Type 1 Diabetes Mellitus - An Overview

Medically reviewed by Ajidahun Olusina, MD
August 31, 2021

Type 1 Diabetes Mellitus - An Overview

Before we dive into the overview of type-1 diabetes mellitus, it is essential to understand diabetes. This will provide us with a comprehensive knowledge of the disease and how it manifests.

What is Type-1 Diabetes Mellitus?

Type-1 diabetes is one of the most common chronic diseases in children and globally represents a public health challenge. Type-1 diabetes mellitus is an autoimmune disorder. This is a medical term for diseases in which the body attacks itself. As a result, your pancreas' β-cells which produce insulin, are destroyed.

It is not as common as type 2 diabetes, and it accounts for about 10% of people with Diabetes. It is more common in children but can also occur in young adults. Due to a lack of insulin, blood glucose levels rise, resulting in a degeneration of the patient's health. This could lead to several health conditions that could ultimately result in death.

Why is my Blood Glucose level High?

If you have Diabetes, it might be due to:

  • The β-cells (beta-cells) of the pancreas not producing sufficient or any insulin at all, or
  • The β-cells of the pancreas producing insulin, but the cells of the body are not responding to it or not functioning as they should be.

If these two conditions are met in a person's body, the glucose would not be able to get into the body cells. If the glucose stays too long in your bloodstream, your blood glucose (or blood sugar) level would be high, posing a danger to healthy living. At this point, such a person needs to seek medical attention.

What are the symptoms of Type-1 Diabetes Mellitus?

The signs and symptoms of type-1 diabetes mellitus can appear progressively or suddenly, and this may include one of, or a combination of any of the following:

  • Excessive intake of water 
  • Extreme hunger
  • Unplanned weight loss
  • Numbness or tingling in the hands or feet
  • Nonhealing leg injury or ulcer
  • Blurred vision
  • Bedwetting in children who have stopped bedwetting
  • Irritability and mood changes

If you notice any of the above symptoms in yourself or your child, reach out to your health care provider for proper investigation and management.

What are The Risk Factors of Type -1 Diabetes Mellitus?

The presence of a particular gene indicates an increased risk of developing type-1 diabetes. Family History. This is another crucial factor that can predispose a child to have this type of Diabetes. Anyone with a parent or sibling with T1DM has higher chances of developing too. Environment or Location. This type of diabetes is common among children of black origin. It has been established that type-1 diabetes mellitus is diabetes at a young age. However, it can occur at any age. It usually peaks in children between 4 and 7 years old and can also peak in children between 10 and 14.

How Common is Type-1 Diabetes?

The prevalence of type-1 diabetes mellitus varies from country to country. It is not rare in African children, and probably an important number of undiagnosed cases exist. Its burden is huge in developing countries due to the lack of essential means of reaching a diagnosis and reasonable glucose control.

With the bits of data available on children in Sub-Saharan Africa, the incidence was estimated to be 1.5/100,000 in Tanzania and 10.5/100,000 in Sudan. While in Ethiopia, it accounts for 9.8% of patients attending a diabetic clinic in Addis Ababa. However, this prevalence and incidence may be underestimated since most of them were performed decades ago and were mainly hospital-based studies. The study from Nigeria found it to be higher in children from poor homes.

There is generally a higher incidence in children of black origin compared to others. Girls and boys are almost equally affected, distinguishing type-1 diabetes mellitus from most autoimmune illnesses, which tends to affect females more frequently.

How is Diabetes Mellitus Type-1 Diagnosed?

There are several tests for type-1 diabetes mellitus. Here are some of them:

  • Fasting plasma glucose test: This is usually done around 8:00 am after an overnight fast.
  • Random plasma glucose test: The test may be performed at any time of day, and there is no need to fast for it.
  • Oral glucose tolerance test: For this test, the patient is not required to fast. The glucose level is taken early in the morning. The patient is given 75mg of anhydrous glucose, and the blood glucose level is checked and recorded at intervals of one, two, and three hours.

Management of Type-1 Diabetes Mellitus

It is advisable to maintain regular monitoring of blood glucose. Following the methods below, you may accomplish this at home:

  • Get a glucometer and test strips. This can be gotten over the counter from most pharmacy stores and ensure it is working well.
  • Wipe the finger you plan to prick with alcohol and cotton wool. Assemble the device and insert the test strip into the glucometer. It will make a beeping sound. Prick your finger with the lancing device. The procedure usually causes very minimal discomfort.
  • Squeeze the pricked finger so that the blood form a small bead on your finger. With the blood bead on your finger, touch the strip's tip at the location indicated on the strip. Wait for about 10-15 seconds for the glucometer to read the result. Keep data of your result and discard the lancet and strip used.
  • Turn off and keep the glucometer for the next date of checking Take your result with you on your next clinic visit for your doctor's comment. It will assist your health care professionals in knowing how you are doing and aid in medication modification.

What Is The Normal Blood Glucose Level?

When you check your glucose level, the expected normal value should be between 70-100mg/dl if you checked 2 hours after eating. When fasting, the value should not exceed 100mg/dl, while the value for glucose 2 hours after eating should be less than 140mg/dl. If you're getting values above these stated normal ones, kindly consult your doctor for proper investigation.

Complications of Type-1 Diabetes Mellitus

Some of the complications may include:

  • Nephropathy (kidney damage): The kidneys play a vital role in the body. It consists of numerous small blood vessels and a filtering system that the disease can damage. The end-stage of this might result in kidney failure, which may require dialysis or renal transplant.
  • Damage to the eyes: Just like it could happen to the kidneys, diabetes can also damage the blood vessels of the eyes, resulting in diabetic retinopathy, potentially causing blindness. Apart from that, it can cause cataracts or glaucoma.
  • Diabetic foot ulcer: Diabetes can also damage the peripheral nerves, causing a tingling sensation. This makes the patient feel like their leg is floating. Any injury to the leg that is left untreated may result in a complicated infection, which may ultimately require toe, foot, or leg amputation.

What Are The Challenges Faced in The Management of Type-1 Diabetes Mellitus in Africa?

Some significant issues in Africa and developing countries include late presentation, delayed and missed diagnosis, unavailability of insulin, and poor glucose control. Let us look at more of the challenges in detail.

Patient Education

Education plays a vital role in diabetes management, irrespective of the type. Patients with type1 diabetes mellitus need extensive education if they are to manage their disease safely and effectively and minimize long-term complications. It is best done by the patient's family doctor. Generally, these are the tasks carried out by healthcare professionals when managing this condition:

  • Teaching the patient about the common symptoms of low glucose and how to manage it.
  • Ensuring that patient is aware that their condition is a chronic one and the need for lifestyle modification is essential to prevent further complications.
  • Ensuring the patient understands the positive and negative effects of the treatment and what can happen if the situation isn't handled appropriately.
  • A dietician will provide specific diet control education to the patient and family Nurses will educate the patient about self-insulin injection and finger-prick tests for glucose monitoring.

Prevention of Type-1 Diabetes Mellitus

Unlike type 2 diabetes mellitus, there is no known way to prevent this type of diabetes. There is ongoing research to find ways of preventing further destruction of the native β-cells meant for insulin production. Consult your doctor if you feel you have higher chances of birthing a child with type-1 diabetes.

Conclusion

Type-1 diabetes mellitus is a chronic, lifelong disorder of glucose regulation characterized by autoimmune destruction of the insulin-producing pancreatic β-cell, leading progressively to insulin deficiency and elevated blood glucose. When blood glucose levels are under control, optimal health and well-being can be reached. Intensive management significantly decreases the likelihood of developing the possible complications which may be life-threatening, as mentioned. If you notice a spike in your blood glucose level, reach out to your doctor.

Treatment aims to imitate the function of the native β-cells by replenishing insulin and includes frequent monitoring of blood glucose levels to restore and maintain the average glucose level. A person with this condition will have to be on continuous insulin injection.

References:

Mayo Clinic - Type-1 Diabetes

Web MD - Type-1 Diabetes

Center for Disease Control and Prevention - What Is Type 1 Diabetes? 

BMJ Best Practice - Type 1 Diabetes Mellitus - Epidemiology

 

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