Type 1 Diabetes- Insulin dependent diabetes mellitus
Despite the fact that Insulin dependent (Type 1) diabetes accounts for no more than 5-10% of total diabetes burden in the community, it has a special place in the mind of the public. This is likely to be related to its link to the discovery of insulin and the fact that almost all children with diabetes fall in this category.
When Do Type 1 Diabetes Symptoms Become Apparent?
We now know that that the autoimmune attack starts many years before clinical disease onset. Only when about 60-80% of the insulin-producing cells have been destroyed do the symptoms appear. The combination of genetic markers and markers of autoimmune attack.
Antibodies insulin and other constituents of the insulin-secreting cells, can identify close relatives who are special risk of developing the disease within 5 years. Clinical research trials are ongoing to explore treatments to prevent the onset of Type 1 diabetes.
There are two peaks of high prevalence of the disease : (1) in early childhood and (2) early teens. Type 1 diabetes can present at any time in life up to very old age. In later years the disease may have a more protected course.
Ketoacidosis
The most dramatic way in which Type 1 diabetes may present is ketoacidosis. Not infrequently this is triggered by infection or stress, but often no clear trigger is identified. When the body is extremely low on insulin, carbohydrates cannot be utilized and sugar is lost in massive amounts through the kidney, drawing with it large amounts of fluid. Hence, weight loss, excessive urination and intake of fluids occurs. The body will try and obtain energy from fat stores, but because insulin is also needed for the complete utilization of this energy source, large amounts of acidic intermediates become backed up in the system. Deep breathing is induced to try and compensate for this acidic state (acidosis) by blowing off carbon dioxide.Immediate medical attention in a hospital setting is mandatory, entailing fluid and salt replacement and intravenous insulin infusion.
Diabetic ketoacidosis is a serious medical condition, which is not without mortality especially in older patients i.e. those with coincidental medical conditions, placing stress on the body. These patients usually do not have Type 1 diabetes, but severe underlying illness make them so relatively deficient in insulin that they behave like Type 1 diabetes from a metabolic view-point.
Fortunately, due to increasing awareness of the public of the symptoms of diabetes, the diagnosis of Type 1 is usually made before the onset of ketoacidosis.