with your doctor.
What is type 2 diabetes?
Diabetes is diagnosed when a high level of sugar is detected in the blood. It is less common in children, but it is occurring more frequently, typically among those who are overweight or obese.
It is detected in young, even at 8 years of age and in teenagers incidentally. About 30% of these people do not even know that they have diabetes.
What causes type 2 diabetes?
Nutrients in food are broken down into a simple sugar called glucose, which is an important source of energy for the body.
Glucose enters the cells in the body to become energy with the help of a hormone (a special messenger compound) called insulin.
Insulin is made by cells (called beta cells) in an organ located behind the stomach called the pancreas.
Muscle, fat, and the liver require insulin to take up glucose from the bloodstream and convert it to energy for the body.
Type 2 Diabetes can occur if the body continues to make insulin but is unable to respond to insulin. The tissues (liver, fat cells, skeletal muscle) in our body cannot take up the glucose due to the insulin resistance caused due to the fat pads around the organs.
Over time, the pancreas is not able to make enough insulin to keep normal blood sugar levels and hence diabetes develops.
What are the symptoms of type 2 diabetes?
- No symptoms
- Increased thirst and urination
- New-onset bed-wetting
- Fatigue
- Frequent infections, sores or cuts that are slow to heal
- Tingling or numbness in hands or feet, blurred vision
- Unexplained Weight loss occurring without much change in diet
How is type 2 diabetes diagnosed?
The diagnosis is made when a person has a blood sugar level greater than 200 mg/dL at any time with symptoms of diabetes or if the following test results occur:
- Fasting blood sugar level equal to or greater than 125 mg/dL
- A blood glucose level equal to or greater than 200 mg/dL during an oral glucose tolerance test
Or HbA1c > 6.5% (blood test that measures what percentage of hemoglobin in the blood has glucose attached to it and reflects the average blood sugar level in the blood over the prior 3 months).
This test is called haemoglobin A1c (HbA1c), and a result that is equal to or greater than 6.5% is suggestive of diabetes.
What is prediabetes?
Before the development of full-blown type 2 diabetes, there can be a phase of prediabetes that is called impaired glucose tolerance (if the blood sugar level after eating is between 140 and 199 mg/dL) or another form of prediabetes called impaired fasting glucose (if the fasting blood sugar level is between 100 and 126 mg/dL).
Who are at risk of type 2 diabetes?
Some people with high blood sugar levels do not have symptoms of diabetes; therefore, the American Diabetes Association recommends that children at high risk should be screened for diabetes when puberty starts, or by age 10 years, and then every 3 years thereafter.
Children at high risk include, Overweight and obese who have any 2 of the following characteristics:
- First- or second-degree relative (mother, father, sister, brother, aunt, uncle, or grandparent) with type 2 diabetes
- Signs of insulin resistance or conditions associated with insulin resistance
- Acanthosis nigricans (darkening/thickening of the skin, usually on the back of the neck)
- High blood pressure
- Atypical blood cholesterol levels
- Polycystic ovary syndrome (with irregular menstrual periods) in girls.