Type 1 Diabetes
The cause of the type 1 diabetes is not known as it usually occurs in previously completely healthy young people. However, sometimes its occurrence can be related to presence of other autoimmune disorders. The essence of type 1 diabetes is improper activation of our own immune system that starts to target our tissues, in this case against pancreatic cells producing insulin. Insulin is a vital hormone that enables glucose entry into the majority of tissue cells. Without insulin these cells are unable to use glucose. This causes disruption of energetic metabolism as glucose is the main source of energy and the accumulation of glucose in blood.
Type 1 diabetes can be randomly found by a pediatrician or general practitioner during preventive examination in a patient with no obvious symptoms. On the other hand untreated diabetes is usually accompanied with a number of signs including fatigue, night sweats, weight loss and abdominal pain. Accumulated sugar is filtered to urine in kidneys and it takes fluid and minerals with. This causes excessive urination, dehydration, mineral deficiency and abnormal thirst. The body cells try to cope with the energetic deficit and produce energy without glucose. This is just an emergency solution as it produces lesser amount of energy and forms substances known as ketones that increase acidity of the internal environment.
Hyperglycemic and hypoglycemic coma
Hyperglycemic condition occurs in untreated type 1 diabetes. High blood sugar level is in this case accompanied with overproduction of ketones (see above) and we mark this as the diabetic ketoacidosis. Homeostasis disruption results in unconsciousness and death without the proper treatment. Hypoglycemic coma is a state of unconsciousness that is caused by too low sugar blood level. In type 1 diabetics it occurs after application of an inadequately high dose of insulin. The best first aid is administration of glucose orally or intravenously leading to the quick return of consciousness.
Damage to the small blood vessels (microangiopathy)
Higher blood sugar in chronic diabetes damages little arteries in the eyes, kidneys and nerve-nourishing arteries. This results in complications such as diabetic retinopathy (that may cause a complete loss of vision), nerve disorders (diabetic polyneuropathy manifesting with disrupted stomach emptying, abdominal pain, problems with erection, etc.) and chronic renal failure.
Damage to the major blood vessels (macroangiopathy)
Large blood vessels are mainly affected by accelerated atherosclerosis. The diabetes is associated with increased production of substances causing the oxidative stress and this causes faster deterioration of blood vessel walls. Diabetics are endangered by all complication of atherosclerosis (see related article) including the increased risk of a heart attack.
The so-called diabetic foot is a combination of disorders of both large and small blood vessels. Diabetic polyneuropathy damages sensitivity of feet and this increases the risk of an injury. High blood sugar damages large and small blood vessels and the limbs are poorly vascularized and less oxygenated. Elevated blood sugar is a suitable “food” for bacteria and chronic diabetes leads to the weakened immunity. These factors increase risk of wound infection and reduce wound healing. The infection may become uncontrollable and lead to the amputation.
Diagnosis may be done accidentally or according to the above mentioned symptoms. It is important to do both the blood tests and urinalysis. In blood we wind elevated level of blood sugar and in urine we find glucose and ketone bodies. The examination is followed by checking the level of so-called C-peptide. C-peptide is a metabolic product formed during insulin creation. Low level of C-peptide means lowered insulin production. Serology allows us to prove the presence of certain autoantibodies in blood of the affected person.
The treatment will be described only briefly. It must be comprehensive and includes both dietary measures and pharmacotherapy. The basic form if therapy is regular administration of prefabricated insulin, usually in form of subcutaneous injections or by a special pump. In addition, we advise regular physical exercise and “healthy diet”. It is not true that a diabetic should not have sugar in the diet, this is just a myth. The diabetic needs the sugar intake as other healthy people but it is the right composition and amount of food that is important. Sugars should be eaten preferably in the form of polysaccharides (cereals) and not in form of sweets. Insulin doses should be tuned to prevent both hyper- and hypoglycemia. The diabetics should also undergo regular examinations including eye retina examination and the control of renal functions.