Diabetes mellitus type 1Type 1 diabetes has many names such as juvenile diabetes, juvenile diabetes or insulin-dependent diabetes. In contrast to diabetes mellitus type 2, juvenile diabetes is usually a genetically determined autoimmune disease and is not acquired during life. Type 1 diabetes must be treated permanently with insulin. If the blood glucose metabolism is derailed, serious complications may arise.
juvenile diabetes, juvenile diabetes
Diabetes mellitus (abbreviated diabetes or commonly known as diabetes) is a disorder of blood sugar metabolism. In type 1 diabetes mellitus, the organism is unable to regulate blood glucose levels. Sugar or. Dextrose (glucose) is one of the carbohydrates. Is the most important energy supplier of the body. Glucose belongs to the group of carbohydrates. Is the body's most important energy supplier. The largest part is taken up by the human body in the form of starch (z.B. in cereals, potatoes, pasta or rice). During digestion, the starch is then broken down into glucose. Insulin from the pancreas ensures that glucose reaches the cells.
This is how diabetes disturbs blood glucose metabolism
If, as in type 1 diabetes, there is too little insulin, the sugar continues to accumulate in the blood. As a result, the blood glucose level rises and at the same time the cells lack an energy supplier, since the sugar remains in the blood. To compensate for the lack of energy in the cells, the liver steps in and produces glucose. But even this newly formed glucose can only enter the cells with the help of insulin, which is still lacking. The energy deficiency in the cells therefore persists.
In order to compensate for this lack of energy, the organism goes to the fat depots. This has consequences: The organism is flooded with free fatty acids. These cannot be broken down normally as a result of the disturbed carbohydrate metabolism. So-called ketone bodies are formed. The large amount of fatty acids and ketone bodies lead to hyperacidity of the blood, which, if untreated, results in a life-threatening ketoacidotic coma (see also further under: diabetic coma). Diabetes type 1 is mainly associated with a blood-. Urine glucose measurement detected. The normal blood sugar concentration is below 100 mg/dl when fasting. After eating, this rises to about 140 mg/dl. Speak for diabetes type 1:
– A repeated casual glucose measurement of more than 200 mg/dl – A fasting blood glucose of more than 126 mg/dl – A sugar stress test (oral glucose tolerance test) of more than 200 mg/dl.
In type 1 diabetes, values are often much higher than those indicated here.
Sugar in urine
Urine is normally free of sugar. However, glucose can be detected in the urine if blood sugar is elevated. This is where the name diabetes comes from, which means "honey-sweet flow" in Greek. For a long time, the urine taste test was a reliable diagnostic criterion for diabetes.
In healthy kidney function, glucose is excreted in the urine at a blood glucose concentration of 180 mg/dl or more (the so-called kidney threshold). Fluid is needed for this. The amount of urine increases dramatically (polyuria). Thirst increases (polydipsia). If the loss of fluid can no longer be compensated for by increased drinking, the body dries out more and more (exsiccosis).
Diabetes is the most common metabolic disorder in Germany. It is estimated that about 6 to 8 percent of the population in this country suffer from diabetes. Doctors distinguish between two major groups of diabetes: Type 1 diabetes. Type 2 diabetes. 90 percent of all diabetics have type 2 diabetes. About 5 percent have type 1 diabetes. 90 percent of all diabetics have type 2 diabetes. About 5 percent have type 1 diabetes. The remaining 5 percent are due to special forms such as hormonal or drug-induced diabetes, diabetes as a result of infections or gestational diabetes.
Insulin is the body's only hormone that lowers blood sugar levels. Insulin is produced in the pancreas. It causes the cells to open their floodgates to sugar and to absorb the sugar from the blood. The pancreas no longer produces enough insulin, or cell changes prevent existing insulin from doing its work. In both cases, the glucose no longer reaches the cells. This results in the symptoms of type 1 diabetes.
In type 1 diabetics, the pancreas can no longer produce sufficient insulin even at a very young age – usually in childhood or adolescence. Over time, an absolute insulin deficiency develops. The sugar concentration in the blood continues to rise. When more than 80 percent of the insulin-producing cells are destroyed, the following symptoms occur:
– sweet urine, because too much blood sugar is excreted in the urine – frequent urination, because the kidneys try to dilute the sugary urine – strong thirst, to make up for the lack of fluid caused by the many urinations – dehydration with dry skin, blurred vision, calf cramps, headache and abdominal pain, because frequent urination can no longer be compensated for by increased drinking – ravenous appetite, especially for sweets (to compensate for the lack of sugar in the cells, but this does not work without insulin) – rapid weight loss within a few weeks because the body needs energy. Since they do not get this in the form of sugar, they metabolize body fats and proteins. After some time, however, all fat reserves are used up. – frequent bladder infections and urinary tract infections, because the sugar crystals in the urine irritate the mucous membranes of the bladder and urinary tract – breath smelling of ketone and ketone bodies in the urine, because acidic ketone bodies are produced when fats are broken down. To prevent the body from becoming acidic and falling into acidosis, the ketone bodies are excreted in the breath and urine.
Progressive weakness and susceptibility to infections
Due to the constant strain on the body caused by the disturbed carbohydrate metabolism, children and adolescents become increasingly weak, their performance decreases and they are constantly tired. In addition, there is an increased susceptibility to infections, and often also to skin and mucous membrane lesions. Any wounds heal only very slowly. The reason for this is the increased release of pro-inflammatory messenger substances in the presence of reduced insulin action. In addition, pathogens such as bacteria or fungi feel more comfortable at high blood glucose levels.
Diabetic coma in type 1 diabetes
If early symptoms are ignored for a long time – and no treatment is initiated – it can become dangerous. Due to the increasingly severe lack of sugar in the cells, the organism slips into what is known as a diabetic coma (coma diabeticum or ketoacidotic coma). Diabetic coma is heralded by the smell of acetone on exhalation, stomach pain and vomiting. To eliminate the ketone bodies, patients breathe remarkably deeply and regularly. Doctors refer to this as Kussmaul breathing. Without treatment, there is a clouding of consciousness and drowsiness. Unconsciousness follows a short time later. The hyperacidity state of diabetic coma is life-threatening. Requires immediate emergency medical intervention.
There is also an opposite complication, namely diabetic shock. However, this does not occur until type 1 diabetes has already been diagnosed and treated with insulin. In this complication, there is too little sugar in the blood. This often happens after an insulin dose that is too high, increased physical exertion, or even if a meal has been skipped. Hypoglycemia usually develops suddenly with a feeling of hunger, sweating, pallor, mild headache, tremor or palpitations.
Patients become restless, sometimes confused, and seizures are possible. If the brain receives no more sugar at all, unconsciousness follows. At the latest then the emergency physician must be alerted immediately. Patients who are still responsive are often helped by a piece of glucose, which most diabetics always carry with them for emergencies.
Complications and consequential damage
The complications of type 1 diabetes are the same as those of type 2 diabetes. Detailed information can be found in the clinical picture of diabetes mellitus type 2.
Type 1 diabetes is an autoimmune disease. The predisposition to diabetes may be genetic. With a corresponding predisposition, the likelihood of developing diabetes type 1 or 2 increases. Diabetes itself is not inherited.
In type 1 diabetes, the body's own defense system destroys the insulin-producing cells of the pancreas in an autoimmune reaction until insulin can no longer be secreted. It is still unclear exactly why this defensive reaction occurs in some people. However, scientists have discovered that certain genetic characteristics increase or decrease the tendency to autoimmune reactions. In this context, physicians speak of risk alleles and protective alleles. People with risk alleles in their genetic makeup are more likely to develop autoimmune diseases such as type 1 diabetes. If protective alleles are present, autoimmune reactions occur much less frequently.
Unfortunately, type 1 diabetes is still not curable. The medical treatment with insulin, however, allows a quality of life that can be compared to that of healthy people. In order to avoid consequential damage such as wound healing disorders or vision problems, the diabetes therapy should be reviewed and adjusted again and again.
Insulin therapy to be practiced in diabetic training courses
Since type 1 diabetics no longer produce sufficient insulin in the pancreas, the hormone that lowers blood glucose levels must be administered. This is done by injections, usually in the form of diabetic pens. Insulin in tablet form is not yet available. Inhaled insulin (similar to asthma sprays) was available a few years ago, but was withdrawn from the market worldwide for various reasons.
It is particularly important that the insulin requirement is precisely adjusted to individual needs. An important role in this context is played by quantity. Type of food consumed as well as physical activity. This is done by regular blood or urine glucose measurements, which type 1 diabetics perform independently. For optimal diabetes therapy, – for children. Parents equally – special diabetic training recommended. It makes sense for such training to take place over several days, possibly even in a clinic.
Behavioral recommendations for type 1 diabetics
Patients with type 1 diabetes must be treated with insulin for life. You should strictly follow the instructions of your doctor. Treatment is only successful in the long term if blood glucose levels remain permanently within recommended limits, i.e. blood glucose levels are stable.
– Normal-weight type 1 diabetics do not need a special diet. The same recommendations apply as for healthy people. According to the current medical opinion, everything (including sweets) may be eaten. Type 1 diabetics only have to adjust the insulin dose to the amount of carbohydrates they consume. Underweight patients receive a specially tailored diet plan from their doctor. Overweight diabetics should normalize their weight. – Most diabetics eat five to six small meals. How to make better use of the insulin you receive. However, three meals are also possible if the amount of insulin is calculated accordingly. – Food or drinks sweetened with a lot of sugar should be avoided, just as healthy people do. Overweight people can use sugar substitutes such as sorbitol and xylitol or sweeteners such as saccharin and stevia to sweeten their food. These have fewer calories than normal household sugar. However, special diabetic sweets, as they used to be, have not been available since 2012. – As alcoholic beverages, dry wines or light beers can be drunk occasionally. Sweet spirits, heavy wines, and regular or non-alcoholic beer are not recommended because of the sugar content and alcohol content. – To avoid hypoglycemia, you should always have a piece of bread or glucose at hand. – Seek out self-help groups. There you can exchange information with other diabetic patients. Often members are informed about all the news in diabetes therapy.
And one last but important tip for parents: Transfer responsibility for diabetes and its treatment to your child as early as possible.
Prevent diabetic sequelae
To prevent diabetic sequelae such as wound healing disorders, kidney weakness or loss of vision, it is imperative to always pay attention to an optimal setting of the blood glucose level. Avoid hypoglycemia or hyperglycemia. In addition, the following tips help to avoid diabetes sequelae:
– Do not start smoking. Smoking exacerbates all circulatory-related conditions. – Ensure a healthy lifestyle with regular exercise and a healthy, balanced diet. Go to diabetic foot care regularly. Take meticulous care of your feet yourself. – Protect your feet from any kind of injury with suitable footwear. – Attend regular check-ups, for example with an ophthalmologist.
The quality of life with type 1 diabetes today is comparable to that of healthy people. Since patients are usually used to insulin administration from an early age, they do not really feel restricted and often have their disease surprisingly well under control. However, this only applies if diabetes-1 is detected as early as possible. With increasing duration of insulin deficiency, the risk of irreversible damage increases.