Type 1 Diabetes

Type 1 diabetes, also known as juvenile diabetes, is a condition where the pancreas no longer makes enough or any insulin leaving the person dependent on insulin injections to regulate blood sugar levels for life. Type 1 diabetes is typically diagnosed in children and adolescents, but it can also be diagnosed in adults. Adults who are diagnosed with type 1 diabetes may actually have a lesser known form of diabetes called type 1.5 diabetes. Type 1 diabetes has no cure, but it can be managed. With proper treatment, type 1 diabetics can live long and healthy lives.  

Typically symptoms of type 1 diabetes come on quickly. Symptoms include increased thirst, frequent urination, bed-wetting, extreme hunger, weight loss, mood changes, weakness, blurred vision, and yeast infections. If your child is experiencing any of the symptoms listed, you should consult a doctor.

In most cases, type 1 diabetes occurs when the immune system starts attacking beta cells in the pancreas. Beta cells are responsible for producing the insulin necessary to move glucose from the blood into cells to be used as energy. Without insulin the glucose remains in the blood leading to high blood sugar levels. High blood sugar levels can have serious and deadly consequences if not addressed. It is not known why the immune system starts attacking beta cells, but it is linked to genetics, environmental factors, and certain viruses.

Treatment for type 1 diabetes has come a long way, especially since insulin was developed. Prior to insulin, type 1 diabetics were subjected to extreme diets, some as low as 450 calories a day, in order to avoid high blood sugar caused by food, and life expectancy was not long.  In 1921 insulin was discovered. In 1922, a young boy in Canada was dying from diabetes, after an insulin injection his blood sugar levels returned to near normal. Insulin has became a miracle drug for type 1 diabetics, allowing them to lead normal healthy lives.  

There have been many advances in insulin therapy since 1921. Now there are many forms of insulin including insulin identical to human insulin, fast acting insulin, and long acting insulin. Currently type 1 diabetics must closely monitor their carbohydrate intake and inject a corresponding amount of insulin to maintain healthy blood sugar levels.  Researchers are currently working on systems, called artificial pancreas devices, that do this automatically. A continuous glucose monitoring system on the body checks blood sugar levels and tells an insulin pump how much insulin to release. This will one day give type 1 diabetics a much easier way of making sure their diabetes is well managed.   

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Diabetic Ketoacidosis

Sugar is the main source of energy for our cells. Normally, the pancreas makes insulin and the insulin then carries the glucose into the cells to be broken down for energy. Diabetics are either not able to produce any or enough insulin or are not able to use it properly due to insulin resistance. If there is not enough insulin present to carry glucose into the cells, hormones are then released. Hormones such as adrenaline and cortisol break down fat as fuel instead of glucose. The by-product of the fats being broken down are ketones. As excess ketones build up in the blood it becomes more acidic and you can develop diabetic ketoacidosis (DKA). DKA is a potentially life-threatening condition and must be addressed as quickly as possible. DKA can happen to any diabetic, but it is more likely to occur in Type 1 diabetics and other diabetics who have a limited ability to produce insulin.

Warning Signs of Diabetic Ketoacidosis

• Early Symptoms
  • Thirst or dry mouth
  • Frequent urination
  • High blood glucose levels
  • High levels of ketones in urine
• Other Symptoms
  • Constantly feeling tired
  • Dry or flushed skin
  • Nausea, vomiting, abdominal pain. If vomiting continues for more than 2 hours, contact your doctor immediately.
  • Difficulty breathing
  • Breath that is fruity or smells like nail polish remover
  • Confusion

Checking for ketones can be done with a urine test strip similar to a blood test strip. Experts advise that you check your urine for ketones if your blood glucose is more than 240 mg/dl. You should check for ketones every 4-6 hours if you are ill and while your blood sugar is elevated. You should also check your ketone levels if you are experiencing any symptoms of DKA.

If your test reveals a high level of ketones, you should call your doctor immediately. You will need to be able to tell your doctor if you have high levels of ketones, if your blood glucose is high, and if you have vomited more than twice in four hours.

DKA can be caused by not enough insulin from missing a dose or being sick, not eating enough food, or low blood glucose. Diabetic ketoacidosis is a dangerous and potentially deadly condition. Contact your doctor immediately if you are experiencing any symptoms of DKA or have elevated levels of ketones.  

Type 1.5 Diabetes

Type 1.5 diabetes, also known as latent autoimmune diabetes of adults (LADA), is a form of diabetes where an adult has aspects of both type 1 and type 2 diabetes. Type 1 diabetes, also known as juvenile diabetes is caused by an autoimmune destruction of beta cells in the pancreas. As the beta cells are destroyed the amount of insulin released decreases and eventually stops leaving the person dependent on injections of insulin to regulate blood sugar levels. Type 2 diabetes, also known as adult-onset diabetes, is caused by insulin resistance and beta-cell dysfunction. Type 2 diabetics may can control blood sugar levels with medication, diet, and exercise and may require insulin injections as well. While type 2 diabetes may be prevented and reversed, there is no cure for type 1 diabetes. .

Type 1.5 diabetes has also been called slow-progressing Type 1 diabetes. Researchers noticed that a number of patients who did not require insulin at the time they were diagnosed with diabetes also showed a significant number auto-antibodies. Specifically antibodies that target beta cells in the pancreas, destroying their ability to manufacture insulin. Type 1.5 diabetics may be able to control their blood sugar levels with diet and oral medication initially, but within a few years they will need to use insulin because of the destruction of their beta cells. Type 1.5 diabetics should also be screened for auto-antibodies to adrenal and thyroid cells as they are at a higher risk of also having autoimmune diseases.

Below is a chart comparing the key characteristics of Types 1, 1.5, and 2 diabetes.

 

Non-Starchy Vegetables

If you are trying to control your caloric intake, non-starchy vegetables are a great option. The low number of calories in non-starchy vegetables will afford you the opportunity to eat larger portions and feel fuller longer, while at the same time you will have a significant reduction in calories versus other types of foods. Below is a chart of a typical serving size of various non-starchy vegetables and their respective caloric impact.

What Type 2 Diabetes Medications Should I Take?

There are many different types of type 2 diabetes medications. Choosing the right one for you is something you and your doctor will need to discuss. As your body, diet, exercise habits, and overall health change over time, adjusting diabetes medications may become necessary. Some common type 2 diabetes medications include:

• Metformin (also called a biguanide)
  • Metformin is an oral medication that helps control blood sugar levels in people with type 2 diabetes. It is not used to treat type 1 diabetes. Do not take metformin if you are in a state of ketoacidosis. Before you start taking the medication be sure to tell your Dr. if you have a history of heart, kidney, or liver disease. Some people may develop a life-threatening condition called lactic acidosis while on the medication. If you have any symptoms including: muscle pain or weakness, numbness or a cold feeling in the arms and/or legs, trouble breathing, stomach pain, vomiting, slow or uneven heart rate, dizziness, or feeling weak or tired seek medical treatment. You are more likely to develop lactic acidosis if you have a history of liver or kidney disease, congestive heart failure, or of you drink large amounts of alcohol. If you have to have a x-ray or CT scan using a dye injected into the vein, you will need to stop taking Metformin for a couple of days to prevent lactic acidosis.  
• Sulfonylureas
  • Sulfonylureas are a class of medication that stimulate the pancreas to release more insulin. They are only effective if there is some pancreatic beta-cell activity present. Sulfonylureas are only used to treat people with type 2 diabetes.
• Thiazolidinediones (TZDs)
  • TZDs express and recess certain nuclear receptors allowing the genes to store more fatty acids. This leads to a decrease in the amounts of fatty acids present in circulation. As a result, cells become more dependent on the oxidation of glucose in order to yield energy for cellular processes. This leads to lower glucose levels in the blood. Several different TZDs have been linked to a number of problems including: bladder cancer, medicine induced hepatitis, liver failure, water retention leading to edema, coronary heart disease, and heart attacks. Your Dr. should run tests frequently to monitor how the TZDs might be affecting you. TZDs are only meant to treat type 2 diabetics, and are often prescribed in conjunction with other diabetes medications.  
• GLP-1 (glucagon-like peptide-1) receptor agonists
  • This class of medications encourages the pancreas to increase insulin synthesis and release. GLP1Rs also stimulate the part of the brain that controls appetite, and some patients have reported a loss in weight. There is a lower risk for hypoglycemia than with some other medications, however the pancreas does need to be monitored.
• SGLT2 (sodium-glucose cotransporter 2) inhibitors
  • SGLT2 inhibitors, inhibit the reabsorption of glucose into the kidneys. The glucose is instead disposed of in urine. This can lead to lower blood glucose levels. SGLT2 inhibitors are only used to treat type 2 diabetics. There is a risk of developing ketoacidosis, urinary tract infections, yeast infections, and hypoglycemia. This medicine can be prescribed alone or in addition to other diabetes medications.
• DPP-4 (dipeptidyl-peptidase-4) inhibitors
  • Incretin is a hormone that tells your body to release insulin after you eat. Insulin delivers glucose into the cells for energy, lowering the glucose levels in the blood. An enzyme called DPP-4 removes incretin from the body. Because some type 2 diabetics do not make enough incretin which leads to a higher blood glucose level, so it may be necessary to add a DPP-4 inhibitor. A DPP-4 inhibitor slows the removal of incretin, allowing it to remain in the body longer thus lowering blood glucose levels.
• Insulin
  • Insulin is produced by beta cells in the pancreas. It promotes the absorption of glucose into cells and inhibits the production of glucose in the liver. Type 1 diabetics do not have the ability to produce insulin, and must inject it subcutaneously in order to control blood glucose levels. Patients with type 2 diabetes may need to take insulin in addition to other diabetes medications depending on how much insulin their pancreas is capable of making.

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Lipohypertrophy

Lipohypertrophy is a lump that forms under the skin. It is an accumulation of fat that forms in sites where there are repeated subcutaneous injections of insulin. The buildup of fat can be unsightly and mildly painful. It is typically smoothly rounded, somewhat firm, and can range from centimeters to inches across. The size will typically depend on how closely the injections are placed together as well as how often insulin is injected in that particular area. Lipohypertrophy can also affect the absorption rate of insulin which can lead to blood glucose levels that are either too high or too low.

If you suspect you are developing lipohypertrophy, talk to your doctor and stop injections at that particular site immediately. Lipohypertrophy will generally disappear after injections are stopped in the affected area over a period of months. In severe cases, liposuction may be needed to remove the fatty buildup. Your doctor may also want to change the type of insulin or needles that you are using to avoid the problem in the future.  

To avoid lipohypertrophy, you need to rotate injection sites. As a part of diabetes education, you should be given a rotation chart. If you do not have a rotation chart your health care team should be able to provide you with one. This will help you to remember where you have been injecting insulin, and where you should be in the future.

There are four areas that are recommended as injection sites including the abdomen, thigh, arm, and buttocks. Keep in mind that insulin absorption rates may vary from site to site, which could affect blood glucose levels. When choosing an injection site, make sure the area is free of moles, scars, skin blemishes, varicose veins, and cuts. The abdomen is the preferred injection site for many people as insulin is absorbed more quickly and predictably there. Choose an area between the bottom of the ribs and the pubic area and avoid injecting within two inches of the belly button.When picking an injection site on the thigh, look for a spot at least four inches below the top of the leg and four inches above the knee. The fatty area on the back of the arm between the shoulder and elbow is also a good injection site. When injecting in the buttocks try to not inject the area you sit on, instead opt for the area your pockets would normally rest.

Your diabetes management team should be able to answer any questions you may have about treating and avoiding lipohypertrophy. As with many complications of diabetes, education and prevention are the most important steps you can take to avoid developing the complication in the first place.  

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Low Blood Sugar

Hypoglycemia occurs when your blood glucose level is lower than normal. When blood glucose drops below 70 mg/dL, failure to bring it back up quickly can lead to potentially dangerous side effects including passing out, coma, and death. If you experience low blood glucose levels a few times a week, you need to talk to your doctor or diabetes educator. There are many things that can cause low blood glucose including diet, exercise, medication, and even supplements. An adjustment might be necessary to ensure proper blood glucose management.

Signs of low blood glucose include:

• Blurry Vision
• Rapid Heartbeat
• Sudden Mood Change
• Nervousness
• Unexplained Fatigue
• Pale Skin
• Headache
• Hunger
• Shaking
• Sweating
• Trouble Sleeping
• Tingling Skin
• Trouble Concentrating
• Loss of Consciousness

If you or anyone else is exhibiting signs of hypoglycemia eating about 15 grams of a carbohydrate that can be quickly digested as soon as possible is recommended. Some examples of carbs that might be readily available include:

• Glucose tablets
• Glucose gel
• A half cup of juice or soda
• 1 tablespoon of honey or sugar
• 5 Saltine crackers
• Hard candy
• 1 cup milk

If you have diabetes, it is important that the people around you regularly are aware of the symptoms of hypoglycemia and what needs to be done in an emergency situation. Wearing a medical id bracelet is also a good idea. In case of an emergency, responders will be better able to get you the care you need faster.  

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What Foods Can I Eat as a Diabetic?

Trying to decide what foods you can and can’t eat does not have to be hard. There are many myths about what types of food are good for you and what is off limits for diabetics. People with diabetes will benefit from the same healthy habits as everyone else, but the truth is that most things in moderation are fine for diabetics. The only way to know how your body will react to a certain food or beverage is to try it out and test your blood glucose levels.

If you want to know how a food will affect you it is best to start a food journal. Test your blood glucose level before you eat or drink. Then eat or drink a reasonable portion. About two hours later test your blood glucose again. If your blood glucose is under 140 then you are properly metabolizing that item. If your blood glucose is above 140 then you should probably avoid that particular item.

There are still many best practices that would be in your best interest to adhere to. Portion control is key. Below is a chart that shows the recommended portions for various foods using your hand as a reference point.

 

As always it is recommended that you stick to a healthy diet for the most part. Trying to eat 5 fruits and vegetables a day, whole grains instead of processed, small portions of lean proteins, and small amounts of healthy fats are all a part of a healthy diet. Cheating is also a part of a healthy diet. Just make sure you know what your body can handle the item you want to eat, and allow yourself to enjoy a treat every now and then!

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Life’s Simple 7

A study released recently shows that the adoption of as few as two or three of the Life’s Simple 7 goals significantly reduces the risk of developing diabetes. The more of these seven goals that you include in your daily routine, the lower your risk of developing not only diabetes but also many other complications.

• Manage Blood Pressure – Uncontrolled high blood pressure can lead to: heart attack, stroke, aneurysm, heart failure, weakened blood vessels in the body, thickened or broken blood vessels in the eyes, problems with memory, and metabolic syndrome. The longer blood pressure goes uncontrolled, the greater the damage that can be done.
• Control Cholesterol – High cholesterol can cause a buildup on the walls of the arteries. These deposits can reduce blood flow and cause complications such as: chest pain, heart attack, and stroke.
• Normalize Blood Sugar – Untreated hyperglycemia (high blood sugar) can lead to several long-term complications including: cardiovascular disease, nerve damage, kidney damage, damage to the blood vessels in the retina, cataracts, foot problems due to poor blood flow, bone and joint problems, skin problems, and teeth and gum infections. If blood sugar is too high for too long the complications could be life threatening. Diabetic ketoacidosis develops when there is not enough insulin to break down sugar. Instead of sugar being used for energy, fat is  breaken down and leaves behind ketones in the blood. This can lead to diabetic coma. Hyperglycemic hypersmolar syndrome occurs when insulin does not work properly and glucose is not broken down. This can also lead to coma.
• Get Active – Physical activity is a prevention for over 35 chronic illnesses. Accelerated aging, premature death, type 2 diabetes, heart disease, osteoporosis, deep vein thrombosis, cancer, erectile dysfunction, bone fracture, and depression are just a few examples of the complications of inactivity.
• Eat Healthier – Poor eating habits including under-eating, over-eating, not eating enough healthy foods, or eating too many foods that are low in fiber or high in fat, salt, and/or sugar. Poor nutrition leads to tiredness, obesity, tooth decay, high blood pressure, high cholesterol, heart disease, stroke, type 2 diabetes, osteoporosis, cancer, depression, and eating disorders.  
• Lose Weight – Obesity not only diminishes your quality of life, but it can also lead to a myriad of health complications. A few of those complications include: High HDL “bad” cholesterol, type 2 diabetes, high blood pressure, metabolic syndrome, heart disease, stroke, cancer, breathing disorders, gallbladder disease, infertility, erectile dysfunction, nonalcoholic fatty liver disease, and osteoarthritis. Depression, disability, shame, and isolation are also common complications in patients who are overweight.
• Stop Smoking – Cigarette smoking harms nearly every organ in the body. According to the CDC, cigarettes cause more than 480,000 deaths each year in the United States. In addition to death, smoking causes cancers throughout the body, not just the lungs and throat. There are also many chronic diseases that can be attributed to cigarettes including: stroke, cataracts, heart disease, pneumonia, respiratory problems, diabetes, infertility, weakened bones, erectile dysfunction, and immune problems.

Many of the complications and diseases listed above have been listed under several of the Life’s Simple 7 points. A healthy lifestyle including diet and exercise are important factors in the control of each of the 7 points. If you are concerned about any any of the conditions listed above, you should talk to your doctor to find out how you can lessen your risk of developing or controlling any complications.  

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Getting Enough Exercise

Diabetes increases your risk of developing many complications including; heart disease, high blood pressure, nephropathy, peripheral neuropathy, autonomic neuropathy, retinopathy, peripheral vascular disease, osteoporosis, and arthritis. Regular exercise is highly recommended as a way to prevent or lessen the effects of these complications.

Here are some tips for getting started with the right type of exercise for you:

• Ask your doctor what type of exercise is best for you. Several conditions can be made worse by activities that are strenuous, high-impact, require rapid changes in movement, and require prolonged weight bearing. But don’t worry. There is always some form of exercise you can do, you might just have to think a little out of the box.
• Check your blood sugar before and after you exercise. This will allow you to be more aware of how exercising is going to affect your body.
• Wear a medical alert ID band and notify any lifeguards or trainers about your condition. In case of an emergency, EMS and others will be able to get you the treatment you need faster.
• Push through the pain. There are two types of pain. Good pain such as being sore after a workout should be expected. If you suffer from chronic pain and your pain level is the same at rest as when you exercise, then you should monitor the pain and continue exercising. If however you experience an increase in pain levels either during or after you exercise you should stop. You don’t want to make any underlying conditions worse.
  • Think about your pain on the 0-10 scale. A zero would indicate no pain. A ten would be excruciating. If your pain is around the 2-4 it is generally safe to continue exercising. If your pain is a 5 or above you should talk to your doctor to see if you should continue or change your routine.
• Take it slow. It is recommended that you get at least 30 minutes of exercise a day 5 days a week. Try not to take two days off in a row. Take walking for example. If 30 minutes of walking proves to be too much for you to handle, break it up. Try walking for 10 minutes 3 times a day. As your body gets used to walking it will become easier. Set a goal of increasing the amount of time you walk by a few minutes each week until walking 30 minutes becomes more manageable.
• Keep an open mind. There are many forms of exercise you can do. If getting out of a chair is hard try doing exercises while you are seated to build up your muscles. Walking, riding a bike, yoga, pilates, swimming, and light weight lifting are all great options. If none of those appeal to you there are a plethora of other options available as well.
• Have an exercise buddy. If you and your exercise buddy hold each other accountable and have fun together, you are both going to be more successful at exercising more and more often. Keep in mind that while it may be hard and uncomfortable now, your body will adapt. After a while you should start feeling better physically and emotionally.

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