Type 1 diabetes, formely called juvenile diabetes or insulin-dependent diabetes, usually appears during childhood or adolescence, as well as among young adults. in Algeria, 8% of diabetic population is touched.
It is an auto-immunedisease. The body’s own immune system which normally fights harmful bacteria and viruses mistakenly attacks the beta cells in the pancreas that makes insulin.
The glucose builds up then in the bloodstream instead of going into the cells. The level of glucose increases in the blood.
This destruction of the beta cell occurs in people with a genetic (family) predisposition but the other causes are not well known. But the other causes remain unknown. The environment may play a role, too.
The tendency to develop autoimmune diseases, can be inherited from your parents (08% from a diabetic father and 04% from a diabetic mother, if both of them are diabetic, the risk may rise to 30%),
What are the first signs of Type 1 diabetes?
Increased thirst, frequent urination, unexpected weight loss
Biologically, a high level of sugar exceeding 1.26 g/ l “hyperglycemia” may be found in the blood, and a presence of sugar (Glycosuria) and ketone bodies may be found in the urine when hyperglycemia exceeds 1.80 g/ l.
If diabetes is not diagnosed in time and quickly taken care of, symptoms of ketoacidosis may appear : nausea and vomiting, loss of appetite, drowsiness, fruity breath or abnormal urine odor and dehydration. It is a life-threatening emergency.
What are the Diabetes related risks?
There are 02 type 1 diabetes related risks:
- Acute metabolic complications
- Hypoglycemia : is a fall in blood sugar to levels below normal (below 0,70 g/ l). Type 1 diabetics mild to moderate hypoglycemia incidence is about 30 episodes per patient and per year (less than 1 episod per week) . while severe hypoglycemia is about 3.2.
It may result in the following symptoms:
- Intense hunger
- Stomack pain
- Rapid heartbeat/ Palpitation
- Intense fatigue
- Tingling sensation of the limbs extremities
- Feeling numbness
- Blurry vision and balance troubles
Sometimes, it may result in more seriousneuro psychic troubles, such as:
- Agressive behavior/ melancholia
- Mental confusion
- Short term memory loss
- Intense psycho motor activity
- Blurry/ double vision
- Epileptic seizure
- Coma (loss of consciousness) along with sweating, convulsion, hypertonia.
An urgent treatment is essential to avoid death or serious neurological sequelae that may be encountered, in particular in the elderly or weakened people.
2. Causes and risk factors
The most frequent risks may arise from other factors, such as:
- It could occur from therapeutic error in the treatment of diabetes such as an overdose of insulin, or excessive dietary restriction;
- A too severe low-calorie weight loss diet
- Unexpected and intense physical activity
3.How do you manage hypoglycemia?
Prevention is the fondamental principle for Hypoglycemia management.
4.What would be the best therapeutic education for patient with hypoglycemia and their relatives?
Therapeutic education for patients and their relatives consists of:
– Recognizing the warning signs of hypoglycemiaand how to correct it effectively by taking fast absorbing glucose.
– Performing capillary glycemic test with your blood glucose meter, interpreting the results and correct them accordingly
–Understanding the mechanism of action and the pharmacodynamics of the different insulins prescribed by your attending physician as well as the basic dietary elements (foods containing carbohydrates).
– Assessing physical activities related risk; hypoglycemia factors being the ones prolonged or unusually intense, insufficient carbohydrate intake relative to insulinemia, lack of glycemic control before or during activity and insensitivity to hypoglycaemia. Low blood sugar following any activity (upcoming hours) are not without risk. It is therefore important to perform glycemic control in each step of the physical activity (before, durng, after)
If the glucose level is low or normal-low before any physical activity, it is recommended to have a snack and to carry lumps of sugar when exercising. If the physical activity is planned to last for more than 3 hours, the dose of slow insulin should be adjusted accordingly.
- How to treat hypoglycemia as per its severity?
|-If your blood sugar < 0.72 g / l: Have 15 g of glucose = 4 lumps of sugar = 2 teaspoons of honey = 2 tablespoons of syrup = 1.75 dl of sweet drink (fruit juice or soda * or Lemonade *, etc.)|
|– If your hypoglycemia < <0.45 g / l and you are conscious: have 30 g of sugar = 8 lumps of sugar = 4 teaspoons of honey = 4 tablespoons of syrup = 3.5 dl of sweet drink (fruit juice or soda * or lemonade *, etc.)|
|– Repeat capillary blood glucose 20 to 30 minutes following carbohydrate intake – If blood glucose < < 0.72 g / l , have 15–30 g of carbohydrate|
|– if your relative has hypoglycemia with altered state of consciousness / coma, inject him with glucagon in IM and give him > 30 g of sugar once you regain consciousness (call for help and consult urgently)|
* Not light or zero.
- Ketoacidosis : : It consists of a build-up of toxic substances called ketones that make the blood too acidic.
A ketone bodies increase in the blood level is easily treated if early detected and treated without delay; however, if left unchecked, the person may eventually fall into a coma and die.
Diabetic ketoacidosis often leads to type 1 diabetes diagnosis. It may also occur in people with already known type 1 diabetes when they forget to take their dose of insulin, contract an infection or experience trauma or injury.
Since cells cannot use glucose due to a lack of insulin, the body breaks down fat for energy, which releases ketones (toxic substances). Ketones build up in the blood, making it more acidic.
The default is insulin which allows sugar to be transported inside cells for energy; cells will look for other sources of energy. During this time, glucose builds up in the bloodstream and when diabetic ketoacidosis is seen, the level of sugar in the blood (blood sugar) is often very high, over 2.52 g / L, while the insulin concentration is very low.
- Microvascular complications:
Chronic hyperglycemia in diabetics progressively damages the small blood vessels and nerves in the kidneys and eyes, causing respectively eyes, neural and kidney disorders. The vessels get clogged, and if some parts of the body are nor sufficiently irrigated, they may die. L’excès permanent de sucre dans le sang engendre donc des complications telles la cécité, une insuffisance rénale, une neuropathie (atteinte des nerfs) des jambes pouvant provoquer des “maux perforants plantaires” ou encore des atteintes des nerfs commandant le sexe.