ALL YOU NEED TO KNOW ABOUT TYPE 1 DIABETES MELLITUS & ITS MANAGEMENT
Diabetes mellitus is a group of disorders, characterized by high blood glucose concentrations resulting from defects in insulin secretion, insulin action, or both.
CLASSIFICATION: The different types of diabetes have been classified by the American Diabetes Association (ADA) as follows:
- Type 1 Diabetes (T1DM)
- Type 2 Diabetes (T2DM)
- Gestational diabetes mellitus
Specific types of diabetes due to other causes
- Type 1 Diabetes Mellitus: The primary defect in the pancreas (organ producing blood sugar controlling hormone: insulin) usually leading to absolute insulin deficiency.
- Hyperglycaemia: Excess of glucose in the bloodstream.
- Polyuria: Production of abnormally large volumes of dilute urine.
- Polydipsia: Abnormally great thirst
- Polyphagia: Excessive eating or appetite
- Weight loss
- Electrolyte disturbance: Electrolytes are chemicals in the body that regulate important physiological functions. Examples of electrolytes are sodium, chloride, magnesium, potassium, and calcium.
- Ketoacidosis: Insulin normally plays a key role in helping sugar (glucose) enter your cells. Without enough insulin, your body begins to break down fat as fuel. This process produces a buildup of acids in the bloodstream called ketones, eventually leading to diabetic ketoacidosis if untreated.
- Dry mouth: Two of the main causes of dry mouth for people with diabetes are medication side effects and high blood sugar levels, according to the American Diabetes Association. Other causes, not directly related to diabetes but which can exacerbate the problem, are poor hydration, breathing through your mouth, and smoking. Developing diabetic neuropathy can also cause dry mouth.
- Upset stomach and vomiting: People with diabetes may experience nausea as a result of many causes, including gastroparesis (delayed gastric emptying), certain medications, and diabetes-related complications, such as high or low blood sugar levels.
- Fatigue: It results due to the body’s inability to get glucose from the blood into cells to meet our energy needs.
- Blurry vision: High blood sugar causes the lens of the eye to swell, which changes your ability to see.
- Heavy, labored breathing (your doctor may call this Kussmaul respiration): Kussmaul breathing is a type of hyperventilation that is the lung’s emergency response to acidosis. It reduces carbon dioxide in the blood due to an increased rate or depth of respiration.
- Frequent infections of your skin, urinary tract, or vagina: People with diabetes are more susceptible to developing infections, as high blood sugar levels can weaken the patient’s immune system defenses. In addition, some diabetes-related health issues, such as nerve damage and reduced blood flow to the extremities, increase the body’s vulnerability to infection.
- Crankiness or mood changes: Changes in blood sugar levels can affect a person’s mood and mental status. When blood sugar returns to a normal range, these symptoms often resolve. Fluctuations in blood glucose can result in rapid mood changes, including low mood and irritability.
- Bedwetting in a child who’s been dry at night: If you have diabetes, your body doesn’t process glucose, or sugar, properly and may produce larger amounts of urine. The increase in urine production can cause children who normally stay dry overnight to wet the bed.
There’s no way to prevent type 1 diabetes. Doctors don’t know all the things that cause it. But they know that your genes play a role. They also know that you can get Type 1 diabetes when something around you, like a virus, tells your immune system to go after your pancreas. Most people with type 1 diabetes have signs of this attack, called autoantibodies. They’re there in almost everyone who has the condition when their blood sugar is high. Type 1 diabetes can happen along with other autoimmune diseases, like Graves’ disease or vitiligo.
MANAGEMENT OF T1DM:
Type 1 diabetes is a life-threatening condition that needs to be closely managed with daily care. Type 1 diabetes is managed with:
- Insulin replacement through lifelong insulin injections or use of an insulin pump
- Monitoring of blood glucose levels regularly
- Following a healthy diet and eating plan
- Taking regular exercise
Everyone with type 1 diabetes needs to use insulin shots to control their blood sugar. When your doctor talks about insulin, they’ll mention three main things:
“Onset” is how long it takes to reach your bloodstream and begin lowering your blood sugar.
“Peak time” is when insulin is doing the most work in terms of lowering your blood sugar.
“Duration” is how long it keeps working after onset.
Several types of insulin are available.
Rapid-acting starts to work in about 15 minutes. It peaks about 1 hour after you take it and continues to work for 2 to 4 hours.
Regular or short-acting gets to work in about 30 minutes. It peaks between 2 and 3 hours and keeps working for 3 to 6 hours.
Intermediate-acting won’t get into your bloodstream for 2 to 4 hours after your shot. It peaks from 4 to 12 hours and works for 12 to 18 hours.
Long-acting takes several hours to get into your system and lasts about 24 hours.
I. CARBOHYDRATE: Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load should be advised over other sources especially those containing sugars. Visible sugar (Add on) can be restricted to 10% of Total Energy Intake (TEI). The type and amount of carbohydrates are both important factors. It depends upon the Glycemic Index (GI) and Glycemic Load (GL) of food.
GLYCEMIC INDEX: The Glycemic Index (GI) is a relative ranking of carbohydrates in foods according to how they affect blood glucose levels. Carbohydrates with a low GI value (55 or less) are more slowly digested, absorbed, and metabolized and cause a lower and slower rise in blood glucose and, therefore usually, insulin levels.
GLYCEMIC LOAD: The glycemic load (GL) is an equation that takes into account the planned portion size of food as well as the glycemic index of that food. Glycemic Load = GI/100 multiplied by the net grams of planned carbohydrate (net carbohydrate is the total grams of carbohydrate minus the dietary fiber).
CARBOHYDRATE COUNTING: It is a method of calculating grams of carbohydrate consumed as it provides an accurate ‘guess’ of how the blood glucose will rise after a meal or snack. For example, 15 grams of carbohydrate in fruits are approximately 120g of apple, 180g of orange, 90g of grapes, etc.
II.PROTEINS: 20% of total energy from protein is seen to improve glucose and insulin concentrations, reduce appetite, and improve satiety. Also having protein in every meal helps in gradual raising if blood glucose. While people with kidney diseases along with diabetes should limit their protein intake to 0.8g/kg body weight.
III. FATS: Fat is a part of an everyday healthy diet. The quality of fat is far more important than the quantity of fat. Fats containing MUFA’s and PUFA’s should be included whereas trans fat should be restricted. Fats also help in raising blood glucose levels gradually and not spiking it all at once.
IV. ALCOHOL CONSUMPTION: Risks include low blood sugar levels (hypoglycemia), weight gain, and high blood glucose levels (hyperglycemia) for those consuming excessive amounts.
V. ARTIFICIAL SWEETENERS: Sweeteners approved by FDA along with their recommended amounts should only be taken. These include:
Sucralose- 5mg/kg body weight/day
Aspartame- 50mg/kg body weight/day
Acesulfame (contraindicated in hyperkalemia) – 15mg/kg body weight/day
Saccharin(contraindicated in pregnancy) – 5mg/kg body weight/day
Steviol glycosides- 4mg/kg body weight/day
SGFE- Not specified
Advantame- 32.8g/kg body weight/day
Neotame- 0.3g/kg body weight/day
Source: U.S. Department of Health and Human Services.
The American Diabetes Association recommends two different types of exercise for managing diabetes: aerobic and strength training.
The Importance of Exercise in Treating Diabetes:
- Increased insulin sensitivity (insulin works better).
- Lower blood sugar levels.
- Increased energy and endurance throughout the day.
- Weight loss with increased muscle tone.
- A healthier heart and lower blood pressure.
- Better sleep at night.
- Stronger bones and a lower risk of osteoporosis.
- Better resistance to illness.
- Improved cholesterol, heart rate, and blood pressure levels
- Lower stress, anxiety, boredom, frustration, and depression
Precautions for Exercising with Diabetes
- Always consult with your doctor before beginning any exercise program to be sure it is medically safe to exercise and review the principles noted below.
- Exercise can lower blood sugar suddenly, but in the case of strength training, it can increase blood sugar levels. Be sure to monitor blood sugar levels before and after all exercise routines to better understand how your body responds to exercise and to prevent any severe deviations.
- Those with Type 1 diabetes should also test for ketones in their urine (if blood sugar is severely or unexplainably high) before exercising and should avoid vigorous activity/exercise when ketones are elevated. You can likely exercise when your blood sugar is high as long as there are no ketones in your urine and blood sugar is not severely high.
- Low blood sugar is less common in diabetic patients who are not treated with insulin or insulin secretagogues (Secretagogues, such as sulfonylureas and glinides, increase insulin secretion from the pancreas.), and no preventive measures for low blood sugar are usually needed in these cases.
- Stop exercising and seek immediate help if you have any of these symptoms during, or even several hours after, exercise:
Lightheadedness or dizziness
Jaw, arm, or upper back discomfort
Unusual shortness of breath
Severe or unusual fatigue or sleepiness
Severe discomfort of any kind