Symptoms
The possible acute symptoms of type 1 diabetes include:
- Thirst (polydipsia) and hunger (polyphagia).
- Increased urination (polyuria).
- Visual disturbances
- Weight loss
- Fatigue, exhaustion, declining performance.
- Poor wound healing, infectious diseases.
- Skin lesions, itching
- Acute complications: Hyperacidity (ketoacidosis), coma, hyperosmolar hyperglycemic syndrome.
The disease usually manifests in childhood or adolescence and is therefore also called juvenile diabetes. An untreated type 1 diabetes is acutely life-threatening and can lead in the longer term to severe late effects such as cardiovascular disease (heart attack, stroke), nerve damage, kidney disease, blindness and amputations. Type 1 diabetes (about 5%) is much rarer than type 2 diabetes (about 95%).
Causes
The disease is caused by a failure to secrete the pancreatic hormone insulin, which is responsible for triggering the transport of glucose into cells. This results in an increase in blood glucose (hyperglycemia). Insulin is produced by beta cells in the pancreas. Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the insulin-producing cells. Risk factors include family history and viral infections. The exact causes have not been fully elucidated.
Diagnosis
Diagnosis is made by medical treatment based on patient history, physical examination, and with measurements of blood parameters. For several years, the HbA1c value has been primarily recommended for diagnosis (glycosylated hemoglobin, ≥ 6.5%). Two other options are the determination of the blood glucose value (fasting ≥ 7 mmol/L) and an oral glucose tolerance test (oGTT, ≥ 11.1 mmol/L). Both HbA1c and blood glucose are also measured regularly for follow-up during treatment.
Nonpharmacologic treatment
- Regular control of blood glucose
- Sufficient physical activity
- Healthy diet
- Healthy body weight
- Pleasure foods: give up smoking, little or no alcohol
Drug treatment
The basis of drug treatment of type 1 diabetes is the lifelong replacement of the missing endogenous insulin with biotechnologically produced insulins. Natural insulin from cattle and pigs (bovine and porcine insulin) is rarely used today. In addition to natural human insulin, insulin analogues with a slightly modified peptide structure and different pharmacokinetics are available today. Insulins with rapid onset and short duration of action are injected immediately before meals:
- Insulin aspart (NovoRapid).
- Insulin lispro (Humalog)
- Insulin glulisine (Apidra)
- Human insulin
Long-acting basal insulins are administered once or twice daily:
- Insulin detemir (Levemir)
- Insulin glargine (Lantus)
- Insulin degludec (Tresiba)
- Isophane insulin (eg, with human insulin).
Insulins are now usually injected subcutaneously with an insulin pen. Another option is the use of an insulin pump. Less common, however, is the use of insulin syringes. Since insulins can lower blood sugar too much, causing hypoglycemia, diabetics should carry glucose with them, which they can use to raise blood sugar quickly. Also included is a glucagon injection, which can be administered by family members if severe hypoglycemia results in unconsciousness.
