Type 1 Diabetes

Who gets Type 1 Diabetes?

Type 1 Diabetes can occur at any age however, it is most common in children and young adults.

What is the cause of Type 1 Diabetes?

The cause is not known.

However, it is thought that the body produces proteins that attack and destroy the pancreas, stopping the production of insulin.

The pancreas is an organ that makes insulin.

Insulin is a hormone/chemical that is meant to regulate the blood sugar level in the body.

What are the signs and symptoms of Type 1 Diabetes?

There is no way of confirming type 1 and type 2 diabetes without tests.

Below are the common signs of diabetes.

Children

Excessive urination:

This can be in the form of

Increasingly frequent urination or excessively wet diapers in babies

Excessive nighttime urination, bedwetting or passing urine without warning, in a child who was previously able to make it to the toilet

Increasing thirst/excessive thirst

Weight loss

Urine infections

Problems with eye sight

Drowsiness/feeling tired

Vomiting

Dehydration

Diaper rash that takes long to treat or keeps coming back

Adults

  • Excess thirst

  • Weight loss

  • Excess urination

  • Infections

  • Problems with eyesight

  • Confusion

  • Abdominal pain

  • Vomiting

  • Feeling tired

How will the doctor diagnose Type 1 diabetes?

Type 1 Diabetes is diagnosed using blood tests.

  1. The first step is to confirm it is Diabetes (a blood sugar problem).

  2. Second step is to confirm the type of Diabetes.

Confirming diabetes

This is done by

a) Option 1

Your doctor may ask you to have your sugar checked first thing when you wake up before you have eaten anything. (You should have not eaten for at least 8 hours)

(If it is over 7, you're may have diabetes.)

or

c)Option 2

Your doctor may ask for a blood test called HbA1C.

(It is a blood test that can predict how your sugars have been for the past 3 months even before you were feeling unwell).

(If it is more than 6.5% then it is suggestive of diabetes)

It works because diabetes does not develop in a day. It develops slowly over time before we experience or realize the symptoms and there are markers in the blood that can can be used to estimate the blood sugar in the past 3 months.

Confirming Type 1 Diabetes

The doctor will do several blood tests to confirm that it is Type 1 Diabetes.

These tests will verify that the diabetes is caused by a lack of insulin production in the body.

Some tests can be done to confirm the production of the proteins that destroy the insulin-producing organ(pancreas) in the body.

The results of these test can take several days to return.

How is Type 1 Diabetes treated?

Using insulin.

Type 1 Diabetes is not treated with tablets because tablets cannot substitute the insulin that the body is not able to produce.

How is insulin taken?

It is taken as an injection into the fat in the tummy, arm or thigh.

These areas tend to have plenty of fat under the skin.

You need to clean the area, pinch the skin in the area and inject .The needle is only short enough to get into the fat under the skin.

It is best to change injection sites to avoid infections and the accumulation of insulin in one spot.

Don’t inject insulin into an area that looks infected. Signs of infection are like skin that appears red, swollen, painful or has pus.

You may need antibiotics in case you have a skin infection.

Types of Insulin

  • Long acting insulin

    This type of insulin is called ‘long acting’ because its effects last for very many hours in the body (About 20 to 24 hours. Some last up to 42 hours).

    Normally our bodies produce insulin even when we are not eating.

    This background insulin acts without our knowledge to ensure that our blood sugar levels remain stable throughout the day.

    Long acting insulin works like the natural background insulin our bodies produce. Its work is to keep the blood sugar controlled even when we are not eating.

    It cannot be used alone to manage high blood sugar related to a meal because it starts working after 1-2 hours and acts very slowly.

    Because of this, it is often used in the morning or evening and a short/rapid acting insulin is needed for meal times.

  • Rapid/Short acting insulin

    It is insulin that works for a limited time in the body.

    It is usually taken around meals. It starts to work soon after you take it.

    (Most start working within 30minutes and their effects last up to about 4 to 6 hours).

    Because they act quickly, they can be used to bring the blood sugar level down quickly when the levels are very high. For example after you eat a meal.

    Since the effects last only 4 to 6 hours you need to have it 3 or 4 times in a day, each time you eat.

  • Intermediate acting insulin

    It is called intermediate because its effects last up to 16 to 18 hours in a day.

    It works similarly to long acting / background insulin. It regulates sugar even when we are not eating.

    Therefore it an be used when long acting insulin is not available. It does not work immediately and neither does it last the whole day .

    It tends to be taken twice a day so its effects last day and night.

Long acting insulin in Type 1 diabetes

Most circumstances do not require you to stop your long acting insulin. There will be occasions when the doctor may adjust your dose, like when your fasting, however, you should use it consistently.

Avoid using short acting insulin alone. It can lead to large variations in your blood sugar levels.

Is the injection painful?

The injection causes very minimal pain.

The reason is because the insulin needle is very short and tiny.

See the orange needle in the picture. It is short enough and just goes up to the fat under our skin.

Compare it with other needles that are used medically.

How else can you receive insulin?

Continuous insulin pump

It is a battery powered device in which you put an insulin cartridge of rapid acting insulin.

It pumps insulin throughout the day and night through a thin tube into a needle placed into the fat under your skin.

The rate of insulin pumped is set by the user.

The rate of insulin delivered is guided by your doctor depending on your blood sugar levels and how much carbohydrate you eat.

During meal time you may need to increase the amount of insulin depending on what you eat. This extra dose of insulin is called a bolus.

Some pumps come with sensors that detect the blood sugar level and trigger the pump to give certain amounts of insulin.

The amount of insulin will be based on the information you put into the machine prior.

This information includes;

  • how much insulin you usually need for a given amount of carbohydrate,

  • your current blood sugar level ,

  • and how much carbohydrate you will be eating in a given meal. This will guide the machine on how much insulin to dispense.

Other machines may require that you manually check your sugar and estimate how much insulin you need for what you are going to eat.

You need to change the site of the needle every 3 days.

.

Is there any benefit of a continuous insulin pump over the usual insulin injections?

Some benefits.

Most people with type 1 diabetes are on what is medically called a basal bolus regimen.

This means that you take a long acting and a short acting insulin.

The long acting is taken once or twice a day in the morning or evening and the short acting is taken just before meals.

The long acting serves as the background insulin to control blood sugar even when you are not eating and the short acting insulin works to control the blood sugar level when you eat and up to 5 hours after eating (when your food is being digested and absorbed).

This is a very effective combination.

The reason to use a pump is mostly

  1. a personal choice-instead of self injecting

  2. to try and get blood sugar levels under better control. People may delay having insulin or forget .The pump works 24hours and may improve things. If it is fully automated, it can give accurate amounts of insulin once programmed.

  3. There is a lower chance of low sugars. Automated machines that come with sensors can monitor your blood sugar level 24 hours of the day and if the blood sugar levels are low they can trigger an alarm or cut back on the insulin it is giving. This is most useful if you tend to get low sugars often or you don’t get symptoms with low blood sugars or if you tend to get low blood sugars at night.

  4. Flexibility- You can eat what you like and give yourself the required insulin .You don’t need to have planned your meals in advance.

Challenges of the pump

The continuous pump has its challenges including

  • it is battery powered so batteries can run out at any point

  • it needs a lot of user training. You need to learn how to program it. You need training on how to manage if it stops working suddenly.

  • it is expensive to buy and will need maintenance as well

  • you will still need to have the long and short acting insulin around in case the pump stops working suddenly.

  • Your blood sugar level will go up very quickly if the pump stops working suddenly. This is because the insulin the pump is using a rapid/short acting insulin which lasts a short time. That is why it has to be given continuously over 24 hours.

  • The pump can have technical errors like: a blockage of the tube, it can give the wrong insulin if the wrong amount is programmed, the insulin can leak, the needle site can develop an infection.

How do you measure your blood sugar level?

You will need

  • a blood sugar machine/device

  • a small needle also called lancet

  • paper strips that are made for the particular machine your using and go into the machine

  • piece of cotton wool

You measure your sugar by

  • First cleaning your hands then

  • Create a small prick at the tip of your finger using the needle/lancet

  • Apply a small drop of blood on the edge of the paper strip in the machine

  • Wait for 1-2 minutes to get the measurement of your blood sugar level

  • Hold a piece of cotton against the spot you pricked to stop any bleeding

When to check your sugars

  • Before exercising: to avoid low sugar. You may need to have a snack like a slice of bread or a small piece of fruit before exercise or you may need to reduce your insulin dose.

  • Before or after meals like breakfast, lunch and supper

  • When you are unwell: For example if you have diarrhea or are vomiting. Your sugars are likely to be very low or very high. By checking you can reduce or increase your insulin dose as required.

  • When pregnant: It best to monitor your sugars to ensure they are regulated most of the time to avoid complications to you and the baby.

  • Before driving: Low blood sugars while driving can make you loose consciousness and is a risk to other motorists and pedestrians.

  • When the dose of your insulin has been changed: There is a risk of low sugars or high sugars when your dose of insulin is adjusted. You need to monitor your sugars to ensure that the insulin your getting is enough to regulate your blood sugar levels. Too much insulin is risky and can cause low blood sugars and even death and too little insulin can lead to complications of diabetes in the long run.

What is the harm of very low blood sugar levels?

Very low blood sugar levels CAN KILL.

It can lead to sudden unexpected death.

It is a blood sugar level less than 4.

It triggers symptoms like

  • sweating

  • feeling your heart racing

  • feeling weak and tired

  • confusion

  • passing out

Some people do not experience warning signs of low blood sugar and may need to monitor their blood sugar levels more.

What are the causes of low blood sugar levels?

  • Excess insulin

  • Excess exercise

  • Skipping meals

  • Drinking excess alcohol

  • Delaying meals

Who can experience low blood sugar without any warning?

  • Those who use insulin

  • Those who drink plenty of alcohol

  • Those who have had diabetes for a long time(over 5 years)

Treating low blood sugar

  • Eat a tablespoon of honey.

  • Eat a tablespoon of sugar.

  • Drink a half a cup of juice.

  • Eat hard sweets.

  • Or give a glucagon injection.

Other forms of sugar may take time to work. The above options raise the blood sugar levels quickly.

Call an ambulance if the blood sugar level remains low or if you don’t have glucagon and the person with low sugars is unconscious or passed out.

Low blood sugar can kill.

Fasting during Ramadhan

This is one of the pillars of Islam.

The main concern is low blood sugar levels.There are guidelines to help with managing diabetes around ramadhan.

Summary

  • PREPARE

Prepare for Ramadhan by seeing your doctor a month before Ramadhan to plan your medications and insulin if you plan to fast.

It is best to make sure your diabetes is well controlled before Ramadhan if you intend to fast.

Well controlled means a HbA1C test or 3 monthly blood control test result of 6.5% or 7%.

You will need to monitor your sugars more frequently during Ramadhan.

Most guidelines recommend at least every 3 hours between Suhur and Iftar.

WHEN TO BREAK YOUR FAST

You should break your fast if your sugar is equal to or less than 3.9.Sugars lower than this can lead to death.

WHO IS AT HIGHEST RISK

Fasting will be very risky for you if you have one of the following

  • low blood sugar in the months before Ramadhan

  • don’t get symptoms when your sugar is low

  • are pregnant

  • constantly high sugars before Ramadhan

  • are unwell and have diabetes

  • have kidney disease

    TYPE 1 DIABETES

If you have type 1 diabetes it is recommended that you continue to use your long acting insulin while fasting, but at an adjusted dose depending on how much you eat during Suhur (morning meal) or Iftar (evening meal).

If you are using short acting insulin or intermediate insulin the amount and timing will need to be adjusted so that you take them closer to the main meals of the day(Suhoor and iftar)

TYPE 2 DIABETES

Your tablets will need to be assessed by the doctor as some may not be safe when fasting

Also your insulin use will need to be changed-both timing and amount so you take them around Suhoor and Iftar

DIET

Eat healthy during Iftar and Suhoor .Using high fiber foods rather than processed sweet or fatty foods

Diabetes and driving

It is recommended to check and ensure your bloods sugar level is over 5mmol/l before driving.

Before driving have some snacks in the car to avoid low blood sugar levels.

Diabetes in the older adult

Diabetes in the older adult is important.

Our elderly(over 65 years) are at risk of having low blood sugar levels.

It is important to ensure they don’t have episodes of low blood sugar(less than 4) which can be harmful to their health and even cause death.

Aiming for a sugar between 5 and 10 after meals is sufficient in most of our elderly.

The target should be closer to 5 after meals if they are elderly and have few medical problems.

If they have multiple medical conditions, around 10 should be sufficient.

A target between 5-8 before breakfast is also sufficient