Juvenile diabetes mellitus is now more commonly called Type 1 diabetes, a form of diabetes mellitus that results from the autoimmune destruction of the insulin-producing beta cells in the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), and weight loss.
An estimated 17 million people in the U.S. have diabetes, of which about 1.4 million have Type 1 diabetes. The highest prevalence of Type 1 diabetes is in Scandinavia, where it comprises up to 20 percent of the total number of patients with diabetes.
The prevalence of Type 1 diabetes is about 5-10 percent of the total number of diabetes patients in the U.S., while in Japan and China, less than 1 percent of patients with diabetes have Type 1. Approximately 35 American children are diagnosed with juvenile diabetes every day.
The exact cause of Type 1 diabetes (juvenile diabetes) is still unclear. However, it is believed that Type 1 diabetes results from an infectious or toxic insult to persons whose immune system is genetically predisposed to develop an aggressive autoimmune response either against altered pancreatic B antigens (proteins) or against molecules of the B cell resembling a viral protein (called molecular mimicry). It is not caused by obesity or by eating excessive sugar.
The risk of juvenile diabetes is higher than virtually all other severe chronic diseases of childhood. Juvenile diabetes tends to run in families. Brothers and sisters of a child with juvenile diabetes have at least 100 times the risk of developing juvenile diabetes as a child in an unaffected family.
Type 1 diabetes happens most often in children and young adults but can appear at any age. Symptoms may include:
- Being very thirsty
- Urinating often
- Feeling very hungry or tired
- Losing weight without trying
- Having sores that heal slowly
- Having dry, itchy skin
- Losing the feeling in your feet or having tingling in your feet
- Having blurry eyesight
A blood test can show if you have diabetes. If you do, you will need to take insulin for the rest of your life.
It’s important to diagnose diabetes as early as possible, so that treatment can be started.
If you experience the symptoms of diabetes, you should visit your GP as soon as possible. They’ll ask about your symptoms and may request a urine and blood test.
Urine and blood tests
Your urine sample will be tested to see whether it contains glucose. Urine doesn’t usually contain glucose, but if you have diabetes, some glucose can overflow through the kidneys and into the urine. Your urine may also be tested for ketones (chemicals) that indicate type 1 diabetes.
If your urine contains glucose, a blood test can be used to confirm the diagnosis of diabetes. A sample of your blood will be taken in the morning, before you’ve had anything to eat, and it will be tested to measure your blood glucose levels.
If your blood glucose levels aren’t high enough for your GP to diagnose diabetes, you may need to have an oral glucose tolerance test (OGTT), which is also sometimes referred to as a glucose tolerance test (GTT).
After drinking a glucose drink, samples of your blood will be taken every half an hour, for two hours. The samples will be tested to find out how your body is dealing with the glucose.
Glycated haemoglobin (HbA1c)
The glycated haemoglobin (HbA1c) test is another blood test that can be used to diagnose diabetes.
In people who’ve already been diagnosed with diabetes, the HbA1c test is often used to show how well their diabetes is being controlled.
The HbA1c test gives your average blood glucose level over the previous two to three months. The results can indicate whether the measures you’re taking to control your diabetes are working.
There are blood tests for specific antibodies that can identify type 1 diabetes.
If you’ve been diagnosed with diabetes, it’s recommended that you have your HbA1c measured at least twice a year. However, you may need to have your HbA1c measured more frequently if:
- you’ve recently been diagnosed with diabetes
- your blood glucose remains too high
- your treatment plan has been changed
Unlike other tests, such as the GTT, the HbA1c test can be carried out at any time of day and doesn’t require any special preparation, such as fasting. However, it’s less reliable in certain situations, such as during pregnancy.
The advantages associated with the HbA1c test make it the preferred method of assessing how well blood glucose levels are being controlled in a person with diabetes.
HbA1c is also increasingly being used as a diagnostic test for type 2 diabetes, and as a screening test for people at high risk of diabetes.
Type 1 diabetes requires treatment to keep blood sugar levels within a target range. Treatment includes:
- Taking several insulin injections every day or using an insulin pump.
- Monitoring blood sugar levels several times a day.
- Eating a healthy diet that spreads carbohydrate throughout the day.
- Regular physical activity or exercise. Exercise helps the body to use insulin more efficiently. It may also lower your risk for heart and blood vessel disease.
- Regular medical checkups. You will get routine screening tests and exams to watch for signs of complications, such as eye, kidney, heart, blood vessel, and nerve diseases.
- Not smoking.
- Not drinking alcohol if you are at risk for periods of low blood sugar.
Blood sugars are easier to predict and control when mealtimes, amounts of food, and exercise are similar every day. So getting into a daily routine helps a lot.
Some people find out that they have type 1 diabetes when they are admitted to a hospital for diabetic ketoacidosis. If their symptoms are severe, they may need to be treated in an intensive care unit.
Treatment for diabetic ketoacidosis includes fluids given through a vein (intravenous, or IV) to treat dehydration and to balance electrolytes, and insulin to lower the blood sugar level and stop the body from producing ketones.
The honeymoon period
If your blood sugar levels return to the normal range soon after diagnosis, you are in what is called the “honeymoon period.”
This is a time when the remaining insulin-producing cells in your pancreascamera.gif are working harder to supply enough insulin for your body.
Treatment during this time may include:
- Keeping in close touch with your doctor.
- Testing your blood sugar level often, to see if it is rising.
- Taking very small amounts of insulin or no insulin. Even though you may not need insulin, some doctors prefer that you take small doses of insulin daily throughout the honeymoon period. This may decrease the stress on the pancreas.
There is no proven way to prevent type 1 diabetes. Vitamin D deficiency, which is very common, may increase the risk of diabetes. However, correcting the deficiency has not been yet shown to prevent diabetes. Likewise, avoiding cow’s milk during infancy may possibly prevent type 1 diabetes in genetically susceptible infants. But there is no definite proof that this prevents the disease.
People with type 1 diabetes generally adjust quickly to the time and attention that is needed to monitor blood sugar, treat the disease and maintain a normal lifestyle.
As time goes on, the risk of complications is substantial. But it can be reduced greatly if you strictly monitor and control your blood glucose levels.