Type 1 Diabetes

Type 1 Diabetes
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In type 1 diabetes, the body’s ability to regulate blood glucose is severely impaired. Blood glucose (blood sugar), is produced from the digestion of food (mostly carbohydrates) and by the liver, and is the source of energy for every cell of the body. The pancreas no longer produces the hormone insulin. Insulin's job is to take the glucose from the blood and transport it to the cells to create energy. Lack of insulin causes the glucose to build up in the blood, and overtime cause serious damage to all body systems.

Type 1 diabetes is an autoimmune disease where the body's immune system attacks the insulin producing cells of the pancreas, called beta-cells, and destroys them. Very little is yet known why this happens, but the body must now depend on external insulin to survive.

Reasons of Type 1 Diabetes

It is suspected that some kind of infection or virus triggers the autoimmune response that attacks the beta cells of the pancreas. The anti-body GAD (glutamic acid decarboxylase) is found in 70-80 percent of type 1 diabetes patients.

The environment may also be a factor. More cases of diabetes are diagnosed in the winter months, in Northern climates, and in Caucasians. For instance, Canada has 60 percent more cases diagnosed per year than the U.S. Other factors that have been explored are childhood feeding practices, childhood viruses, and genetic susceptibility.

Treatment- Basics of Insulin

Without the internal production of insulin, digestion turns food into glucose (energy) but the glucose cannot be used for energy and so glucose builds up to high levels in the blood. The cells need the glucose but the key to unlock the energy is missing- insulin.

All persons with type 1 diabetes need intensive insulin therapy (three or more injections of insulin per day). Great advances have been made in insulin medications as well as the injection or delivery to the body. The newer insulins work similar to what the body used to make. The insulin is stored in syringes with needles, and even newer insulin pens are available. Today's needles are very thin and short, and nearly painless. Many people with type 1 diabetes use Insulin Pump Therapy (CSII-Continuous Subcutaneous Insulin Infusion) which eliminates the 3-5 shots a day to one insertion every three days.

If your child is diagnosed with type 1 diabetes, you will have a lot of questions and will want to learn as much as possible. Here are a few books that will help (See online resources in a later section):

• Understanding Diabetes 12th Edition, Peter Chase M.D.
• First Book for Understanding Diabetes (The Pink Panther Booklet)- by H. Peter Chase, M.D. 11th edition 2006. This booklet - and the above mentioned Understanding Diabetes -- is available through the Barbara Davis Center for Childhood Diabetes at the University of Colorado. It can be read online or purchased at the website. This booklet is a must have, and may be a part of the education you receive at the hospital.
• The Everything Parent's Guide to Children with Juvenile Diabetes: Reassuring Advice for Managing Symptoms and Raising a Happy, Healthy Child - Moira McCarthy, Jake Kushner, Adams Media: 2007.

Starting Insulin

Your health care provider will start you on an insulin regimen specifically designed for you. Sometimes only one daily injection is required of this long-acting insulin. This is a long acting insulin or basal insulin (glargine or detemer) and it is taken at the same time every day and delivers a continuous "peakless" background insulin just like the pancreas used to do. Think of this insulin as "baseline" for basal dose, to cover all the time. This insulin will never make you go low or hypoglycemic.

Next, a rapid-acting insulin is added, which mimics the first and second phase secretions of insulin when you eat food. This is also referred to as multi-daily injections or MDI. There are a number of rapid-acting insulins, with slightly different onsets, peaks and durations. Your health care provider will determine the best for you. Lispro, aspart, and glulisine are the current rapid acting insulins available on the market. You will need to test your blood glucose before each meal and then adjust your insulin dose (as directed by your physician) and give yourself an insulin shot just before you eat. This is called a bolus shot, which controls the rise of blood glucose from the food you are eating. Think "bowl" like a bowl of food. When you are taking rapid acting insulin with meals you need to make sure and eat carbohydrate foods or you run the risk of going low or experiencing hypoglycemia.

Just as we are all unique as individuals, there are a variety of insulins and schedules that can be created to best control your blood glucose for your unique lifestyle. You might work night shift, or care for the child with diabetes who is a picky eater, or you may be an athlete and have hours of training exercise a day. A child with Type 1 will need to have treatment plans adjusted for growth spurts. Parents and the child will learn how to adjust for sports, birthday parties and sick days. You need to work closely with a diabetes specialist to get the best treatment plan for you.

Delivering Insulin Into Your Body

You or your child will be instructed on the proper technique for insulin administration. There are several ways to take insulin, and you should be aware that there are options:

• 1. Syringe: A syringe is a hollow plastic tube with a plunger and a needle at the other end. There are markers to measure the units of insulin. The syringe is inserted into a vial of insulin and the insulin is extracted to the proper dose. Good eyesight and finger dexterity is needed for this technique.
• 2. Insulin pens: A newer and easier method to inject insulin, especially for people on the go, visually impaired and poor coordination. The pen has an insulin cartridge, and a small needle for injection.
• 3. Insulin pump: The pump is a small computerized device that delivers insulin in two ways- a constant small amount of basal insulin and then a bolus of insulin at meals that the wearer determines. However, only rapid acting insulin is used in the pump. The pump is attached to the body all the times (except when showering and swimming) and is the size of a beeper or cell phone. The need for four or more shots a day is gone- the pump tubing is replaced every three days and a small plastic catheter inserted in the skin (with a needle) delivers the insulin. People who are comfortable with technology and want to be free of the daily shots and who need better glucose control find the pump a positive change. Starting on a pump is a decision the patient must be comfortable with, and must have demonstrated self-monitoring and assumed responsibility for good control. Small children benefit from the pump because very small doses of basal insulin can be given and there are less needle pricks. Explore the pros and cons here. Most people who choose the pump achieve even better glycemic control. A diabetes educator can help the patient decide if he/she is ready for the pump, review the types of pumps, and identify which one would best serve his/her needs.

Treatment- Monitoring Blood Glucose

In order to know how much insulin to take, you need to know what the blood glucose level is. A finger prick and a glucometer will give you this immediate information. You can determine if your glucose level is going too high or too low. You can them make adjustments with more or less insulin, food or exercise.

The goal is to regulate the blood glucose as close to normal as possible. This is a chart of the goals at different times of the day.

Insulin Therapy Blood Glucose Goals

Time	Ideal Glucose Level (mg/dl)	Acceptable Glucose Level (mg/dl)
Before Meals	70-110	90-130
One Hour After Meals	80-120	160-180
Two Hours After Meal	80-120	160-180
Bedtime	80-120	110-150
2 a.m.-3 a.m.	80-120	100-140

Tracking your blood glucose and keeping good records lets you know if you are on target, and if you should be making changes.

Continuous Glucose Monitor

Technology is always forging ahead, and the newest invention is the Continuous Glucose Monitor (CGM). Although not commonly used in the past, more insurance companies are covering the cost of this device. The CGM is worn all the time, and reports blood glucose every 5 minutes. The data is displayed on the screen with a graph, and the trend of the readings, up or down, is easily read. Fingers must still be pricked once or twice daily to calibrate the CGM. Some people wear one for a week to analyze blood glucose patterns that are puzzling and to figure insulin dosing changes. Some “pumpers” (people on the insulin pump) wear one continuously.

Teamed up with an insulin pump, a person with diabetes has the latest in diabetes technology. The CGM is recommended for age 18 and over, but some younger people have benefited from the use. Research is moving toward an "artificial pancreas," which combines the CGM with a pump to regulate insulin with little human intervention.

But remember always take the suggestions of the doctors. Wish your good health.