Type I Diabetes
Type I Diabetes – The Needle As A Way Of Life
Prevention is better than cure …
… and with Type I diabetes there is no known prevention nor any known cure, although further research may change that.
The nomenclature, ‘Type I diabetes’, has superseded a number of other terms formerly used with varying degrees of frequency. Some of these names were more descriptive than ‘Type I’, for example, ‘juvenile diabetes’, ‘childhood-onset diabetes’, or ‘insulin-dependent diabetes mellitus’, (IDDM).
As with Type I, ‘Type II diabetes’ has superseded a number of other terms, some of which were more descriptive than ‘Type II’, for example, ‘non-insulin-dependent diabetes mellitus’, (NIDDM), ‘adult-onset diabetes’, ‘late-onset diabetes’, or ‘obesity-related diabetes’.
There really is no Type III, although that may change if interested parties can come to agreement. Possible candidates for the ‘Type III’ tag include insulin-resistant Type I diabetes, which is also known as ‘double diabetes’ for the obvious reason that the sufferer is affected by both a deficiency of insulin and insulin resistance; gestational diabetes; latent auto-immune diabetes of adults (LADA), which is also sometimes called ‘Type 1.5 diabetes’; and Type II diabetes which has progressed, if that is the word, to a stage where injection of insulin is necessary.
Type I diabetes
As discussed in our article Diabetes, Type I diabetes arises from a deficiency of insulin because of the loss of the beta cells in the islets of Langerhans in the pancreas which produce insulin. Broadly speaking, about 10% of the diabetes suffered in North America and Europe is Type I. Type I diabetes does arise in adults as well as children but as the formerly common term ‘juvenile diabetes’ indicates, the majority of diabetic children are affected by Type I diabetes. Whether child or adult, most Type I diabetics are healthy and of ‘normal’ weight at onset. Typically, their response to insulin is normal, at least early on.
Type I diabetes is treated with injected (synthetic) insulin or insulin analogs, usually via disposable syringe. It is also possible to supply insulin via a pump at pre-configured levels over 24 hours. Besides the steady’drip-feed’, meal time doses can also be programmed. Another delivery system is a multi-use ‘pen’.
Just a little prick …
Since it is necessary to be aware of blood sugar levels, patients become more or less accustomed to repeated, self-administered, ‘prick tests’, which draw minute blood samples to be tested on ultra-compact, portable, battery powered ‘glucose meters’, most of which not only display, but also store, the results, for later analysis of blood sugar levels over time.
Inhalable insulin was FDA-approved in 2006, and withdrawn from the market the following year. There is current research into non-insulin treatments such as implanted islets and stem cell-derived treatments.
A Lifetime of Discipline
Untreated Type I often leads to ketoacidosis which may well result in coma and/or death. Although Type I cannot be reversed, diet and exercise regimes are recommended, and treatment is ‘for life’.
‘Normal’ life is possible with effective patient education, medical supervision, patient discipline in blood sugar level testing, and administration of insulin in a timely manner. The burden of the required self-discipline should not be underestimated – patients do become worn down and depressed. If too much insulin is taken, hypoglycemia can arise as blood sugar levels become too low. The results of ‘hypos’ can include nervousness, irritability, fatigue, faintness, dizziness, tremors, cold sweats, migraines, insomnia, digestive upsets, forgetfulness, mood swings, anxiety, confusion, a limited attention span, lack of concentration, and blurred vision. At the other pole lies hyperglycemia which results from elevated blood sugar levels when insufficient insulin is taken. This is also discussed in our article, Diabetes.
A patient with Type I diabetes is advised to maintain as closely as possible an average blood sugar level (BSL) of 4–6 mmol/l which is considered normal. The target BSL may be increased to about 7-7.5 mmol/l if a patient experiences frequent ‘hypos’ at lower levels.
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