Type 1 diabetes

Diagnosis

The diagnosis of type 1 diabetes can be diagnosed by the following tests:

• Fasting blood sugar test: The blood sample will be taken following a overnight fasting which will check the sugar level in the blood. A healthy fasting blood sugar level is under 100 mg/dL (5.6 mmol/L). Prediabetes is defined as having a fasting blood sugar level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L). You have diabetes if it is 126 mg/dL (7 mmol/L) or above on two separate tests.
• Random blood sugar test: A random blood sample will be drawn, and other tests may be used to validate the results. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or greater suggests diabetes regardless of when you last had your meal.
• Glycated hemoglobin (A1C) test: This blood test reveals your average blood sugar level during the previous two to three months. It measures the quantity of blood sugar bonded to the protein in red blood cells that carries oxygen (hemoglobin).

If the A1C test is unavailable or the patient have a condition that could make the test inaccurate, like pregnancy or a rare kind of hemoglobin, patient should consult their medical professional.

• Antibody test: A blood test to identify whether you have Type 1 or Type 2 diabetes, it looks for autoantibodies, which are typical with type 1 diabetes. Type 1 diabetes is indicated by the presence of certain autoantibodies. In most Type 2 diabetes patients, autoantibodies are absent.

In order to evaluate the general health and determine whether you have diabetes-related ketoacidosis, a serious acute complication of undiagnosed or untreated Type 1 diabetes, the doctor may additionally request the following tests:

• Basic metabolic panel: A blood test called a basic metabolic panel evaluates eight distinct chemicals in your blood. The panel offers valuable knowledge regarding the metabolism and chemical balance of your body.
• Urinalysis: When Type 1 diabetes is identified, the doctor will likely order the test to look for ketones, which the body produces when it must burn fat for energy rather than glucose. The blood becomes acidic when the patient have a lot of ketones, which can be dangerous and life-threatening.
• Arterial blood gas: measures the levels of oxygen and carbon dioxide in the blood by drawing a blood sample from an artery in the body.

Treatment

Synthetic insulin is required by people with Type 1 diabetes several times each day to maintain good health and to maintain healthy blood sugar levels.

The treatment of Type 1 diabetes is complex and highly customized since numerous factors affect the blood sugar level.

The following are the key elements of Type 1 diabetes management:

• Insulin
• Blood glucose monitoring
• Counting carbohydrates, fats and protein
• Healthy foods
• Regular exercise
• Maintain a healthy weight

To delay or avoid complications, it is important to keep the blood sugar level as close to normal as possible.

Insulin for type 1 diabetes management:

The patient will require several daily injections that combine a long-acting insulin and a rapid-acting insulin. Compared to earlier insulin regimens that only required one or two shots each day, these injections behave more like the body’s typical use of insulin. It has been demonstrated that combining three or more insulin injections daily will lower blood sugar levels.

Anyone with type 1 diabetes will need insulin therapy lifelong. There are different insulin types, such as:

• Short-acting insulin: will work 30 minutes after injection. The duration is 4 to 6 hours, with the peak effect occurring between 90 and 120 minutes. (Examples include Afrezza, Novolin R, and Humulin R.)
• Rapid-acting insulin: will work after 15 minutes and will last about 4 hours, reaching its full effect about 60 minutes. This kind is frequently taken 15 to 20 minutes before meals. (Examples include glulisine, lispro, and aspart).
• Intermediate-acting insulin: This kind of insulin, also known as NPH insulin, begins to work within one to three hours. It takes 6 to 8 hours to attain its greatest effect and lasts 12 to 24 hours (Examples include insulin NPH (Novolin N, Humulin N).
• Long- and ultra-long-acting insulin: This kind of insulin may offer protection for up to 14 to 40 hours. (Examples include detemir, glargine, and degludec).
• Rapid-acting inhaled insulin: This is an inhaled typed of insulin through the mouth. In comparison to other insulin kinds, it operates more faster.

Options for insulin delivery

It is not possible to take insulin orally to reduce blood sugar since stomach enzymes will degrade the medication and render it ineffective. Patients may need to use an insulin pump or injection shots.

• Injections: If patient decide to take injection shots, they will likely need a variety of types of insulin to use both at night and throughout the day. When injecting insulin under the skin, they can use an insulin pen or a small needle and syringe. Insulin pens come in disposable and refillable types and have an ink pen-like appearance.
• An insulin pump: A catheter is implanted beneath the skin of the abdomen and connected by a tube to a reservoir of insulin. A small device is set up, which the patient wears on the outside of the body, to release predetermined doses of insulin at certain times of the day and after meals.

Blood sugar monitoring

It is recommended that patients with diabetes need to check and record their blood sugar level at least four times a day, depending on the type of insulin therapy they choose or require.

It is recommended to check the blood sugar level before meals and snacks, before going to bed, before engaging in physical activity or driving a vehicle, or if suspected to have low blood sugar.

Blood sugar levels can change even if the patient takes insulin and follows a strict diet plan. They will discover how their blood sugar levels alter in reaction to several factors, including diet, exercise, illness, drugs, stress, hormonal changes, and alcohol.

• Continuous glucose monitoring (CGM): Blood sugar levels are monitored via continuous glucose monitoring to avoid low blood sugar. A tiny needle is used to attach continuous glucose monitors to the body beneath the skin. Every several minutes, they monitor the blood glucose levels.
• Closed loop system: The implanted device connects an insulin pump with a continuous glucose monitor. Every five minutes, the monitor measures the blood sugar. When the monitor indicates that more insulin is needed, the device automatically administers the appropriate dosage.

Other prescribed medications

People with type 1 diabetes may also be prescribed other drugs, such as:

• Medications for high blood pressure: To maintain healthy kidneys, the doctor might prescribe angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), which block the angiotensin II receptor. For diabetics with blood pressures more than 140/90 mmHg, these drugs are advised.
• Aspirin: To protect the heart, the doctor could recommend to take regular aspirin every day. The possibility of bleeding if the patient takes aspirin will be discussed by the doctor.
• Cholesterol-lowering drugs: Because diabetics have a higher chance of developing heart disease, cholesterol standards are stricter for them.

Healthy lifestyle

• Healthy food intake: The patient will be advised to consume fewer meat products and processed carbs, such as white bread and sugary foods. Even those without diabetes are encouraged to follow this nutritious eating regimen. The focus of your diet should be on nutrition, low-fat, high-fiber foods like fruits, vegetables, and whole grains.
• Physical activity: It’s important to keep in mind that exercise decreases blood sugar. Check the blood sugar more frequently than normal if undergoing a new activity until there is an understanding of how it affects blood sugar levels. Because of the increased exercise, it may be necessary to modify the diet or insulin dosage. Prior to the physical activity, it is advised to get the approval of their doctor.

Possible treatment that may be used

• Pancreas transplant: If a pancreas transplant is successful, insulin would no longer be required. However, pancreatic transplants are not always successful and have significant complications. Pancreas transplants are typically used for patients with extremely difficult-to-manage diabetes since the complications can be much more serious than the diabetes itself. Additionally, they can be applied to those who also require kidney transplants.
• Islet cell transplantation: New insulin-producing cells from a donor pancreas are provided. The success of the treatment may increase with the development of new methods and better medications to stop islet cell rejection.

Side effect of Diabetes treatment

Low blood sugar (hypoglycemia) is the main adverse reaction of insulin-based diabetic treatment. If the patient take too much insulin based on their food consumption and/or degree of activity, low blood sugar may result. Below 70 mg/dL is typically considered as hypoglycemia.

Low blood sugar symptoms can appear suddenly and differ in how they are felt by different individuals. The unpleasant symptoms of hypoglycemia serve as good indicators that the patient needs to act before their blood sugar levels drop even lower.

It is important to treat hypoglycemia as soon as possible because it might be harmful.
Low blood sugar symptoms include:

• Shaking or trembling
• Chills or sweating
• Nervousness or irritability
• Rapid heart rate
• Headache
• Dizziness or lightheadedness
• Restlessness
• Weakness

For a low blood sugar episode, the American Diabetes Association advises following the “15-15 rule,” which includes:

• 15 grams of carbohydrates from food or drink will increase blood sugar.
• Check blood sugar after 15 minutes
• Take another 15 grams of carbohydrates if blood sugar is still below 70 mg/dL.
• Continue until your blood sugar level reaches at least 70 mg/dL.