camp told them that he seemed to not have much energy. When he got home from camp, John’s parents noticed that he was thirsty all the time and running to the bathroom. He was very hungry but seemed to be losing weight, despite eating more than enough. John’s parents took him to the pediatrician, who did several blood glucose tests and diagnosed their son with type 1 diabetes mellitus (T1DM), which used to be called juvenile diabetes or insulin-dependent diabetes.
This story has a happy ending because John’s parents were willing to do the necessary things to bring John’s glucose under control. John is just as energetic as ever, but he has had to get used to a few inconveniences in his daily routine. (I cover such daily lifestyle changes in Part III.) The following sections touch on the symptoms and causes of this type of diabetes.
Note: Type 1 diabetes is covered extensively in my book Type 1 Diabetes For Dummies (John Wiley & Sons, Inc.). Because this book is mainly about type 2 diabetes, I simply point out where the two types are the same and where they differ.
✔ Frequent urination
✔ Increase in thirst
✔ Weight loss
✔ Increase in hunger
✔ Weakness
Type 1 diabetes used to be called juvenile diabetes because it occurs most frequently in children. However, so many cases are found in adults that doctors don’t use the term juvenile any more. Some children are diagnosed early in life, and other children have a more severe onset of the disease as they get a little older.
With children over age 10 and adults, the early signs and symptoms of diabetes may have been missed. These people have a great deal of fat breakdown in their bodies to provide energy, and this fat breakdown creates other problems. Ketone bodies, products of the breakdown of fats, begin to accumulate in the blood and spill into the urine. Ketone bodies are acidic and lead to nausea, abdominal pain, and sometimes vomiting.
✔ The honeymoon period, a natural occurrence, is a time after the diagnosis of diabetes when the person’s insulin needs decline for one to six months and the disease seems to get milder. The honeymoon period is longer when a child is older at the time of diagnosis, but the apparent diminishing of the disease is always temporary.
✔ Males and females get type 1 diabetes to an equal degree.
✔ Warm summer months are associated with a decrease in the occurrence of diabetes compared to the winter months, particularly in children older than 10. The probable reason for this occurrence is that a virus is involved in bringing on diabetes (which I discuss in “Getting type 1 diabetes”), and viruses spread much more when children are learning and playing together inside in the winter.
When your doctor diagnoses you with type 1 diabetes, you almost certainly will wonder what could have caused you to acquire the disease. Did someone with diabetes sneeze on you? Did you eat so much sugary food that your body reacted by giving you diabetes? Rest assured that the causes of diabetes aren’t so simple.
Type 1 diabetes is an autoimmune disease, meaning that your body is unkind enough to react against – and in this case, destroy – a vital part of itself, namely the insulin-producing beta (B) cells of the pancreas. One way that doctors discovered that type 1 diabetes is an autoimmune disease is by measuring proteins in the blood, called antibodies, which are literally substances directed against your body – in particular, against your islet cells. Another clue that type 1 diabetes is an autoimmune disease is that drugs that reduce autoimmunity also delay the onset of type 1 diabetes. Also, type 1 diabetes tends to occur in people who have other known autoimmune diseases.
You may wonder how doctors can know in advance that certain people will develop type 1 diabetes. The method of prediction isn’t 100 percent accurate, but people who get type 1 diabetes more often have certain abnormal characteristics on their genetic material, their chromosomes, that are not present in people who don’t get type 1 diabetes. Doctors can look for these abnormal characteristics on your DNA. But having these abnormal characteristics doesn’t guarantee that you’ll get diabetes.
Another essential factor in predicting whether you will develop type 1 diabetes is your exposure to something in the environment, most likely a virus. I discuss this factor in detail in the next section.
To develop diabetes, most people also have to come in contact with something in the environment that triggers the destruction of their beta cells, the cells that make insulin. Doctors think that this environmental trigger is probably a virus. This type of virus can cause diabetes by attacking your pancreas directly and diminishing your ability to produce insulin, which quickly creates the diabetic condition in your body. The virus can also cause diabetes if it is made up of a substance that is also naturally present in your pancreas. If the virus and your pancreas possess the same substance, the antibodies that your body produces to fight off the virus will also attack the shared substance in your pancreas, leaving you in the same condition as if the virus itself attacked your pancreas.
A small number (about 10 percent) of patients who develop type 1 diabetes don’t seem to need an environmental factor to trigger the diabetes. In them, the disease is entirely an autoimmune destruction of the beta cells. If you fall into this category of people with diabetes, you may have other autoimmune diseases, such as autoimmune thyroid disease.
The most important study of prevention of diabetes complications ever done for type 1 diabetes is called the Diabetes Control and Complications Trial (DCCT), published in 1993. The DCCT showed that keeping very tight control over your blood glucose is possible but difficult. The difficult part of keeping your blood glucose close to normal is that you increase your risk of having low blood glucose, or hypoglycemia (see Chapter
