What is type 1 diabetes?
Diabetes mellitus type 1 is a disorder affecting glucose metabolism. Glucose cannot enter cells due to a lack of the hormone insulin. In people with diabetes, insulin-producing cells in the pancreas are destroyed.
Unused glucose accumulates in the blood and the urine. Fats are used as an alternative energy source, which leads to a build-up of ketones in the blood that may eventually cause convulsions and diabetic coma. Treatment is based mainly on taking insulin by injection or pump to maintain normal blood-sugar levels.
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What is diabetic ketoacidosis?
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High blood glucose (hyperglycemia) is what leads to finding out that you have diabetes type 1. Your body destroys the cells that make insulin, which is the hormone allowing glucose to enter cells and provide energy.
In type 1 diabetes, glucose cannot enter cells (owing to the absence of insulin) and it builds up in the bloodstream.
It should be added that not all cells require insulin to obtain glucose. These include the brain, nerve fibers, red blood cells, the retina, the kidneys, and blood vessels.
Diabetic ketoacidosis
If the process of increased blood glucose is not stopped and reversed by providing insulin, the person becomes sick, eventually leading to diabetic ketoacidosis (DKA).
A blood glucose reading over 250mg/dl indicates (DKA), though mild DKA may be experienced at lower readings.
Road to DKA
You are on the road to DKA when it's found you have type one diabetes. If you were not treated with insulin, you would get DKA and eventually die. Fortunately, since the discovery of insulin, this does not need to happen.
DKA in the USA
In the United States, 30 percent of adults and 20 percent of children with type 1 diabetes receive their diagnosis as a result of being treated for DKA, which means they have had diabetes for some time.
When your body does not have enough insulin, muscles cannot take in the glucose they need. So your body breaks down fat for energy.
Ketones are the by-product of this breakdown. If they build up faster than your body can get rid of them in the urine, they accumulate in the blood.
Dehydration
These acidic products poison your blood. And at the same time, glucose enters your urine, your kidneys produce more and more urine, and you become dehydrated.
When you are dehydrated and have ketones in your blood, you have DKA.
Fortunately, before you get to DKA there are symptoms along the way indicating you have high blood sugar. These include increased urination and an unquenchable thirst, which alerts you, or a family member, to seek medical help.
A more complete list of approaching DKA includes:
- abdominal pain, probably caused by acid in the blood.
- impaired vision
- fatigue, caused by inability to get glucose into cells.
- increased thirst, caused by blood glucose rising and entering the urine, pulling water and other nutrients with it. The patient has to uninate a lot, causing dehydration.
- nausea, caused by acid blood and failure of normal functioning of the gastrointestinal tract.
- weight loss, lack of insulin prevents glucose from being stored in the liver; amino acids can't be converted into protein; and fat can't be stored.
- vomiting
- loss of menstruation
- acteone (fruity) smelling breath, caused by ketones which are products of fat breakdown
- rapid, labored breathing, called Kussmaul breathing after the German doctor who discovered it.
- rapid heart rate
- low body temperature
- reduced blood pressure
At the hospital or clinic, your blood glucose level will be tested. Once diagnosed with type one diabetes you'll be given insulin and your blood will return to a normal level within the range 80 to 120 mg/dl.
Risk of DKA
The risk of DKA does not completely disappear even if you manage your diabetes with insulin. It can can occur for the following reasons:
- infections, usually pneumonia or a urine infection.
- interruption of insulin treatment, e.g. a sick person might mistakenly stop taking insulin because she doesn't feel hungry.
- some drugs contribute to DKA, e.g. cortisol, plus drugs used for treating psychosis, such as clozapine and olanzapine.
- not sticking to the correct doses of insulin, which is a problem among poor people who cannot afford insulin and reduce or skip injections.
- acute alcoholism
Ketones in urine
If your urine shows small amounts of ketones, it's a sign you need insulin or carbohydrates (depending on your blood glucose readings).
If your urine has moderate to large amounts of ketones, you need to take fast-acting insulin right away. Drink plenty of sugar-free fuids as well to prevent dehydration.
If the ketones in your urine don't go down quickly or if you're vomiting, seek medical care immediately.
Long term complications
There are many long-term complications caused by having persistently high blood glucose.
These include eye disease (retinopathy) and kidney damage (nephropathy).
Too much much glucose can speed up the normal hardening of the arteries (atherosclerosis) as you age.
It can also damage nerve cells and change the electrical messages that nerve cells send throughout your body, especially to the feet.
The key to preventing these long term problems is monitoring your blood glucose level and keeping it within the normal range.
By David Hay Jones. Written using American Diabetes Association Complete Guide to Diabetes
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