Definition

Type 1 Diabetes Mellitus (type 1 DM) is a condition where the immune system destroys insulin-producing cells in the pancreas, leading to a lack of insulin production. These insulin-producing cells are known as pancreatic beta cells. Insulin is a crucial hormone that regulates blood sugar, or glucose levels.

Under normal conditions, the body breaks down the food you eat into glucose (sugar), which is used as an energy source. Glucose enters the bloodstream and signals the pancreas to release insulin. Insulin helps glucose enter muscle, fat, and liver cells to be used as energy. When glucose enters the cells, its levels in the bloodstream decrease, signaling the pancreas to stop releasing insulin.

Without enough insulin, blood glucose levels become high, causing hyperglycemia (high blood glucose levels). This can prevent the body from using food as an energy source. If left untreated, this condition can lead to serious health problems or even death.

People with type 1 Diabetes Mellitus need artificial insulin daily for their everyday needs. Type 1 DM is often diagnosed in children and young adolescents, which is why it is also known as juvenile diabetes.

Causes

Autoimmune

Type 1 Diabetes Mellitus is caused by the immune system attacking the pancreas itself (autoimmune response), leading to a lack of insulin production. This can occur over months or years, resulting in insulin deficiency.

Risk Factor

Several risk factors can increase the likelihood of developing type 1 Diabetes Mellitus, including:

• Family history
• If you have parents or relatives with type 1 DM, you are at a higher risk of developing it.
• Genetics
• Having certain genetic markers can increase the risk of type 1 DM.
• Geography
• The prevalence of type 1 DM tends to be higher in regions near the equator.
• Age
• Type 1 DM can occur at any age but is commonly diagnosed during two peaks. The first peak occurs between the ages of 4 and 7 years, and the second between 10 and 14 years.

Symptoms

The symptoms of type 1 Diabetes Mellitus usually appear gradually but can worsen and become more severe over time. This progression can take days, weeks, or months as the pancreas produces less insulin. Common symptoms of type 1 DM include:

• Excessive thirst
• Frequent urination
• Increased hunger
• Unexplained weight loss
• Fatigue
• Blurred vision
• Slow-healing sores and wounds
• Infections in women, such as vaginal infections

Diagnosis

The diagnosis of type 1 Diabetes Mellitus is made through medical history, physical examination, and diagnostic tests.

Medical History

A medical history involves a session of questions and answers between the doctor and the patient. The doctor will ask about:

• Current symptoms
• Past medical history
• Family medical history
• Occupational and daily activities

Physical Examination

After the medical history, the doctor will conduct a physical examination, including measuring blood pressure, respiratory rate, pulse, and body temperature. The doctor will also assess the patient's weight and height.

Diagnostic Tests

Additional tests are necessary to confirm the diagnosis of type 1 Diabetes Mellitus. The doctor may recommend the following:

Laboratory Tests

• Blood glucose test
  • This test measures the amount of sugar in the blood. It can be done as a random test (without fasting) or as a fasting test (no food or drink for 8 hours before the test). High blood glucose levels may indicate type 1 DM.
• HbA1c test
  • If your blood glucose test indicates diabetes, your doctor may recommend an HbA1c test, which measures your average blood sugar levels over the past three months.

• Antibody test

• This test checks for autoantibodies to determine if you have type 1 or type 2 diabetes. Autoantibodies are proteins that intentionally attack body tissues. The presence of certain autoantibodies suggests you have type 1 DM. These autoantibodies usually do not appear in type 2 DM.

Read more: Diabetes Melitus Type 2 - Definition, Cause, Symptom, and Treatment

If you have a condition related to diabetes, such as diabetic ketoacidosis, a severe acute complication of diabetes mellitus, your doctor may recommend additional tests to assess your overall health, including:

• Metabolic panel
• This blood test checks eight different components in the blood to provide an overview of your chemical balance and metabolism.
• Urinalysis
• This test analyzes urine visually, chemically, and microscopically to check for ketones in the urine.
• Arterial blood gas analysis
• This test requires a blood sample from an artery to measure oxygen and carbon dioxide levels in the blood.

Read more: Blood Gas Analysis - Indications, Contraindications, Results And Suggestions

Management

Patients with type 1 Diabetes Mellitus need multiple daily doses of artificial insulin to survive. They must also maintain their blood glucose levels within a normal range. Treatment for type 1 DM is individualized based on the patient's condition.

There are three main principles for managing type 1 Diabetes Mellitus:

• Insulin
• Several types of synthetic insulin work at different speeds and remain in the body for varying durations. You may use a combination of insulins. The amount of insulin needed depends on factors such as weight, age, physical activity, diet, and random blood glucose levels.
• Blood glucose monitoring
  • Blood glucose meters: You prick your finger and place a small drop of blood on a test strip. The glucose level will appear on the meter within seconds. This option is cheaper but only provides a snapshot of your blood glucose at the time of testing.
  • Continuous glucose monitoring (CGM): This method requires inserting a small sensor under the skin every 7 to 14 days. The sensor is installed by a doctor and monitors glucose levels continuously. This method is more expensive than using a blood glucose meter.
• Patients with type 1 DM require continuous blood glucose monitoring throughout the day. Keeping blood glucose within a normal range is crucial to avoid health complications. Some methods for monitoring blood glucose include:
• Carbohydrate counting
• This involves calculating the carbohydrates in the food and drinks you consume to determine the amount of insulin needed. Carbohydrates are converted into glucose in the body, increasing blood glucose levels.

Complications

Possible complications of type 1 Diabetes Mellitus include:

• Vision problems, such as diabetic retinopathy, cataracts, macular edema, and glaucoma
• Foot problems, such as infections and gangrene
• Heart disease
• High blood pressure
• Kidney problems
• Oral health issues
• Diabetes-related nerve disorders
• Skin conditions, such as dry skin, bacterial infections, and fungal infections
• Stroke
• Ketoacidosis

If you want to know more about diabetic retinopathy, you can read it here: Diabetic Retinopathy - Definition, Cause, Symptom, and Treatment

Prevention

The prevention of type 1 diabetes mellitus is currently unknown. This type of diabetes can be inherited, so doctors may recommend screening family members for autoimmune conditions that could lead to the disease. The presence of autoantibodies, even without symptoms of diabetes, indicates the possibility of type 1 DM.

When to See a Doctor?

If you experience symptoms of diabetes, such as:

• Ketoacidosis
• High blood glucose levels
• Nausea and vomiting
• Rapid breathing

Seek emergency care immediately, as these conditions can be life-threatening. Consult an endocrinologist (a doctor specializing in hormonal disorders and type 1 Diabetes Mellitus) to discuss your test results.

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