Diabetes is a disorder that affects 8.3 percent of the American population, or more than 25 million people. About 5 percent of people with diabetes have type 1 diabetes, which usually appears in children and adolescents, although some adults may also develop it. This type of diabetes has no definitive cure, but careful management of blood sugar can help prevent some complications that might develop with time.
Type 1 Diabetes
Type 1 diabetes is believed to be an autoimmune condition with a genetic component, because it tends to run in families. It is thought to possibly develop when a genetically susceptible person has a viral infection that triggers an abnormal immune response. The person's immune cells erroneously attack cells in the pancreas that make insulin. Insulin helps move glucose in the blood into your cells, which need it as an energy source. In type 1 diabetes, insulin production falls and eventually stops, resulting in blood glucose levels that are constantly high. Initial symptoms of diabetes include constant hunger with a lack of energy and possible weight loss, being thirsty all the time and urinating frequently. In most people, taking insulin on a regular basis helps keep blood glucose in a normal range and reverses these symptoms.
If you have type 1 diabetes, your risk of gradually developing certain complications might increase, especially if your insulin and glucose levels are not well controlled. When blood glucose is high for any period of time, it could thicken and injure the walls of tiny blood vessels called capillaries, making it more difficult for blood gases and nutrients to cross between your tissues and blood. This can be especially damaging for nerves and lead to a type of nerve damage called neuropathy. Symptoms can include tingling, numbness or a sensation of burning or pain that begins in the fingers or toes and spreads eventually into the limbs. If nerves in the penis are affected, this can cause erectile dysfunction in men. When nerves in the gastrointestinal tract are injured, you might experience nausea, vomiting or other digestive problems.
When blood glucose is not well controlled in type 1 diabetes, other complications become more likely, especially in organs that depend heavily on a good blood supply. The kidneys, for example, contain delicate clusters of capillaries that bring blood into each organ for filtration. When these capillaries are injured and become abnormal, this puts stress on the kidneys that can damage them, eventually leading to kidney malfunction and, in severe cases, kidney failure. The retinas of your eyes receive their nutrients from a small but vital capillary network, which can also be damaged by high blood glucose. Because of this, poorly controlled type 1 diabetes can raise the risk of a retinal disorder called retinopathy and of other vision problems. People with diabetes also have a higher risk of coronary artery disease caused by damage to arteries supplying the heart, and they sometimes experience general difficulty with healing of wounds or abrasions. If a woman with diabetes becomes pregnant and her blood sugar levels aren't well managed, her risk of miscarriage and pregnancy-induced hypertension is also increased. While all these possible complications might become serious, research suggests that controlling your blood sugar levels can significantly lower your risk of developing them.
In a large, government-sponsored, 10-year trial beginning in 1983, 1,400 subjects with type 1 diabetes were treated either with conventional therapy of 1 to 2 insulin injections daily or with intensive glucose monitoring and several daily insulin injections or insulin delivered by a pump. This trial ended one year early because the magnitude of benefit from intensive therapy was so obvious. Called the Diabetes Control and Complications Trial, it showed that close monitoring and careful control of blood glucose can effectively prevent development of vascular and neurological complications that otherwise might develop. A later trial, called the Epidemiology of Diabetes Interventions and Complications, followed the participants in the earlier study for an additional 14 years and found that those who had received intensive therapy in the earlier trial had fewer complications later in their lives than those who had been treated conventionally. These research trials confirmed that close monitoring and careful regulation of blood glucose in those with type 1 diabetes can greatly lessen the likelihood of future, potentially serious complications.
- American Diabetes Association: Diabetes Statistics
- Nature Reviews Endocrinology: The Diabetes Control and Complications Trial -- The Gift that Keeps on Giving
- Circulation: Effects of Prior Intensive Insulin Therapy on Cardiac Autonomic Nervous System Function in Type 1 Diabetes Mellitus -- The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study
- Journal of the Arkansas Medical Society: A Better Future for Children with Type 1 Diabetes -- Review of the Conclusions From the Diabetes Control and Complications Trial and the Epidemiology of Diabetes Interventions and Complicatons Study
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