TYPE 1 DIABETES

 

Pathophysiology 

Type 1 diabetes mellitus is the destruction of insulin-secreting beta-cells, that are found in the pancreas. Insulin secretion decreases to an insufficient amount, where the body is no longer able to maintain normal blood glucose levels. Often 80-90% of the beta-cells in the pancreas are destroyed, causing the body to become hyperglycaemic (elevated blood sugar levels). If an individual’s blood sugar remains elevated for a long period of time, they will often be diagnosed with type one diabetes. 

Even though type two diabetes has a similar end product, of the body being unable to produce insulin to combat blood sugar levels, they have very different ways of achieving the end goal.

Risk Factors

Type 1 diabetes has no single determining factor however contributing factors include family history, genetics, geography, and age.

Type 1 diabetes can be diagnosed at any age but it’s one of the most prevalent diseases in childhood. The often occurrence of type 1 diabetes arises between the ages of 5 to 7 years of age, with boys and men possessing a greater risk of the disease.

The development of type 1 diabetes can begin as early as the utero stage (before birth) and can continue into the first months of childhood. If a previous family member has suffered from type 1 diabetes, then it’s likely that their offspring may develop type 1 diabetes.

The incidence of type 1 diabetes can vary depending on the location of the birthplace of the disease carrier. Atkinson and colleagues (2014) suggest that the distance from the equator can play a role in the prevalence of type 1 diabetes, although many other variables play a part in this. Environmental influences such as adolescent diets, vitamin D, overall hygiene and the gut microbiome.

Prevalence of type 1 Diabetes

Overall the prevalence of Type 1 diabetes is significantly less than type 2 diabetes in the UK, with only 8% of the population suffering from Type 1. Approximately 375,000 people are suffering from type 1 diabetes in the UK, with numbers increasing. The population of people suffering from diabetes has doubled in the past 20 years.

Symptoms

The symptoms of type 1 diabetes are almost identical to those of type 2 diabetes, however, type one diabetes symptoms appear much earlier. Some of the symptoms that can appear relatively suddenly are increased thirst, ravenous hunger, unintended weight loss, frequent mood changes and fatigue and weakness at unexpected times.

Diagnosis

When testing for type 1 diabetes, several tests may take place, as it's common that no one test can conclude the diagnosis of the disease. The oral glucose tolerance test (OGTT) is often used after a ten-hour fasting period. This test involves an initial blood test, followed by 4 blood tests every 30 minutes after consuming a high sugar drink.

Another similar test that is used is a random blood sugar test, which involves a blood test taken at any point in the day. The usual blood sugar readings of people with type 1 diabetes are often >7.0 mmol/L and can range up to >30 mmol/L.

Prevention

Type 1 diabetes is an auto-immune disease, where the body’s immune system works counterintuitively against itself attacking useful cells. At current type 1 diabetes cannot be reversed unlike type 2 diabetes, it can only be managed with insulin therapy, nutrition and exercise.

Treatment

The only treatment for type 1 diabetes is for the individual to manage their own blood sugar levels by injecting insulin or taking medication, to reduce overall blood sugar. However, there are several nutritional methods that can be implemented in your everyday life to help manage blood sugar levels. The treatment of diabetes is individualised to each person and should be discussed and managed by a diabetes specialist clinician.

Although diabetes treatment is monitored closely, the patient can play a vital part in managing type 1 diabetes by taking responsibility for their weight. Maintaining a consistent healthy weight (BMI between 18 – 25Kg/m2) can aid with the familiarisation of insulin doses. This can be achieved by following a nutritional plan, including carbohydrate-based foods with a low glycaemic index (use the link below to find low GI foods), high fibre content and lean protein (both animal and plant-based). As insulin treatment can induce weight gain (usually 4-5Kg over a 5 year period), it’s essential to monitor calorie balance and physical activity (3).

In addition, exercise should also be encouraged for people with type 1 diabetes, including yoga (predominantly stretching), aerobic training (running, cycling and rowing machine) and resistance training, usually consisting of whole-body function exercise. Although the fear of hypoglycaemia is a psychological barrier, this should be overcome to make weight management considerably easier (4).

Although Type 1 diabetes is a lifelong condition, maintaining a healthy weight through appropriate diet and exercise can minimise the risk of complications. For more information and support on Diabetes visit https://www.diabetes.org.uk.

References

Secrest, A.M., Costacou, T., Gutelius, B., Miller, R.G., Songer, T.J. and Orchard, T.J., 2011. Associations between socioeconomic status and major complications in type 1 diabetes: the Pittsburgh Epidemiology of diabetes complication (EDC) Study. Annals of epidemiology, 21(5), pp.374-381. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079455/

NCVIN (2016), Diabetes Prevalence Model for England + estimated growth between 2015–2020 from APHO (2010) Prevalence Models for Scotland and Wales.

Moser, O., Tschakert, G., Mueller, A., Groeschel, W., Pieber, T.R., Obermayer-Pietsch, B., Koehler, G. and Hofmann, P., 2015. Effects of high-intensity interval exercise versus moderate continuous exercise on glucose homeostasis and hormone response in patients with type 1 diabetes mellitus using novel ultra-long-acting insulin. PLoS One, 10(8), p.e0136489. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552855/

Muttalib, A., Kasetty, M., Mar, J.Y., Elseaidy, T., Ashrafzadeh, S. and Hamdy, O., 2017. Weight management in patients with type 1 diabetes and obesity. Current diabetes reports, 17(10), p.92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5569154/

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