Islets of Hope for persons with type 1 diabetes

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Article disclaimer

Article by Lahle Wolfe, Founder, Islets of Hope.

Article sources:

National Diabetes Clearinghouse Information (NDIC) Diagnosing Diabetes

NIH Publications:

Your Guide to Diabetes: Type 1 and Type 2

Prevent diabetes problems:  keep your diabetes under control

"What diabetes is"


Fast Click to More Diabetes Information

Join an IOH Support Group
Conventional Treatment
Complimentary Treatment
Conventional vs. Intensive
     
Insulin Therapy
Hyper & Hypoglycemia
Long-Term Complications
Blood Glucose Testing Tips
Other Disorders Associated
     
with Diabetes
Gen'l Diabetes Information
Diet & Nutrition

See "Treatment" for more information about insulin, shots, and insulin pumps.


"Never regret. If it's good, it's wonderful.
If it's bad, it's experience."

        – Victoria Holt


Remember that learning to master your diabetes is an ongoing challenge. Don't let bad days discourage you from succeeding the next day!


Great Books About
Type 1 Diabetes

psyching out diabetes  
Richard R. Rubin, Ph.D., C.D.E.

Psyching Out Diabetes:  
This book examines the psychological obstacles of diagnosis such as panic, fear, anger, shame, and guilt and how to put them into perspective. Through proper maintenance, diet, and education, this book is tailor-made for the diabetic or anyone with a diabetic in their life who wants to overcome the negative emotions associated with this disease and learn the coping skills necessary to integrate diabetes into their daily life.  Dr. Rubin is a faculty member of the John's Hopkins Medical School.

think like a pancreas  Gary Scheiner, CDE
Think Like a Pancreas:  Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas"--that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books.

101 medication tips for people with diabetes   Betsy Carlisle
101 Medication Tips for People with Diabetes by University of New Mexico Diabetes Care Team.

a diabetic doctor looks at diabetes  Peter A.. Lodewick
A Diabetic Doctor Looks At Diabetes:  Written from the unique perspective of a doctor who has lived with diabetes for the past 30 years, A Diabetic Doctor Looks at Diabetes has been updated to give people with diabetes the up-to-the-minute tools and information they need to understand, cope with, and live with the disease.


Links for Diagnosis, Screening, Tests and Symptoms of Diabetes

American Association for Clinical Chemistry (A1C Tests & Information)

American Association for Clinical Chemistry (Glucose Tests)

National Diabetes Clearinghouse Information (NDIC) Diagnosing Diabetes

National Institutes of Health (NIH) Oral Glucose Tolerance Tests .PDF Format


Resource Links for General Diabetes Information

All About Diabetes (ADA)

Center for Disease Control
(CDC) Diabetes Public Health Resource

Center for Disease Control (CDC) Frequently Asked Questions About Diabetes

Food and Drug Administration (FDA) Diabetes Information

Mayo Clinic Diabetes Center

National Center for Farmworker Health (NCFH) Pictorial - What is Diabetes? (Spanish)

National Diabetes Information Clearinghouse (NDIC)

National Diabetes Education Program (NIH)
NIH Senior Health Site


Islets of Information

Diabetic Retinopathy: 24% of type 1 diabetics will develop retinopathy after 5 years, almost 60% after 10 years and 100% after 20 years. But research funded by JDRF at Melbourne's St Vincent's Hospital led by Prof. Richard Gilbert has found a new treatment that appears to be effective against diabetic retinopathy, macular edema and neuropathy - three typical complications of type 1 diabetes. Support JDRF

Even with a genetic predisposition for develop- ing diabetes most people still do not get it.  This is why researchers focus on what environmental triggers contribute to the onset of diabetes in people.  More people are diagnosed with type 1 diabetes during winter months as well as in colder climates in general, so cold weather is a suspected environmental trigger.  Another trigger seems to be a virus, and diabetes is less common in breast-fed infants than those who started solid food at an early age.

People with diabetes often test positive (even years before onset) for a certain kind of autoanti- body.  Antibodies are normally good; a protein that attack and destroy bacteria and viruses that invade the body.  But in diabetes autoantibodies (“auto” meaning self) mistake healthy cells for bad ones and these autoantibodies attack and destroy the insulin producing beta cells in the pancreas.

There are genetic tests that can be conducted to help predict your child’s odds of developing type 1.  Most Caucasians with type 1 have either HLA-DR3 or HLA-DR4 genes.  If you and your child are Caucasian and share these genes, your child has greater risk of developing type 1 diabetes. 


Important Medical Disclaimer

All material found on this site is intended for general informational purposes only.  This site should not be used for self- diagnosis or as a substitute for professional medical care.  IOH recommends that you seek the advice of a competent health  professional for diagnosis and treatment options, or before making any changes to your current diabetes care plan.

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Type 1 Diabetes - Section 1
Also called Juvenile Diabetes, Childhood Diabetes
and Insulin-Dependent Diabetes Mellitus
Symptoms, Causes, Diagnosis, Treatment, and Management


Section 1
What is Type 1 Diabetes?
Other Names for Type 1 Diabetes
Subtypes of Type 1 Diabetes
Diagnostic Criteria for Type 1 Diabetes
Daily Concerns with Type 1 Diabetes
Long-Term Complications of Type 1 Diabetes
Resource Links for Diagnosis, Tests & Symptoms
Resource Links for General Type 1 Diabetes Information

Section 2
Lifestyle Management
Medical Treatment
Why Insulin?
Stress Management
Resource Links for Nutrition and Treatment  

What is Type 1 Diabetes?

There is more than one form of type 1 diabetes and each can develop for different reasons.  Type 1 diabetes can result from hereditary deficiencies in the beta-cells of the pancreas (maturity onset diabetes of the young, or MODY),  damage to the pancreas from trauma or drugs, another illness like hemochromatosis (iron overload) or cystic fibrosis that damages the pancreas, or will result when the pancreas is surgically removed.

The most commonly diagnosed form of type 1 diabetes is juvenile diabetes, or, insulin-dependent diabetes.  People with juvenile type 1 diabetes have an inherited genetic predisposition towards developing diabetes (the genes are different for type 1 and type 2 but both have a genetic aspect involved).  Many people have these genes but will never develop the disease. For those that do become diabetic, something triggers the body to attack and destroy the insulin producing beta cells in the pancreas.  

Triggers for type 1 diabetes are thought in include certain viruses (including rotaviruses), chemical, or some other environmental factor.  Visit our general diabetes information page for causes of diabetes, genetic transmission rates of diabetes for type 1 and type 2 diabetes, and other diseases and disorders that are associated with diabetes.

Other diseases that affect persons with diabetes at a higher rate than in the general population include Addison's Disease, Hashimoto’s Thyroiditis. celiac disease (sprue, or gluten intolerance), and polycystic ovarian syndrome.  Anyone diagnosed with type 1 diabetes should also be tested for these.

Juvenile type 1 diabetes is an autoimmune disease.  An autoimmune disease is when the body attacks and destroys good cells and tissues mistaking them as foreign intruders.  With type 1 diabetes the insulin-producing beta cells in the pancreas are slowly destroyed and eventually they fail to produce insulin.  When this happens a person will need to take insulin to live.

    

Other Names for Juvenile Type 1 Diabetes

Other names (most of which are considered outdated) include childhood diabetes, insulin-dependent diabetes mellitus (IDDM)  (diabetes mellitus is a group of autoimmune metabolic disorders all of which include hyperglycemia), and ketone prone diabetes.  It is important to note that type 1 diabetes and type 2 diabetes are not the same thing, however, some people can have both types, and people with type 2 can eventually become type 1 diabetic. 

All type 1 diabetics must take insulin to live while only some type 2 diabetics require insulin.  Type 1 onset is usually fast, over days or weeks, and although most often diagnosed in children can occur at anytime in life even in adulthood.

Subtypes of Type 1 Diabetes

Type 1 diabetes has several subtypes, including type 1A diabetes, type 1B (idiopathic diabetes), and latent autoimmune diabetes of adulthood (LADA).  LADA may be initially misdiagnosed as type 2 diabetes because onset is usually much slower than in juvenile diabetes and diagnosis of LADA is most likely to be after age 25.

Maturity Onset Diabetes of the Young (MODY), another form of type 1 is not the same as juvenile type 1 diabetes, but is treated the same way (with blood glucose monitoring and insulin).  Persons with MODY may require only very small amounts of insulin because their pancreas may still produce some insulin.  It can be misdiagnosed as juvenile diabetes because it is so similar and usually occurs prior to age 25.  Persons with MODY often test negative for thyroid antibodies and may have polycystic kidneys as part of the disease.  There is more than one type of MODY and specific treatment varies.

Type 1 subtypes are treated basically in the same manner as type 1 diabetes with stress management, lifestyle changes, and insulin.  

    

Diagnostic Criteria for Type 1 Diabetes 

A person with two fasting plasma glucose levels of 126 mg per dL (7.0 mmol per L) or greater is considered to have diabetes mellitus.  Some doctors may use a postprandial (after eating) test instead where blood glucose is measured 2 hours after 75 g of glucose is given.  Any 2-hour postprandial reading over 200 is considered diabetic.  And any two casual readings of 200 mg/dL or higher is also considered diabetic.

The fasting glucose tolerance test is generally preferred for diagnosis, however, any two abnormal tests are sufficient to classify a person as diabetic.  Additionally:

  • Type 1 diabetes mellitus is characterized by beta cell destruction caused by an autoimmune process, usually leading to absolute insulin deficiency (the pancreas makes no insulin).  Onset is rapid, usually occurring over a period of days or weeks.
  • Over 95 percent of persons with type 1 develop the disease before the age of 25.  Persons who develop type 1 diabetes over the age of 25 may be diagnosed with Latent Autoimmune Diabetes of Adults (LADA).  Sometimes, LADA, which may also be called "slow onset diabetes" or type 1.5, is initially misdiagnosed as type 2 diabetes.
  • There is an equal incidence of diabetes mellitus in both sexes, but an increased prevalence is seen in caucasians.
  • A family history of type 1 diabetes mellitus, celiac disease (gluten enteropathy) or other endocrine disease such as Polycystic Ovarian Syndrome (in women), or Hashimoto’s Thyroiditis, is often found in those with “immune-mediated form” of diabetes mellitus.
  • Persons with type 1 diabetes have in increased risk of having Addison’s disease, vitiligo, Polycystic Ovarian Syndrome (PCOS), Hashimoto’s Thyroiditis, Celiac Disease, or pernicious anemia.  All persons diagnosed with type 1 should also be tested for antibodies for Hashimoto’s thyroiditis and for celiac disease.
  • Some, usually those of African or Asian origin, have no antibodies but because they meet clinical criteria for diabetes they are classified as having idiopathic type 1 diabetes.

What is considered normal blood glucose range?  

  • Morning Fasting Blood Glucose of  less than 110 mg/dL  
  • 2 hour Postprandial (after eating) of less than 140 mg/dL

What if you are not in the normal range, but not in the diabetic range?

Blood glucose levels higher than normal, but lower than diabetic ranges, classify a person as having impaired glucose homeostasis, specifically as follows:  

Both IFG and IGT are associated with an increase risk in developing type 2 diabetes and lifestyle changes, including weight loss and an exercise program, as well as possible oral medications such as Glucophage are sometimes indicated.

It is important to note that while there is no cure for type 2 (or type 1) diabetes, pre-diabetes can often be completely reversed with proper medical intervention and changes in lifestyle. 

    

Persons with diabetes need to check their blood sugar no less than four times each day.  The IOH is a strong advocate of tight diabetes control, especially with type 1, and believes that more frequent testing is necessary to help improve the odds of a healthier long-term outcome.  Uncontrolled diabetes presents serious issues.    

    

Daily Concerns With Type 1 Diabetes

Type 1 diabetes must be managed on a daily basis.  This includes monitoring blood glucose frequently, following a healthy lifestyle and food plan, testing urine for ketones, and most importantly, thinking long term.  How you manage your diabetes on a daily basis will have tremendous impact on health years down the road.

Daily concerns of type 1 diabetes include watching for, and dealing with, hypoglycemia (low blood glucose), and hyperglycemia. Both can present dangerous situations immediately, on unchecked, can also present possibility of long-term complications as well.

Hypoglycemia (think "O" is in too low) is when blood glucose becomes too low to be healthy or safe. Your doctor should help you determine what constitutes a mild versus a severe low.  In children, a critical low may be set at 60 or 70 mg/dl, an adult might not be considered critical until a low of 50 mg/dl.  

What is considered low varies between individuals as well as time of day, when insulin was last administered, and level of activity.  Medically speaking, a reading of 40 mg/dl or lower is always considered critical for anyone with diabetes.  If blood glucose becomes too low a person becomes disoriented, may experience seizures, loss of consciousness, and even death.

See "Hypoglycemia" for symptoms, causes, treatment, and prevention of low blood glucose.

Hyperglycemia (think HIGH-per) is too much blood glucose in the blood stream.  Over time, hyperglycemia can cause serious damage, cells, and organs resulting in diabetes complications.  It can also lead to a state called diabetic ketoacidosis (DKA) that can results in coma or death.

See "Hyperglycemia" for symptoms, causes, treatment, and prevention of high blood glucose.

    

The picture above shows damage to the nerves in the eye from neuropathy caused
by high blood sugars.  
24% of type 1 diabetics will develop retinopathy after
5 years, almost 60% after 10 years and 100% after 20 years.

Long-Term Complications of Diabetes

Complications of diabetes are grim and include heart disease, blindness, high blood pressure, nerve damage, diabetic retinopathy (which can lead to blindness), amputation, and kidney failure. But it is possible to maintain tight control over diabetes and help reduce the risk of long-term complications.  High blood glucose over time destroys nerves (neuropathy) and tissues (see image below).  Blood glucose kept in good target ranges will help preserve organs, eyesight and improve longevity.  To better understand why it is important to test your blood glucose often (read diabetes statistics).

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Page Updated 02/23/2006