Type 1 Diabetes

Dr Rajeswaran, consultant diabetologist explains all about investigations, treatment and complications of type 1 diabetes. Please email him if you need more information.

Type 1 diabetes is seen more often in children and young adults. Some elderly people can also develop type 1 diabetes. Type 1 diabetes is thought to be an autoimmune disease like Graves disease, Hashimoto’s thyroiditis, coeliac disease and Addison’s disease. This means the immune system produces antibodies against the beta cells in the pancreas.

People with type 1 diabetes lack insulin, which is  a vital hormone for metabolism. Symptoms of type 1 diabetes include:

• Excessive urination
• Excessive thirst
• Weight loss

Treatment of type 1 Diabetes

Not taking insulin can lead to life threatening complications. Hence people with type 1 diabetes should never skip or miss a dose of insulin unless agree with diabetes nurse or doctor.Aim of the treatment is to bring about good blood glucose control, avoiding hypoglycaemia and prevent complications.

Key to improving blood glucose control is to monitor blood glucose regularly and act upon it. There are several blood glucose monitoring devices. recently it has becomes easier to monitor blood glucose using Freestyle libre and other Continuous Blood Glucose Systems(CGMS).

To prevent hypoglycaemia (low blood glucose) or hyperglycaemia(High blood glucose), it is important to check blood glucose levels:

• More often, if having frequent hypoglycaemia
• At different times in the day either after meals for before meals
• Occasionally, should do fasting blood glucose
• During and after vigorous exercise.
• During illness, like fever, vomiting or infection

There are several types of insulin and regimes, which people are prescribed. Usually for type 1 diabetes it is a combination of short or rapid acting insulin along with long acting or intermediate acting insulin called the “Basal bolus regime”.

Others are on premixed insulin, which an insulin combination of intermittent and short acting insulin, together in a pen.

Insulin can also be delivered through pump. These days a closed loop pump has also been used.

Annual diabetes check for type 1 diabetes

People with type 1 diabetes  should have have yearly check up with their nurse or diabetes team.This helps to identify underlying problems and address them immediately. Below is a list of checks, which needs to be done yearly and during every three to four monthly visit:

1. Review blood glucose profile
2. Check and review HbA1c (glycosylated haemoglobin)
3. Advice on insulin injection technique
4. Check insulin injection sites for lipo hypertrophy or hypoatrophy
5. Hypoglycaemia prevention advice
6. Assess if hypoglycaemia warning is present
7. Blood pressure check
8. Cholesterol check
9. Eye screening, using digital retinal screening
10. Foot and leg check
11. Kidney tests( blood test and urine for microalbuminuria)
12. Weight management advice if applicable
13. Enrol in DAFNE or relevant course of type 1 diabetes
14. Flu jab
15. Alcohol and smoking cessation advice
16. Advice for any sexual problems
17. Psychological support if required
18. Contraception advice and  advice if  planning to have a baby
19. Check for any associated auto immune conditions
20. Advice on driving

Complications of type 1 Diabetes 

These are similar to type 2 diabetes but people with type 1 diabetes are more likely to get life threatening complication called Diabetic Ketogenic Acidosis(DKA). They are also more likely to get hypoglycaemia and may be troubled with hypoglycaemia unawareness.

In addition high blood glucose  is also sen when not complaint with insulin and/or when thee is infection. Hyperglycaemia can lead to excessive thirst and urination and weight loss. Hypoglycaemia occurs when the level of blood glucose drops too low, usually below 4 mmol/L.

Click here to read more about hypoglycaemia.

Long term complications of type 1 diabetes

Long term complications usually occur when blood glucose remains high for a long duration. This is shown by high HbA1C.Complications in people with type 1 diabetes also occurs when blood pressure and microalbuminuria, when present is not managed.So, long term complications of type 1 diabetes include:

1. Eye problems predominantly retinopathy, which can lead to blindness
2. Neuropathy or nerve damage leading to loss of sensation, numbness and tingling
3. Peripheral vascular disease, which is due to narrowing of blood vessels in the limbs.
4. Foot ulcers and amputations, which is due to neuropathy and/or loss of blood supply
5. Heart problems, like coronary artery disease leading to heart attack and heart failure
6. Kidney disease, starting initially with proteinuria or leakage of protein in the urine leading finally to kidney failure

What is hypoglycaemia unawareness?

People who have had type 1 diabetes for a very long duration can also have hypoglycaemia unawareness. When blood glucose is around 4mmol/L and dropping below that, people have hypoglycaemia. Symptoms of hypoglycaemia include hunger, irritability, sweating, tremors, headache and palpitation. If hypos is not corrected, one may have drowsiness, seizures and lead to unconsciousness.

However when symptoms of hypoglycaemia are neglected, with time the symptoms which normally should come on when blood glucose is around 4mmol/L, fails to come on. So, they do not get warning to dropping blood glucose and this is a serious condition. One should seek immediate help if you have such a condition and this can have an impact on your driving.

 

Dr C. Rajeswaran is a consultant Physician specialising in Endocrinology, Diabetes and Obesity. He  has private endocrine, diabetes and weight loss clinics in Harley Street, London, Claremont Hospital,Sheffield, Nuffield Hospital,Leeds and simplyweight, Bradford.

He has face to face consultations with people from Leeds, Sheffield, Barnsley, Rotherham, Chesterfield, Doncaster,Wakefield, Huddersfield, Bradford, Harrogate,  Bradford, Leeds,  Sheffield and London. He also offers video consultations.