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Type 1 diabetes


Definition:

Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.

Alternative Names:

Insulin-dependent diabetes; Juvenile onset diabetes; Diabetes - type 1

Symptoms:

HIGH BLOOD SUGAR

The following symptoms may be the first signs of type 1 diabetes. Or they may occur when blood sugar is high.

  • Being very thirsty
  • Feeling hungry
  • Feeling tired all the time
  • Having blurry eyesight
  • Feeling numbness or tingling in your feet
  • Losing weight without trying
  • Urinating more often (including urinating at night or bedwetting in children who were dry overnight before) 

For other people, these serious warning symptoms may be the first signs of type 1 diabetes. Or, they may happen when blood sugar is very high (diabetic ketoacidosis):

  • Deep, rapid breathing
  • Dry skin and mouth
  • Flushed face
  • Fruity breath odor
  • Nausea or vomiting; inability to keep down fluids
  • Stomach pain

LOW BLOOD SUGAR

Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms usually appear when a person's blood sugar level falls below 70 milligrams per deciliter (mg/dL). Watch for:

  • Headache
  • Hunger
  • Nervousness
  • Rapid heartbeat (palpitations)
  • Shaking
  • Sweating
  • Weakness
Exams and Tests:

Diabetes is diagnosed with the following blood tests:

  • Fasting blood glucose level: Diabetes is diagnosed if it is higher than 126 mg/dL two different  times.
  • Random (non-fasting) blood glucose level. You may have diabetes if it is higher than 200 mg/dL, and you have symptoms such as increased thirst, urination, and fatigue. (This must be confirmed with a fasting test.)
  • Oral glucose tolerance test: Diabetes is diagnosed if the glucose level is higher than 200 mg/dL 2 hours after you drink a special sugar drink.
  • Hemoglobin A1c (A1C) test: Diabetes is diagnosed if the result of the test is 6.5% or higher.

Ketone testing is also used sometimes. The ketone test is done using a urine sample or blood sample. Ketone testing may be done:

  • When the blood sugar is higher than 240 mg/dL
  • During an illness such as pneumonia, heart attack, or stroke
  • When nausea or vomiting occur
  • During pregnancy

The following tests or exams will help you and your doctor monitor your diabetes and prevent problems caused by diabetes:

  • Check the skin and bones on your feet and legs.
  • Check if your feet are getting numb (diabetic nerve disease).
  • Have your blood pressure checked at least once a year. The goal should be 140/80 mm Hg or lower.
  • Have an A1C test done every 6 months if your diabetes is well controlled. Have the test done every 3 months if your diabetes is not well controlled.
  • Have your cholesterol and triglyceride levels checked once a year.
  • Get tests once a year to make sure your kidneys are working well (microalbuminuria and serum creatinine).
  • Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease.
  • See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.
Support Groups:

There are many diabetes resources that can help you understand more about type 1 diabetes. You can also learn ways to manage your condition so that you can live well with diabetes.

Outlook (Prognosis):

Diabetes is a lifelong disease and there is no cure.

Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control.

Possible Complications:

After many years, diabetes can lead to other serious problems:

  • You could have eye problems, including trouble seeing (especially at night) and sensitivity to light. You could become blind.
  • Your feet and skin could develop sores and infections. If you have these sores for too long, your foot or leg may need to be amputated. Infection can also cause pain and itching.
  • Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to heart attack, stroke, and other problems. It can become harder for blood to flow to the legs and feet.
  • Nerves in the body can become damaged, causing pain, tingling, and numbness.
  • Because of nerve damage, you could have problems digesting the food you eat. You could feel weakness or have trouble going to the bathroom. Nerve damage can also make it harder for men to have an erection.
  • High blood sugar and other problems can lead to kidney damage. The kidneys may not work as well as they used to. They may even stop working so that you need dialysis or a kidney transplant.
When to Contact a Medical Professional:

Call 911 if you have:

  • Chest pain or pressure, shortness of breath, or other signs of angina
  • Loss of consciousness
  • Seizures

Call your doctor or go to the emergency room if you have symptoms of diabetic ketoacidosis.

Also call your doctor if you have:

  • Blood sugar levels that are higher than the goals you and your doctor have set
  • Numbness, tingling, or pain in your feet or legs
  • Problems with your eyesight
  • Sores or infections on your feet
  • Symptoms that your blood sugar is getting too low (weakness or fatigue, trembling, sweating, irritability, trouble thinking clearly, fast heartbeat, double or blurry vision, uneasy feeling)
  • Symptoms that your blood sugar is too high (thirst, blurry vision, dry skin, weakness or fatigue, need to urinate a lot)
  • Blood sugar readings that are below 70 mg/dL

You can treat early signs of hypoglycemia at home by eating sugar or candy, or by taking glucose tablets. If signs of hypoglycemia continue or your blood glucose level stays below 60 mg/dL, go to the emergency room.

Prevention:

Type 1 diabetes cannot be prevented. There is no screening test for type 1 diabetes in people who have no symptoms.

References:

Alemzadeh R, Ali O. Diabetes mellitus. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 583.

American Diabetes Association. Standards of medical care in diabetes -- 2014. Diabetes Care. 2014;37:S14-S80. http://www.ncbi.nlm.nih.gov/pubmed/24357209.

Eisenbarth GS, Buse JB. Type 1 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 32.


Review Date: 8/5/2014
Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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