Demystifying Diabetes Mellitus: Understanding Causes, Types, and Management

Diabetes is one of the common diseases that can have numerous adverse effects on the entire body. One of the forms of diabetes mellitus is type 1 diabetes, also known as type 1 diabetes. The various types of diabetes mellitus differ significantly in their cause, diagnosis and therapy. As a result, it is crucial for those affected to know as much as possible about the disease, its symptoms, the chances of recovery and possible consequences. Here, we present the unique features of type 1 diabetes.

What is type 1 diabetes mellitus?

Diabetes mellitus includes a group of metabolic diseases (diseases of the metabolism). There are four different types, which differ in their cause and therapy. The diseases have in common that they are characterized by a pathological increase in blood sugar (hyperglycemia). How this increase in blood sugar comes about is different for each type of diabetes.

Type 1 diabetes mellitus usually manifests itself in children and adolescents. In the past, this type was also called juvenile diabetes.

 

Causes: how does type 1 diabetes mellitus develop?

Type 1 diabetes is an autoimmune disease. This means that the body produces substances (antibodies) that attack structures in its body. In type 1 diabetes, the antibodies attack the cells responsible for insulin production.

Insulin is a hormone responsible for processing sugar in the human body. It is released when the blood sugar level is high, for example, after eating, and ensures it drops again. With the help of insulin, the sugar (glucose) gets into the tissue and cells, where it is needed for energy production.

Insulin is formed in the pancreas’s so-called ß-cells (beta cells). The antibodies in type 1 diabetes attack and destroy the ß-cells. When about 80 per cent of the ß-cells have been destroyed, insulin production is no longer sufficient to control the blood sugar level. This is then referred to as an absolute insulin deficiency. The result is increased blood sugar levels.

What is the difference between type 1 and type 2 diabetes?

Type 2 diabetes tends to affect older people, although this form of diabetes can also occur in younger people. However, type 2 diabetes does not have an autoimmune cause. The ß-cells of the pancreas are not destroyed, and insulin can continue to be produced.

Instead, in this form of diabetes, insulin insensitivity (insulin resistance) is in the foreground. The development of type 2 diabetes is usually attributed to being overweight ( obesity ) and a lipid metabolism disorder. Hereditary factors are also discussed.

Read this article for detailed information on the causes of type 2 diabetes.

 

Diabetic coma is the first sign.

Type 1 diabetes usually manifests itself at an early age. The so-called coma diabetic (diabetic or hyperglycemic coma) can appear as the first symptom (one then speaks of a first manifestation).

A diabetic coma is a life-threatening clinical picture that is caused by a derailment of the metabolism. The cause of the metabolic derailment is the lack of insulin. It leads to high blood sugar (hyperglycaemia), which increases the excretion of water and minerals in the urine (polyuria) – those affected, therefore, excrete more urine.

This, in turn, leads to a lack of volume (hypovolemia) in the bloodstream. But this means that there is no water in the vessels. In addition, the lack of insulin leads to a relative lack of energy in the tissue. This is because the sugar is in the blood but cannot be absorbed into the cells where it is needed.

The lack of insulin and energy leads to a breakdown of fat stores (lipolysis). So-called ketone bodies are formed in the liver from the released fatty acids. Ketone bodies are chemical compounds that the body’s cells can use for energy when sugar isn’t available. However, these chemical compounds have an acidic (acidotic) reaction in the body. There is, therefore, a shift in the blood pH value towards the acidic range. A so-called metabolic acidosis is the result. It leads to vomiting, which increases hypovolaemia – i.e. the lack of water in the vessels.

As a result of hypovolemia and mineral deficiency, unconsciousness and hypotension may occur. Other characteristic symptoms of ketoacidosis coma are acetone-smelling breath (breath smells like overripe fruit or nail polish remover), abdominal pain, also known as diabetic pseudoperitonitis, and deepened breathing (Kussmaul breathing).

What are the symptoms of type 1 diabetes mellitus?

Type 1 diabetes is not always discovered when a diabetic coma occurs. Possible signs of type 1 diabetes are:

• Thirst/drinking too much (polydipsia)
• Reduced performance/fatigue
• leg cramps
• itching
• weight loss
• visual disturbances
• increased water excretion (polyuria)
• nausea/vomiting
• desiccation (exsiccosis)
• low blood pressure (hypotension)
• clouding of consciousness

How dangerous is type 1 diabetes mellitus?

In particular, the diabetic coma as a life-threatening clinical picture is acutely dangerous for type 1 diabetics. In addition, there are potentially dangerous consequences of the disease. The possible consequences and complications are mainly due to long-term hyperglycaemia and include:

• Microangiopathies:  These are changes in the smallest blood vessels. They appear after about five to ten years of hyperglycemic metabolism. Consequential damage is found in particular in the small vessels of the kidneys (nephropathy), the retina (retinopathy) and the nerves (neuropathy).
• Macroangiopathies are changes in larger blood vessels, such as the formation of deposits (plaques). Consequential damage can be peripheral arterial disease (PAD) or a heart attack.

Diagnose des Diabetes Typ 1

The diagnosis of type 1 and type 2 diabetes does not differ fundamentally. The fasting blood sugar level, measured using a blood sample, is essential in both cases. If this value alone does not provide any information, the so-called oral glucose tolerance test (OGTT) can be consulted. The long-term value of HbA1c is beneficial for monitoring the progression.

In type 1 diabetes, the antibodies that destroy the ß-cells can also be searched for. However, these examinations are not routine diagnostics. These tests are only performed if the diagnosis remains unclear after routine tests.

The search for antibodies is essential when diagnosing a particular form of type 1 diabetes, the so-called LADA. This abbreviation stands for Latent Autoimmune Diabetes in Adults. To a certain extent, this is type 1 diabetes, but it only becomes apparent in adulthood. The differentiation from type 2 diabetes mellitus is, therefore, difficult. The search for specific antibodies can help here.

Therapy of Diabetes Mellitus Type 1

Treating type 1 diabetes involves replacing the missing hormone insulin (substitution). Therapy without insulin substitution, as is sometimes used in type 2 diabetes, is not possible in type 1 diabetes due to the absolute lack of insulin.

Insulin therapy aims to keep the blood sugar level as optimal as possible and to prevent hyper- and hypoglycaemia, i.e., high and low blood sugar levels. To achieve this goal, there are different application schemes with their advantages and disadvantages. The doctor and the patient decide which scheme is most suitable.

A cure for type 1 diabetes is currently not possible due to the irreversible destruction of the ß-cells. Life with type 1 diabetes mellitus is very possible after an adjustment phase. Life expectancy is usually unaffected with reasonable blood glucose control and correct use of the insulin regimen.

Diet in type 1 diabetes mellitus 

People with diabetes can eat anything. There are no forbidden foods or strict guidelines. However, a varied, conscious diet can help treat the disease and prevent negative consequences. The same rules apply that generally also apply to non-diabetics. Eating lots of whole grains, plenty of fruits and vegetables and preferably vegetable oils is recommended. Sugar should account for at most ten per cent of the daily energy. So if you eat 2,000 kcal (kilocalories) daily, no more than 200 kcal should come from sugar.

In addition, no more than 30 per cent of the daily energy should be consumed in the form of fats, but at least 40 grams of fibre. 

These numbers and rules are to be understood as rules of thumb and aid those affected can use as a guide.

It is more important – especially for type 1 diabetics – to know the nutrients, nutritional values ​​and their effects on the body and the disease. Type 1 diabetics need to adjust their insulin levels to the food they eat. Therefore, they need to know how the required amount of insulin changes due to the food they eat. In connection with sports activities, it may also be necessary to reduce the amount of insulin accordingly to avoid possible hypoglycaemia.