Diabetes mellitus type 1 insulin dependant: Description, Causes and Risk Factors:
Alternative Name: Diabetes mellitus Type 1, juvenile onset diabetes.
IDDM is a chronic disease that occurs when the pancreas does not produce enough insulin to properly control blood sugar levels.
Diabetes mellitus type 1 insulin dependant can occur at any age. Many patients, however, are diagnosed after age 20. An estimated 23.6 million people in the United States have diabetes. IDDM appears to be most common in people of northern European descent and in specific Mediterranean groups (such as Sardinians). It is less common among Asians and African-Americans. Still, African-Americans with IDDM are 50% more likely to die from it, than Caucasians, mostly due to lower-quality health care.
The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.
Diabetes mellitus type 1 insulin dependant is an autoimmune disease. In Diabetes mellitus type 1 insulin dependant, the immune system attacks the insulin-producing beta cells in the pancreas and destroys them. The pancreas then produces little or no insulin. At present, scientists do not know exactly what causes the body's immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved. Some researchers believe one or more viral infections may trigger the disease in genetically susceptible individuals. An infection introduces a viral protein that resembles a beta-cell protein. T cells and antibodies are tricked by this resemblance into attacking the beta protein as well as the virus. Among the viruses under scrutiny are enteric viruses, which attack the intestinal tract. Epidemics of Coxsackie virus, as well as mumps and congenital rubella, have been associated with incidence of Diabetes mellitus type 1 insulin dependant.
Genetic Factors: Researchers have found at least 18 genetic locations, labeled IDDM1 - IDDM18 that are related to Diabetes mellitus type 1 insulin dependant. The Diabetes mellitus type 1 insulin dependant region contains the HLA genes that encode proteins called major histocompatibility complex (MHC). The genes in this region affect the immune response. New advances in genetic research are identifying other genetic components of IDDM. Other chromosomes and genes continue to be identified.
The odds of inheriting the disease, however, are only 10% if a first-degree relative has diabetes, and even in identical twins, one twin has only a 33% chance of having IDDM if the other has it. Children are more likely to inherit the disease from a father with type 1 diabetes than from a mother with the disorder.
Genetic factors cannot fully explain the development of Diabetes mellitus type 1 insulin dependant. Over the past 30 years, a major increase in the incidence of IDDM has been reported in certain European countries, and the incidence has nearly tripled in the northeastern U.S.
Symptoms may include:
The following tests are used for diagnosis if Diabetes mellitus type 1 insulin dependant:
FPG Test: A fasting plasma glucose (FPG) test measures blood glucose in a person who has not eaten anything for at least 8 hours. This test is used to detect diabetes and pre-diabetes. The FPG test is not always reliable, so a repeat test is recommended if the initial test suggests the presence of diabetes, or if the tests are normal in people who have symptoms or risk factors for diabetes. For example, people who take the test in the afternoon and show normal results may actually have abnormal levels that would be revealed if they are tested in the morning.
OGGT Test: An oral glucose tolerance test (OGTT) measures blood glucose after a person fasts at least 8 hours and 2 hours after the person drinks a glucose-containing beverage. This test can be used to diagnose diabetes and pre-diabetes.
Test for glycosylated hemoglobin (Hemoglobin A1c): This test examines blood levels of glycosylated hemoglobin, also known as hemoglobin A1c (HbA1c). The test is not affected by recent food intake so it can be taken at any time.
Ketone testing is also used in IDDM. Ketones are produced by the breakdown of fat and muscle. They are harmful at high levels. The ketone test is done using a urine sample. Ketone testing is usually done at the following times:
- Being very thirsty.
- Increased fatigue and weakness.
- Urinating often.
- Absence of menstruation.
- Feeling very hungry or tired.
- Losing weight without trying.
- Having sores that heal slowly.
- Having dry, itchy skin.
- Losing the feeling in your feet or having tingling in your feet.
- Having blurry eyesight.
A definitive diabetes diagnosis requires a second positive test performed on a different day. If symptoms of high blood glucose are extreme (e.g., diabetic ketoacidosis) and blood glucose levels are significantly elevated, your doctor may not require a second follow-up test.
In some cases, especially in those where it is unclear whether IDDM (Diabetes mellitus type 1 insulin dependant (type II is present, a physician may also prescribe additional blood tests. These may include a c-peptide test (which measures levels of this protein associated with insulin production) or tests for islet cell antibodies (ICA), insulin auto-antibodies (IAA), and/or glutamic acid decarboxylase (a beta cell protein known as GAD).
The following tests will help you and your doctor monitor your diabetes and prevent complications of diabetes:
- When the blood sugar is higher than 240 mg/dL.
- During an illness such as pneumonia, heart attack, or stroke.
- When nausea or vomiting occur.
- During pregnancy.
- Check the skin and bones on your feet and legs.
- Check the sensation in your feet.
- Have your blood pressure checked at least every year (blood pressure goal should be 130/80 mm/Hg or lower).
- Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled; otherwise, every 3 months.
- Have your cholesterol and triglyceride levels checked yearly (aim for LDL cholesterol levels below 100 mg/dL).
- Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
- Visit your ophthalmologist at least once a year, or more often if you have signs of diabetic retinopathy.
The immediate goals of treatment are to treat diabetic ketoacidosis and high blood glucose levels. Because IDDM can come on suddenly and the symptoms can be severe, newly diagnosed people may need to stay in the hospital.
Insulin is essential for strict control of blood glucose levels in IDDM. Tight blood glucose control is the best way to prevent major complications in IDDM, including those that affect the kidneys, eyes, nerve pathways, and blood vessels. Intensive insulin treatment in early diabetes may even help preserve any residual insulin secretion for at least 2 years.
Standard insulin therapy usually consists of one or two daily insulin injections, one daily blood sugar test, and visits to the health care team every three months. For strictly controlling blood glucose, however, intensive management is required. The regimen is complicated although newer insulin forms may make it easier.
Insulin cannot be taken orally because the body's digestive juices destroy it. Injections of insulin under the skin ensure that it is absorbed slowly by the body for a long-lasting effect.
Fast-Acting Insulin: Insulin lispro (Humalog) and insulin aspart (Novo Rapid, NovoLog) lower blood sugar very quickly, usually within 5 minutes after injection. Insulin peaks in about 4 hours and continues to work for about more 4 hours. This rapid action reduces the risk for hypoglycemic events after eating (postprandial hypoglycemia). Optimal timing for administering this insulin is about 15 minutes before a meal, but it can also be taken immediately after a meal (but within 30 minutes). Fast-acting insulins may be especially useful for meals with high carbohydrates.
Regular Insulin: Regular insulin begins to act 30 minutes after injection, reaches its peak at 2 - 4 hours, and lasts about 6 hours. Regular insulin may be administered before a meal and may be better for high-fat meals.
Long-Acting (Ultralente) Insulin: Long-acting insulins, such as insulin glargine (Lantus), are released slowly. Insulin glargine matches parts of natural insulin and maintains stable activity for more than 24 hours. Studies suggest that it poses less of a risk for hypoglycemia and weight gain. Ultralente insulin peaks at 10 hours and lasts up to 20 hours but varies greatly in activity from day to day.
Insulin Pens: Insulin pens, which contain cartridges of insulin, have been available for some time. Until recently, they were fairly complicated and difficult to use. Newer, prefilled pens (Humulin Pen, Humalog) are disposable and allow the patient to dial in the correct amount.
There is no single diabetes diet. Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs. Healthy eating habits, along with good control of blood glucose are the basic goals, and several good dietary methods are available to meet them.
- Carbohydrates should provide 45 - 65% of total daily calories.
- Fats should provide 25 - 35% of daily calories.
- Protein should provide 12 - 20% of daily calories.
Aerobic exercise has significant and particular benefits for people with IDDM. It increases sensitivity to insulin, lowers blood pressure, improves cholesterol levels, and decreases body fat. Because glucose levels swing dramatically during workouts.
Preventive Measures: People with IDDM need to take certain precautions:
- Avoid exercise if glucose levels are above 300 mg/dL or under 100 mg/dL.
- Before exercising, avoid alcohol and if possible certain drugs, including beta-blockers, which increase the risk of hypoglycemia.
- Avoid resistance or high impact exercises. They can strain weakened blood vessels in the eyes of patients with retinopathy. High-impact exercise may also injure blood vessels in the feet. Because patients with diabetes may have silent heart disease, they should always check with their doctors before undertaking vigorous exercise.
: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.