In this part . . .
**IN a DROPCAP** Chapter 1
Dealing with Type 1 Diabetes
In This Chapter
Discovering what type 1 diabetes is
Dealing with physical and emotional effects
Living life to the fullest with type 1 diabetes
In 2005, the most recent year for which there are statistics, there were 340,000 people in the United States with type 1 diabetes (T1DM) according to the Centers for Disease Control. About half were children up to age 20. There are 30,000 new cases every year, almost all in children.
Whether youāre an older child or young adult able to take care of your own diabetes, or a parent or other caregiver for a young child with this disease, you should be aware that thereās a great deal that you can do to minimize both the short- and long-term complications that may develop and live a long and healthy life with T1DM.
What! You donāt believe me! Consider the story of two brothers, Robert and Gerald. Robert is 85 years old and developed T1DM at age 5. Gerald is 90 and developed T1DM at age 16. The physician who follows them, Dr. George L. King, research director of the Joslin Diabetes Center in Boston, studies patients with T1DM who have lived more than 50 years with the disease. He has more than 400 such patients.
Dr. King says that these patients have a lot in common. They
Keep extensive records of their blood sugars, their diet, their exercise, their insulin dosage, and their daily food consumption
Have a very positive outlook
These actions form the basis of effective T1DM treatment, which I introduce in this chapter. I also give you an overview of the potential consequences of T1DM and tips for living well with it.
At the present time, thereās no way to prevent T1DM, but I believe a change isnāt far off and T1DM may be preventable in perhaps in the next five years. The breakthrough will come with the use of stem cells, transplantation, or the elimination of the cause of T1DM. You can read much more about this subject in Chapters 13 and 21.
Understanding What Type 1 Diabetes Is (and Isnāt)
T1DM, simply stated, is an autoimmune disease. Immunity is what protects you from foreign invaders like bacteria and viruses. In autoimmunity, your body mistakenly acts against your own tissues. In T1DM, the immune cells and proteins react against the cells that make insulin, destroying them. (Insulin is the chemical or hormone that controls the blood glucose; glucose is sugar that provides instant energy.)
Although it often begins dramatically, T1DM doesnāt occur overnight. Many patients give a history of several months of increasing thirst and urination, among other symptoms. Also, T1DM usually begins in childhood, but some folks donāt develop it until theyāre adults. In either case, to verify a diagnosis of T1DM, a sample of blood is taken and its glucose level is measured. If the patient is fasting, the level should be no more than 125 mg/dl; if thereās no fast, the level should be no more than 199 mg/dl. For further confirmation, tests should be done at two different times to check for inconsistencies. However, a person with a blood glucose of 300 to 500 mg/dl who has an acetone smell on his breath clearly has T1DM until proven otherwise.
So how is type 1 diabetes different from type 2 diabetes (T2DM)? The central problem in T2DM isnāt a lack of insulin but insulin resistance; in other words, the body resists the normal, healthy functioning of insulin. Before the development of T2DM, when a personās blood glucose is still normal, the level of insulin is abnormally high because the person is resistant to the insulin and therefore more is needed to keep the glucose normal.
To complicate matters, a type of diabetes called Latent Autoimmune Diabetes in Adults (LADA) is a cross between T1DM and T2DM; a person with LADA exhibits traits of both diseases.
Chapter 2 details the basics of T1DM, including how insulin works, what goes wrong when blood glucose levels are too high, the specific symptoms to watch for, and gathering a team of doctors and other specialists after a diagnosis. Chapter 3 fully explains how T2DM and LADA are different from T1DM.
Handling the Physical and Emotional Consequences of Type 1 Diabetes
What makes diabetes a difficult disease are the physical complications associated with poor control of the blood glucose. These complications are generally divided into short-term complications and long-term complications.
Short-term complications, which I cover in Chapter 4, are the result of a blood glucose thatās either very low or very high. Low blood glucose (called
hypoglycemia) can occur in minutes as a result of too much insulin, too much exercise, or too little food, but high blood glucose often takes several hours to develop. Whereas low blood glucose often can be managed at home, severe high blood glucose (called
diabetic ketoacidosis) is an emergency thatās managed by a doctor in the hospital. Nevertheless, itās important that you understand how it develops in order to prevent it. Chapter 4 describes the signs and symptoms associated with both of these complications and the best ways of handling them.
Long-term complications, which I cover in Chapter 5, can be devastating. Itās much better to prevent them with very careful diabetes management than to try to treat them after they develop. Fortunately, they take 15 or more years to fully develop, and thereās time to slow them down if not reverse them if youāre aware of them. All long-term complications can be detected in the very earliest stages.
The long-term complications consist of eye disease known as retinopathy, kidney disease known as nephropathy, and nerve dise...
