Type 1 diabetes: what is it and how is it treated?

Type 1 diabetes is a serious disease in which the patient must inject insulin throughout his life . It can occur at any age – from a newborn to a ninety-year-old. It most often occurs in adolescence and young adults.

Nowadays, the treatment of type 1 diabetes has seen significant achievements:

• With successful treatment, the life prognosis can be the same as that of a healthy person.
• When treated with modern long-term and short-term insulins, there is a minimal risk of inducing hypoglycemia (significant reduction of blood sugar with the risk of unconsciousness ).
• Today, the patient’s lifestyle can be more relaxed, if he is trained, he can eat irregularly and adjust his insulin doses and food as needed.
• So-called sensors that measure the sugar level continuously and the patient can see their sugar level on their mobile phone are a significant advance. It is more convenient than monitoring blood glucose with a paper.
• It is very likely that in the future, perhaps within 10 to 20 years, the development of this form of diabetes will be stopped. Research into new drugs is extensive .

In the article Prevention of type 1 diabetes , you will learn more about the risk of this type of diabetes, its prevention and treatment with diet and physical activity .

That there are two main forms of diabetes has been known since the 1930s. At that time, these forms were referred to as insulin-sensitive (later insulin-dependent and even later so-called type 1) and insulin-insensitive diabetes (later non-insulin-dependent and even later so-called type 2). The basic pathophysiological differences between these two main forms of diabetes helped to reveal only the possibility of determining insulin in the blood in the 1950s. Patients with insulin-sensitive diabetes lacked their own insulin due to the destruction of all pancreatic islets of Langerhans . Patients with type 2 diabetes were insulin-resistant and had only a relative deficiency of insulin.

Type 1 diabetes is typically accompanied by so-called autoimmune inflammation , i.e. inflammation and the formation of antibodies and white blood cells directed against the islets of the pancreas. This inflammation takes place for many months and sometimes even years before the appearance of symptoms of the disease, i.e. before the appearance of high blood sugar levels . Type 1 diabetes is a disease that typically begins with high blood sugar and ketoacidosis (the patient smells of acetone). The disease belongs to the so-called autoimmune endocrinopathies : people affected by this type of disorder are prone to creating autoantibodies against their own endocrine glands . However, not everyone with this equipment will get the disease. Autoimmune damage to pancreatic beta cells is usually triggered by a virus. Nearly 20 highly variable viruses can be involved in this process, and vaccination against them would be of no use. The rise in blood glucose occurs when autoimmune inflammation has been going on for a long time and the beta-cell capacity has dropped to about 20%. After starting insulin treatment, insulin sensitivity increases and the patient can be treated for months (rarely even years) with a very small dose of insulin and theoretically without insulin, which is not advisable. This period is usually called diabetes remission or the honeymoon period. The risk of type 1 diabetes for relatives of a type 1 diabetic is small (only a few percent), the risk in the whole population is around 0.5%. In the course of the disease, there is usually a gradual disappearance of insulin secretion . Autoantibodies are demonstrable in the disease. Other autoimmune diseases can arise on the same genetic basis , for example the so-called polyglandular autoimmune syndrome . However, these diseases also include autoimmune inflammation of the thyroid gland , reduction of adrenal gland function , early transition , anemia due to lack of vitamin B ₁₂ and celiac disease .

Some antibodies occur only temporarily, others usually persist for life. This made it possible to prove that autoimmune diabetes is common even in old age. This type of diabetes has been designated as latent autoimmune diabetes of adults or LADA (the abbreviation comes from the English name latent autoimmune diabetes in adults ). In other words, an elderly person gets this variant of type 1 diabetes, whose symptoms develop slowly and for a long time it seems that it could be type 2 diabetes .

Type 1 diabetes is treated with diet and regular physical activity (see article Prevention of type 1 diabetes ). It is always necessary to treat with insulin. Recently, it seems that some antidiabetic drugs could be added to insulin , but this is not yet recommended.

The risk of hypoglycemia increases with the duration of diabetes. A newly diagnosed diabetic perceives a lower sugar level as weakness, sweating, heart palpitations and eats on time. With longer duration of diabetes, diabetic nerve damage develops , the so-called diabetic neuropathy , in which there is a risk that the patient may fall into unconsciousness without any warning. Prevention of hypoglycemia is frequent examination of blood glucose from a finger on a so-called glucometer, which patients are equipped with. More recently, so-called sensors measure glycemia continuously; these ensure that the patient knows his blood sugar levels at all times, and that he is warned in time by an alarm. In the event of hypoglycemia, a type 1 diabetic should be permanently equipped with food and can also have an injection with the hormone glucagon , which will quickly increase the sugar level.

A type 1 diabetic is at risk of poor compensation (high sugar levels) for other serious complications , such as, in particular, kidney damage up to the need for dialysis , eye damage up to blindness, and vascular damage (e.g. heart attack , stroke or limb amputation ). As mentioned above, the risk of complications is minimal in a well-trained patient who cooperates in treatment, and his life expectancy is on average the same as in a non-diabetic.

We use different insulins in the treatment of type 1 diabetes . Initially, insulins prepared from the pancreas of animals were used, later human ( human ) insulin produced by modified bacteria and no different from the human insulin molecule . Later, insulin analogues began to be used , i.e. modified insulins that do not occur in nature and have more favorable properties. The so-called short-acting insulin analogues act faster than human insulin and can be administered just before or even just after a meal. On the contrary, long-term insulin analogues work evenly throughout the day and for several days, and hypoglycemia does not occur after them either. Which insulin is suitable for which patient must always be assessed by a doctor. However, it is an advantage when individual doses are adjusted by the trained patient himself according to the detected glycemia, physical activity and according to food.

For type 1 diabetics, so-called intensified therapy

Therapy is another name for treatment. Derived words are therapeutic (healing), therapist (one who heals), etc. Therapy – or treatment…

Learn more

is used , i.e. the application of short-acting insulin usually 3 times a day before meals and long-acting insulin, which keeps the blood level balanced throughout the day and night. Patients can also be treated with a so-called insulin pump , i.e. a device hung, for example, on a belt, which delivers insulin continuously and before a meal, the patient squeezes a so-called bolus – an extra dose with a meal.

A diabetic should reach the target value of glycated hemoglobin (indicator of the level of glycemia in the last three months), which is measured at each check-up, glycemia should not fluctuate. The so-called variability of glycemia is evaluated according to the examination of glycemia . Furthermore, blood lipid levels , weight and blood pressure determined by the doctor should be achieved