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Type 1 diabetes

Type 1 diabetes

Formerly known as insulin-dependent diabetes mellitus (IDDM), it is usually discovered in young people: children, adolescents or young adults. In Algeria, it affects 8% of the diabetic population.

It is an autoimmune disease. The body uses antibodies and immune cells to attack and destroy the beta cells that produce insulin.

Glucose, unable to enter the cells, returns to the bloodstream. Glucose levels rise in the blood.

This destruction of the beta cell occurs in people with a genetic (familial) predisposition, but other causes are poorly understood. The environment may also play a role.

The risk of developing type 1 diabetes in a person born to a diabetic father is 8%, to a diabetic mother 4%, and rises to 30% if both parents are diabetic.

What are the warning symptoms of type 1 diabetes ?

Intense thirst, profuse urination, rapid weight loss.

Biologically, the condition is characterized by high blood sugar levels in excess of 1.26 g/l (“hyperglycemia”), the presence of sugar in the urine (“glucosuria”), and ketone bodies when hyperglycemia exceeds 1.80 g/l.

If diabetes is not diagnosed early and treated promptly, the symptoms of ketoacidosis may appear: nausea and vomiting, loss of appetite, drowsiness, fruity breath or abnormal urine odour, and dehydration. This is a life-threatening emergency.

What are the risks of diabetes ?

There are two types of risk associated with type 1 diabetes:

  • Acute metabolic complications

1.         Hypoglycemia: an excessive drop in blood sugar levels (below 0.70 g/l); the incidence of mild to moderate hypoglycemia in type 1 diabetic patients is around 30 episodes/patient/year (less than one episode per week). The incidence of severe hypoglycemia is 3.2 episodes/patient/year.

It is preceded by signs such as :

  • Sensation de faim intense (fringale) ;
  • Feeling of intense hunger (craving);
  • Sweating ;
  • Nausea ;
  • Abdominal pain ;
  • Palpitation ;
  • Trembling ;
  • Intense fatigue ;
  • Tingling in extremities ;
  • Numbness of limbs ;
  • Headaches;
  • Impaired vision and balance…

Sometimes more serious neuro-psychic disorders :

  • Aggressive or melancholy episodes;
  • Mental confusion;
  • Loss of recent memory;
  • Intense psychomotor activity
  • Double vision ;
  • Hemiplegia;
  • Hallucinations;
  • Epileptic seizure… ;
  • Hypoglycemic coma is accompanied by sweating, convulsions and hypertonia.

Urgent treatment is essential to avoid death or serious neurological sequelae, particularly in the frail or elderly.

2. Causes and risk factors

The most frequent causes are independent of the organism:

  • It may be due to a therapeutic error in the treatment of diabetes, such as an overdose of insulin, or excessive dietary restriction;
  • A hypocaloric diet that is too strict…
  • Unexpected and intense physical activity

3. What to do in the event of hypoglycemia :

he fundamental principle of hypoglycemia management is prevention.

4. Therapeutic education?

Your therapeutic support (therapeutic education) and that of your loved ones consists in enabling you to :

– identify the warning signs of hypoglycemia and how to correct it effectively by taking fast-absorbing glucose.

– perform capillary blood glucose tests with your meter, and act on the results to correct your blood glucose.

– understand the mechanism of action and pharmacodynamics of the different insulins prescribed by your doctor, as well as basic dietary information (carbohydrate-containing foods).

assess the risk of hypoglycemia associated with physical exercise. Factors that may favour hypoglycemia include prolonged exertion or exertion of unusual intensity, insufficient intake of carbohydrates in relation to blood insulin levels, lack of glycemic control before or during exercise, and insensitivity to hypoglycemia. Falls in plasma glucose levels after sport (hours afterwards) are not uncommon. Post-activity blood glucose monitoring is therefore just as important as before and during.

If plasma glucose levels are low or normal-low before physical activity, it is advisable to have a snack and to take sugar with you during physical activity. When the activity is scheduled to last more than three hours, the dose of slow-acting insulin should be adapted as far as possible.

  • Correction of hypoglycemia according to severity

– If your blood glucose < 0.72 g/l, correct with 15 g glucose = 4 lumps sugar = 2

teaspoons of honey = 2 tablespoons of syrup = 1.75 dl of sweetened beverage (fruit juice or soda* or lemonade*, etc.)

– If your hypoglycemia is < 0.45 g/l and you are conscious,

correct with 30 g sugar = 8 sugar cubes = 4 teaspoons honey = 4 tablespoons syrup = 3.5 dl sweet drink (fruit juice or soda* or lemonade*, etc.).

– Repeat capillary blood glucose test 20 to 30 minutes after carbohydrate intake.

carbohydrate intake – If blood glucose < < 0.72 g/l correct again with 15-30 g carbohydrate

– If your loved one experiences hypoglycemia with altered consciousness/coma, inject IM glucagon and correct with >30 g of sugar once you’ve regained consciousness (call the emergency services and seek urgent medical attention).

* no light or zero.

  • Ketoacidosis: This is the accumulation of toxic substances called ketone bodies, Elevated blood ketone levels are easy to treat, if detected and treated promptly; however, if nothing is done, the person may end up in a coma and die.

Diabetic ketoacidosis often leads to a diagnosis of type 1 diabetes. It can also occur in people with known type 1 diabetes when they miss a dose of insulin, contract an infection or suffer trauma or injury.

Since cells can’t use glucose due to a lack of insulin, the body breaks down fats for energy, releasing ketones (toxic substances). Ketones accumulate in the blood, making it more acidic.

Insulin, which transports sugar into the cells to produce energy, fails, so the cells seek other sources of energy. Meanwhile, glucose accumulates in the bloodstream, and when diabetic ketoacidosis occurs, blood sugar levels (glycemia) are often very high, over 2.52 g /L, while insulin levels are very low.

  • Microvascular complications:

The chronic hyperglycemia of diabetics progressively damages the small blood vessels in the kidneys and eyes, as well as the nerves, leading to eye, nerve and kidney problems. Vessels become clogged, and if certain parts of the body no longer receive sufficient blood supply, they can die. The permanent excess of sugar in the blood leads to complications such as blindness, kidney failure, neuropathy (nerve damage) in the legs, which can lead to “plantar perforation pain”, and damage to the nerves controlling sex.

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