People often think that diabetes is a disease that, as we get older, we get fatter. However, there are still young people with diabetes. More than half of people with diabetes are type 2 diabetes. However, how common is type 1 diabetes in people who are both young and thin? Through this article, let’s learn about this type of diabetes.
1. What is type 1 diabetes?
* Points to pay attention to:
+ Most people with diabetes are type 2, but there are still people with type 1.
+ Type 1 diabetes is a disease in which pancreatic cells are destroyed so they cannot secrete insulin.
+ 80% of people with type 1 diabetes are caused by an abnormal immune system that leads to the self-production of antibodies.
+ Type 1 diabetes mostly starts in young people, but it does not mean that only young people have the disease.
Do people think that “Diabetes is a disease that starts in people who are obese in middle age”? Actually, this thinking is not necessarily wrong. The majority of people with diabetes (over 95%) are caused by obesity due to excessive eating, sedentary, gradually getting older, People with diabetes due to this cause will be classified as type 2 diabetes.
Surely someone will have thought that if there is type 2, there must be type 1. And rightly so, compared to type 2 diabetes, type 1 diabetes is a disease that is mostly detected in fairly young people.
First of all, people need to distinguish between type 1 and type 2 diabetes.
Diabetes is a disease where blood sugar levels are too high causing abnormal changes in the body.
Sugar or, in other words, glucose, is a substance necessary to maintain the functioning of the human body. Because the brain can only use glucose as a nutrient that helps control human functions. Therefore, the body will have to adjust itself in many different ways so that blood glucose, or blood sugar levels, are always balanced, not too high or not too low.
The amount of glucose that the body needs is provided mostly through eating. By digesting food, this glucose will be absorbed and converted into nutrition for the brain. Most people with type 2 diabetes have an excessive diet, so the amount of nutrients absorbed into the body is also too much, leading to blood sugar levels always remaining too high and gradually becoming a disease.
However, the human body will have a self-balancing mechanism of blood sugar, that is, high blood sugar the body will adjust it to decrease so that the body returns to normal, so to say easily diabetes is not there, because the disease progresses very slowly.
When the body has high blood glucose levels, a hormone that lowers blood sugar called insulin is secreted from the pancreas. In type 2 diabetes, the body will reduce the function of insulin, causing blood sugar to stay high. There is also another way of calling type 2 diabetes “glucose intolerance”.
On the other hand, there will be cases where it is not “reduced insulin effectiveness” but “inability to secrete insulin”. Because insulin cannot be secreted, it leads to high blood sugar and diabetes, which is collectively known as “type 1 diabetes”. Type 1 diabetes can be caused by damaged pancreatic cells that cannot secrete insulin. This is the point to distinguish type 1 and type 2.
People need to clearly distinguish between type 1 diabetes and type 2 diabetes because the mechanisms are different, so treatments such as diet, exercise and medication, daily habits,… are also different.
Useful information to refer to:
- Proper understanding of diabetes in children
- What is diabetes? Complications and treatments?
- What is type 1 2 diabetes? Differences between type 1 diabetes 2
2. Symptoms, characteristic of type 1 diabetes. What tests are necessary for the diagnosis.
* Things to look out for:
+ Type 1 diabetes is divided into 3 types of diseases.
+ Accurate diagnosis of type 1 or type 2, from which there are specific and clear treatment pathways for each type is very important.
People need to understand that type 1 diabetes is divided into 3 types: acute onset, gradual onset, critical type. Based on information from the state before the onset of the disease, the duration of symptoms can be distinguished from type 2 diabetes. Here we will take a closer look at each type.
– Type 1 diabetes – type of acute disease
Type 1 diabetes – the type of acute illness is the most common type of type 1 diabetes. It may only be months or weeks before the disease progresses.
After the onset of symptoms such as thirst, repeated urination (high amount of urine at a time), weight loss, in just a few months insulin secretion function will completely disappear. In case of a sudden decrease in insulin secretion, symptoms accompanying peripheral neurosis (diabetic ketoacidosis) may also occur. Type 1 diabetes – acute type characterized by autoimmunity and positive for “pancreatic islet-related autoantibodies.” These antibodies exist as proteins in the body that attack pancreatic cells themselves, causing the pancreas to be destroyed.
Type 1 diabetes – type of gradual onset
Type 1 diabetes – a gradual onset is a disease that mostly occurs in people between 30 and 50 years of age, and progresses slowly. Therefore, there are also cases of being confused with type 2 diabetes. This type is also autoimmune, pancreatic cells are also attacked by the immune system, clearly distinguished from type 2 diabetes. Early detection and clear differentiation are essential, as type 1 diabetes, which develops gradually, and type 2 diabetes will have different treatments at different stages.
– Type 1 diabetes – endangered type
This is completely different from the above 2 types, not related to autoimmunity, and the cause is unknown. As the name suggests – dangerous type, this type is also the type with the fastest onset of illness. After just a few days of flu symptoms such as sore throat, fever, stomach ache,… the disease has begun. After just a few days, insulin will disappear and consciousness disorders may appear.
For people identified as having diabetes, the next step is a “diagnosis of the disease,” specifically based on the cause of the disease to examine and differentiate diagnosis of type 1 or type 2 diabetes.
Although there are many methods to check for type 1 diabetes, the final determinant of a type 1 diagnosis is whether a protein called “autoantibodies” is present in the body that will mistakenly attack itself and destroy cells. Common autoantibodies are “GAD antibodies”, “pancreatic islet cell antibodies <ICA>”, “insulin autoantibodies <IAA>”, “IA-2 antibodies”,…. Once these antibodies are found, the likelihood of developing type 1 diabetes is very high.
On the other hand, 20% of type 1 diabetes is not caused by a loss of immune control and autoantibodies are not produced. In other words, 1 out of 5 people with type 1 diabetes has the disease because pancreatic cells are destroyed for unknown reasons and insulin is not secreted. According to the diagnostic criteria for acute-onset type 1 diabetes (2012), cases where autoantibodies are not found but insulin is not secreted from the pancreas or secreted but in insufficient amounts, there is a high probability of type 1 diabetes.
Insulin secreted from the pancreas is metabolized soon after it is secreted, so it is impossible to take a blood sample and measure it. When insulin is secreted from the pancreas, the amount of insulin secreted can be estimated by measuring the “C-peptide” component simultaneously secreted in the same amount. This substance is often used because it can be measured in urine. Measuring the amount of C-peptide in urine and blood, if the results give extremely low values, the patient may be diagnosed with type 1 diabetes.
To check whether insulin is secreted from the pancreas, conduct a test called an “oral glucose tolerance test (OGTT).” Doctors use the results of this test as a basis for diagnosing whether it is type 1 diabetes.
When testing to confirm type 1 diabetes, age is also a reference factor. Many people with type 1 diabetes are told that the disease has an onset from childhood to adulthood. J League player Sugiyama Arata developed type 1 diabetes at the age of 23 and is known to remain active as a professional footballer despite his diabetes. It is said that many type 1 diabetes often begins in young people. In contrast, type 2 diabetes often begins in obese and middle-aged people. However, there are also people who develop type 1 diabetes in middle age, so it is not possible to classify diabetes by age.
Diabetes has different treatment pathways depending on whether it is type 1 or type 2 diabetes. In addition, the patient’s lifestyle will also change according to different treatments. Examining your diabetes and diagnosing whether it’s type 1 or type 2 is important in getting treatment and living with the disease.
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3. Type 1 diabetes treatment: why insulin is preferred?
* Points to pay attention to:
+ Because type 1 diabetes lacks insulin, treatment with insulin injections is mandatory.
+ New methods such as continuous subcutaneous insulin injections, blood glucose monitoring rings to help control blood glucose are also available.
+ Thanks to current advanced treatments, people with type 1 diabetes can also live life like normal people.
The only solution to type 1 diabetes is additional insulin injections
People often think that if you treat diabetes, try to choose the simplest and most effective methods. Therefore, there have also been people focusing on oral medications for type 1 diabetes. However, type 1 diabetes is a disease where the body certainly does not have enough insulin to take, so people cannot choose oral medications. The basis of type 1 diabetes therapy is self-injecting insulin.
Currently in the treatment of type 2 diabetes, oral medications work to increase the pancreas’ ability to secrete insulin, breaking down or delaying the effect of sugar (glucose). Accordingly, it increases the effectiveness of insulin in the body and relieves the symptoms of diabetes. In simpler words, it helps the insulin produced by the body work more efficiently.
But type 1 diabetes is a disease in which pancreatic cells that secrete insulin are destroyed. The body doesn’t have insulin (it can’t make insulin), so the only solution is to inject additional insulin.
When eating, the body will secrete an appropriate amount of insulin to help blood sugar levels remain stable, making the body healthy. Insulin drugs in diabetes treatment take this as a basis, that is, bring the body to the same state of insulin secretion as normal healthy people.
– Inject insulin 1 day from 1 to 2 times
In order for the body to be able to secrete insulin little by little in the same way as normal, one would administer a relatively long-acting insulin drug (intermediate-acting type or long-acting type) that is injected 1 day from 1 to 2 times. On the other hand, when eating, to restore the ability to secrete insulin immediately (supplementation) one injects a fast-acting insulin. It is also known as aggressive insulin therapy.
One problem encountered with insulin injections is that the skin at the injection site becomes stiff if repeated injections are repeated in the same place. In addition, it is also difficult to monitor how many injections a day takes. To overcome these problems, there is a method of “Continuous subcutaneous insulin infusion (CSII)” that does not require repeated injections. This is also called an “insulin pump,” which is a pump that attaches to the body and maintains a subcutaneous injection of insulin equivalent to the basic secretion from a needle in the abdomen. Furthermore, insulin can be injected in proportion to the amount of additional secretion by changing the speed of the pump before each meal. The frequency of replacing the pump is only a few times a few days, which helps the patient avoid having to inject several times in 1 day.
This way of pumping insulin is close to the body’s natural insulin secretion rate, so it has the advantage that patients can eat and move comfortably. In addition, it is thought that the use of insulin pumps helps reduce the incidence of diabetic complications such as diabetic retinopathy, diabetic neuropathy, diabetic kidney disease.
When self-injecting insulin, patients need to measure their own blood sugar levels. This measurement is also very difficult for patients. Use a small needle to prick at the tip of your finger to let the blood flow and measure your blood sugar. This is a measure that brings pain to patients when it has to be done several times a day. Therefore, it is possible to measure blood glucose by measuring the sugar level of interstitial fluid under the skin without blood collection. Wear a sensor on your arm and your blood sugar can be measured continuously for 14 days. It is possible to measure blood sugar continuously without repeated needle punctures.
There is also a treatment called SAP therapy that combines continuous durable subcutaneous insulin infusion with a continuous blood glucose monitor for more appropriate glycemic control.
– Pancreas transplant method
There is also pancreatic transplantation for patients with type 1 diabetes who cannot control blood glucose. Many patients also have kidney dysfunction, so the pancreas and kidney are often transplanted at the same time. After transplantation, patients must take immunosuppressive drugs, but it has been reported that the life expectancy of transplanted patients is longer than that of non-transplant patients.
In addition to pancreatic transplantation, there is also a method called pancreatic islet transplantation. In the pancreas, the tissues that make insulin are called pancreatic islets and this part makes up only 1% of the pancreas. Surgery to transplant the entire pancreas requires general anesthesia and the burden on the body increases. A method that only removes the pancreatic islets that make insulin from within the pancreas and transplants it from the blood vessels of the liver is called pancreatic islet transplantation. Compared to pancreas transplantation, this method reduces the burden on the patient.
Pancreatic transplantation and pancreatic islet transplantation can only be performed in some medical facilities, and the number of patients undergoing surgery is also limited.
Other studies of the artificial pancreas are ongoing. For example, on May 27, 2016 it announced an approval policy in cases where patients satisfy the conditions for a pig’s pancreatic cell transplant with a human that the Japanese Ministry of Health, Labor and Welfare has previously banned. Therefore, the number of people who can receive transplant treatment so far may be improved in the near future.
The successful development of “microencapsulated pig islet cell transplantation encased in a small envelope called a ‘microcapsule’ has also been announced. By doing so, it is thought that the inflammation and immune elimination response induced by animal cell transplantation into humans can be significantly reduced.
Also, because the majority of type 1 diabetes is caused by abnormalities of the immune system, there is already “immunotherapy” aimed at treating these abnormalities of the immune system. Although drugs that work on some immune systems have been tried, they have not been effective in treating type 1 diabetes.
Although not currently published, research on pancreatic primary regeneration is also encouraged. There are studies on the creation and transplantation of the pancreas itself in pigs using ES cells and iPS cells and studies for pancreatic regeneration in the body by stimulating neural networks.
4. Summary
Of the total number of people with diabetes, less than 5% are of rare type 1 diabetes, the symptoms, causes, diagnosis and treatment are outlined in the article. Type 1 diabetes can occur quickly in younger people, but can also develop very slowly in older people. Regardless of the patient, insulin deficiency is unchanged, type 1 diabetes is not a disease that can be treated with eating and exercise, but needs insulin treatment. The more the disease develops, the more continuous insulin injections and blood glucose monitoring need to be, which can be difficult for the person. However, nowadays, increasingly modern medicine with insulin injection devices and continuous blood glucose measurement has helped patients to control and treat diseases more easily.