Type 1 Diabetes; formerly known as Juvenile diabetes or insulin-dependent diabetes typically affects children and young adults but can be seen at any age. The main cause is not exactly known but believed to be an autoimmune disorder (the body sees itself as foreign substance and attempts to fight it). Other supporting factors include viral, hereditary, environmental, and drugs.
Pathophysiology
Our body uses up glucose through the food we eat or from stored glucose (glycogen) found in the liver and skeletal muscles. After eating food, the blood glucose level starts to increase, it signals the beta cells (islet Langerhans) of the pancreas to release the insulin hormone. Insulin encourages glucose to enter the cells perform their normal activity, if it is excess, it encourages the absorption of glucose from the blood into the liver and skeletal muscles to be stored as glycogen. This process helps to decrease the level of glucose in the bloodstream and prevents blood glucose levels from reaching above the appropriate range. If the glucose level starts to decrease the release of insulin from beta cells decreases. This is called negative feedback; the glucagon hormone starts to be released from the pancreas to convert the stored glycogen to glucose. This is how body tries to maintain homeostasis.
However, if there is a deficiency or complete absence of insulin, it will lead to a high blood glucose level in the bloodstream, this is called hyperglycemia. Hyperglycemia is the complete absence or deficiency of insulin due to the destruction of beta cells and is commonly seen in Type 1 diabetes. Due to hyperglycemia (high level of glucose), osmotic diuresis will occur. The excess glucose should be excreted through the kidney to maintain the concentration of the blood. Normally glucose should not be filtered by the glomerulus, but if filtered it should be reabsorbed by the body, because it is essential. However, the kidney has its own glucose threshold of 160-180mg/dl. If the concentration of glucose is above the threshold, it must be excreted. This condition obliges the kidney to release its fluids that lead to frequent urination (glucosuria) that will cause dehydration. That is why we observe polyuria (excess urination), polydipsia (thirsty), polyphagia (hunger) in a diabetic patient.
When cells are depleted of energy (glucose), they break lipids to perform their normal activity, unfortunately, it results in ketoacidosis. This acidosis will affect the PH level of the blood. The disruption of pH level affects the normal function of the kidney and respiratory system. To stabilize the pH, the kidney tries to excrete H ion (measurement of acidity) and retain bicarbonate (HCO3), to decrease the acidity of the blood. The lungs also try to stabilize pH levels by making respiration fast and deep to remove CO2. A Fruity smell and ketonuria, in the urine, can be observed. Moreover, depleting the stored energy (fat) leads to weight loss for the patient.
In other ways, cells use protein when they do not have access to glucose, as we know protein is the building block of the cells. Immunoglobulins are one of the very essential proteins. This affects the immunity of the body. This is the main reason why diabetic patients have lower immunity against infection. Therefore, they should maintain good hygiene and special care for small cuts even.
Chronic hyperglycemia can weaken and damage blood vessels. The capillary of the glomerulus will be damaged, which may cause the development of nephropathy(damage to capillaries that fuel nerves); the capillary of the retina is also sensitive to uncontrolled hyperglycemia, so retinopathy is unavoidable. If the capillaries that supply the nerves are damaged, the supply of oxygen will be affected that can result in neuropathy. Excess glucose in the blood also affects the blood vessels by making them stiff that resulting in cardiovascular disease.
Understanding the role of insulin is helpful especially in diabetic type 1. There is no backup or ways the body can handle it. The only hypoglycemic agent our body has is insulin.
Management
Since it is an insulin-dependent disease, it is only managed by insulin. The above complications can be prevented or delayed by maintaining the blood sugar with regular check-ups, leading a healthy lifestyle, having enough knowledge about the disease, and following the doctor’s recommendation. So, awareness is very important especially differentiating type 1 from type 2 diabetes because they are different while their symptoms are similar.
Prevalence
According to the Beyond Type-1 Organization of Canada, “about 300,000 people live with type-1 diabetes that is around 1% of the total population. As with the rest of the world, the incidence of type -1 is increasing. According to the International Diabetes Foundation, the rate of type -1 incidence is increased by 3% annually for children under the age of 14”.
Beyond Type1, https://beyondtype1.org/canada.
Written By: Emmanuel Tesfamichael
References
1, Beyond Type1, https://beyondtype1.org/canada
2, Mosby’s Canadian Manual of Diagnostic and Laboratory Tests, Pagana. Pagana. Pike-MacDonald 2nd edition Copyright © 2019, Elsevier Inc.
3, Canadian Pediatric Society www.Diabetes-children.ca/en/type-1-diabetes/t1d-t2d/
4, Daphne E. Smith-Marsh Pharm D. CDE reviewed by W. Patrick Zeller MD, Type-1 Diabetes Risk Factors
5, Linne and Ringsruds Clinical Laboratory Science: Concepts, Procedures, and Clinical Applications, Mary Louise Turgeon, 7th edition, 2016 by Mosby, an imprint of Elsevier Inc.