Diabetes – Type 1

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. People with type 1 diabetes need to take insulin every day to stay alive.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as:

  • heart disease
  • stroke
  • kidney disease (diabetic nephropathy)
  • eye problems (diabetic retinopathy)
  • dental disease
  • nerve damage (diabetic neuropathy)
  • foot problems

You can take steps to lower your chances of developing these diabetes-related health problems.

What are the symptoms of diabetes?

Symptoms of diabetes include

  • increased thirst and urination
  • increased hunger
  • fatigue
  • blurred vision
  • numbness or tingling in the feet or hands
  • sores that do not heal
  • unexplained weight loss

Symptoms of type 1 diabetes can start quickly, in a matter of weeks. Symptoms of type 2 diabetes often develop slowly—over the course of several years—and can be so mild that you might not even notice them. Many people with type 2 diabetes have no symptoms. Some people do not find out they have the disease until they have diabetes-related health problems, such as blurred vision or heart trouble.

What causes type 1 diabetes?

Type 1 diabetes occurs when your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Studies such as TrialNet are working to pinpoint causes of type 1 diabetes and possible ways to prevent or slow the disease.

Diabetes Tests & Diagnosis

our health care professional can diagnose diabetes, prediabetes, and gestational diabetes through blood tests. The blood tests show if your blood glucose, also called blood sugar, is too high.

Do not try to diagnose yourself if you think you might have diabetes. Testing equipment that you can buy over the counter, such as a blood glucose meter, cannot diagnose diabetes.

Test for Type 1 diabetes

Most often, testing for type 1 diabetes occurs in people with diabetes symptoms. Doctors usually diagnose type 1 diabetes in children and young adults.

Health care professionals most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose diabetes. In some cases, they may use a random plasma glucose (RPG) test.

Fasting plasma glucose (FPG) test

The FPG blood test measures your blood glucose level at a single point in time. For the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.

A1C test

The A1C test is a blood test that provides your average levels of blood glucose over the past 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. When it comes to using the A1C to diagnose diabetes, your doctor will consider factors such as your age and whether you have anemia or another problem with your blood.1 The A1C test is not accurate in people with anemia.

Your health care professional will report your A1C test result as a percentage, such as an A1C of 7 percent. The higher the percentage, the higher your average blood glucose levels.

People with diabetes also use information from the A1C test to help manage their diabetes.

Random plasma glucose (RPG) test

Sometimes health care professionals use the RPG test to diagnose diabetes when diabetes symptoms are present and they do not want to wait until you have fasted. You do not need to fast overnight for the RPG test. You may have this blood test at any time.

What test numbers tell me if I have diabetes or prediabetes?

Each test to detect diabetes and prediabetes uses a different measurement. Usually, the same test method needs to be repeated on a second day to diagnose diabetes. Your doctor may also use a second test method to confirm that you have diabetes.

The following table helps you understand what your test numbers mean if you are not pregnant.

Diagnosis A1C (percent)  Fasting plasma glucose (FPG)a Oral glucose tolerance test (OGTT)ab Random plasma glucose test (RPG)a
Normal below 5.7 99 or below 139 or below  
Prediabetes 5.6 t0 6.4 100 to 125 140 to 199  
Diabetes 6.5 or above 126 or above 200 or above 200 or above


Which tests help my health care professional know what kind of diabetes I have?

Even though the tests described here can confirm that you have diabetes, they can’t identify what type you have. Sometimes health care professionals are unsure if diabetes is type 1 or type 2. A rare type of diabetes that can occur in babies, called monogenic diabetes, can also be mistaken for type 1 diabetes. Treatment depends on the type of diabetes, so knowing which type you have is important.

To find out if your diabetes is type 1, your health care professional may look for certain autoantibodies. Autoantibodies are antibodies that mistakenly attack your healthy tissues and cells. The presence of one or more of several types of autoantibodies specific to diabetes is common in type 1 diabetes, but not in type 2 or monogenic diabetes. A health care professional will have to draw your blood for this test.

If you had diabetes while you were pregnant, you should get tested 6 to 12 weeks after your baby is born to see if you have type 2 diabetes.

Managing Type 1 Diabetes

Initial Treatment and Education

Those first diagnosed with type 1 diabetes whose blood sugar levels are very high may be suffering from diabetic ketoacidosis, dehydration and other medical complications that require emergency treatment or hospitalization.

Once stabilized, diabetes education and long-term treatment may begin. This includes instructions on proper insulin use, meal planning,weight control, exercise, foot care, and careful self-testing of blood glucose levels.

The goals of treatment are to prolong life, reduce symptoms, and prevent diabetes-related complications.

Insulin

Insulin lowers blood sugar by allowing it to leave the blood stream and enter cells. Insulin is injected under the skin or delivered continuously via a pump. Insulin does not come in pill form.

The injections are needed, in general, from one to four times a day. People are taught how to give insulin injections by their health care provider or a diabetes nurse educator.

Initially, a child's injections may be given by a parent or other adult. By age 14, most children can be expected (but should not be required) to give their own injections.

Diet

Meal planning for type 1 diabetes requires consistency to allow food and insulin to work together to regulate blood glucose levels. If meals and insulin are out of balance, extreme variations in blood glucose can occur.

Physical activity

Regular exercise helps control the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight.

Ask your health care provider before starting any exercise program. Those with Type 1 diabetes must take special precautions before, during, and after intense physical activity or exercise.

Blood Glucose Self-Testing

Blood glucose monitoring is done by checking the glucose content of a small drop of blood. The testing is done on a regular basis and will inform the person with diabetes how well diet, medication, and exercise are working together to control diabetes.

The results can be used to adjust meals, activity, or medications to keep blood sugar levels within an appropriate range. It will provide valuable information for the health care provider to suggest changes to improve care and treatment. Testing will identify high and low blood sugar levels before serious problems develop.

Foot care

Diabetes causes damage to the blood vessels and nerves, which can result in a decreased ability to feel injury to or pressure on the foot. A foot injury could go unnoticed until severe infection develops.

Additionally, diabetes affects the body's immune system, decreasing the body's ability to fight infection. Small infections can rapidly progress to death of the skin and other tissues. Amputation may be needed. You can prevent these complications by establishing a daily foot care routine.

Treating Low Blood Sugar

Low blood sugar, known as hypoglycemia, can occur from too much insulin, too much exercise, or too little food. Hypoglycemia can develop quickly in people with diabetes. Symptoms typically appear when the blood sugar level falls below 70. Watch for weakness, shaking, sweating, headache, nervousness, and hunger.

If these symptoms occur and you have a blood sugar test kit available, do a blood sugar check. If the level is low, the person with diabetes should eat something with sugar: fruit juice, several teaspoons of sugar, a cup of skim milk, or regular soda. If you don't have a test kit handy, sugar should be eaten anyway--it can't hurt. Symptoms should go away within 15 minutes. If the symptoms don't go away, more sugar should be eaten and the sugar level tested again.

AFTER the symptoms go away, more substantial food can be eaten. Eat simple sugar first to get the situation under control. Even if you or your child is hungry, "real" food should not be eaten until the sugar level comes up--real food won't produce enough sugar and takes too long to digest.

If you are a parent, relative, or friend of someone experiencing these symptoms, monitor the person closely. If symptoms become worse--confusion, seizures, or unconsciousness--give the person a shot of glucagon. If you don't have glucagon, call 911 immediately.

You should have some glucagon stored for emergencies. Make sure everyone in your home, as well as babysitters and caregivers, knows how to use it. Periodically remind everyone how to use it, and check the expiration date.

Don't panic. Glucagon works very fast--usually within 15 minutes. Lay the person on the side to prevent choking. If the person is not better in 15 minutes, call 911.

Maintaining Good Health for People with Type 1 Diabetes

Most people with diabetes will need to meet with their doctor, health care provider or diabetes educator regularly.

Medical tests that may be performed regularly include

  • Glycosylated hemoglobin (Hemoglobin A1c)
  • Cholesterol levels
  • Triglyceride levels
  • Kidney function (BUN, creatinine)

People with diabetes are also advised to to have eye exams at least once a year, or more frequently if signs of diabetic retinopathy develop.

People with diabetes should see the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.

Check your feet every day for early signs of injury or infection. Make sure your health care provider inspects your feet at each visit.

Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.

Managing Type 1 Diabetes

You are the most important person in managing your diabetes. Diabetes education involves learning how to live with your diabetes and helps prevent complications. You should know the basic steps to diabetes management:

  • How to recognize and treat low blood sugar (hypoglycemia)
  • How to recognize and treat high blood sugar (hyperglycemia)
  • Diabetes meal planning
  • How to give insulin
  • How to monitor blood glucose and urine ketones
  • How to adjust insulin and food intake during exercise
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them

Outlook for Those with Type 1 Diabetes

The outcome for people with diabetes varies. Studies show that tight control of blood glucose can prevent or delay complications to the eyes, kidneys, and nervous system. However, complications may occur even in those with good diabetes control.

Emergency Treatment for Diabetes

Call your health care provider or go to the emergency room if you have symptoms of ketoacidosis:

  • Increased thirst and urination
  • Nausea
  • Deep and rapid breathing
  • Abdominal pain
  • Sweet-smelling breath
  • Loss of consciousness (This may occur in insulin dependent diabetics who miss a dose of insulin, or if they are sick or have an infection.)

Go to the emergency room or call 911 if you have symptoms of severe hypoglycemia or insulin reaction:

  • Trembling
  • Weakness
  • Drowsiness
  • Headache
  • Confusion
  • Dizziness
  • Double vision
  • Lack of coordination
  • Convulsions or unconsciousness

You can treat early signs of hypoglycemia at home by eating sugar or candy or taking glucose tablets. If your signs of hypoglycemia are still not relieved or if your blood glucose levels remain below 60 mg/dL, go to the emergency room.


Reference: National Institutes of Diabetes and Digestive and Kidney Diseases

Last updated: February 8, 2017

aGlucose values are in milligrams per deciliter, or mg/dL.

bAt 2 hours after drinking 75 grams of glucose. To diagnose gestational diabetes, health care professionals give more glucose to drink and use different numbers as cutoffs.

Source: Adapted from American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(1):S14–S20, tables 2.1, 2.3.

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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