The information on this page is intended for general background informational purposes only. Diabetes patients should visit Health Topics A-Z for the U-M's patient education handout in accordance with clinical care guidelines.

Type 1 Diabetes Mellitus
Also known as juvenile diabetes, juvenile-onset diabetes (JOD), insulin-dependent diabetes mellitus, and IDDM

What is type 1 diabetes?

Type 1 diabetes is a disorder that occurs when the body produces little or no insulin, a hormone made by the islet cells of the pancreas. During digestion, the body breaks down food into sugar (or glucose) which the blood carries to the cells. Insulin's job is to help the sugar leave the bloodstream and enter the cells where it can be used for energy. When the body does not have enough insulin, sugar can't get into the cells and, instead, builds up in the bloodstream. The body is unable to use the sugar for energy despite having high levels of it in the bloodstream and the result is high blood sugar levels and diabetes. If not treated, high blood sugar levels can lead to severe illness, coma, and death.

Type 1 diabetes can occur at any age, but it usually develops in childhood or early adulthood before the age of 40. Approximately 10 percent of people with diabetes have type 1. In fact, it accounts for three percent of all new cases of diabetes each year. There is an estimated one new case per every 7,000 children annually. New cases are less common among adults older than 20.

Causes

The exact cause of type 1 diabetes is unknown. It occurs when most of the cells in the pancreas that make insulin have been destroyed. Sometimes diabetes results from a viral infection or pancreas injury. It is thought to be an immune system disorder.

Symptoms usually develop suddenly and can vary greatly from person to person. If diabetes is not treated, a coma or death can occur. Common symptoms include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unusual weight loss
• Fatigue
• Irritability
• Blurry vision
• Nausea
• Vomiting
• Absence of menstruation
• Abdominal pain
• Muscle deterioration
• Loss of fat
• Dry skin

Tests and diagnosis

The following tests are used to diagnose type 1 diabetes:

• Urinalysis: This test is will show glucose and ketone bodies in the urine, but a blood test is required for diagnosis.
• Blood sugar (or glucose) test:
• A fasting blood glucose of 126 mg/dL or higher indicates diabetes
• A random (non-fasting) blood glucose that exceeds 200 mg/dL indicates diabetes, but this must be confirmed with a fasting test
• Insulin test: Checks for a low or undetectable level of insulin
• C-peptide test: Checks for a low or undetectable level of the protein C-peptide, a by-product of insulin production

Is type 1 diabetes preventable?

No, but you can reduce your risk for long-term problems with proper care, insulin, and blood sugar monitoring.

How long will type 1 diabetes last?

Type 1 diabetes is a lifelong condition and, as such, requires lifelong care.

Treatment and care

The goal of diabetes care is to keep blood sugar levels as close to normal as possible to help prevent short and long-term complications such as blindness, kidney failure, and more damage. Intensive insulin therapy is the primary treatment for type 1 diabetes. Education, meal planning, weight control, exercise, foot care, and careful self-testing of blood glucose levels also are key factors in successful treatment.

•  Insulin therapy
Patients with type 1 diabetes will begin taking insulin as soon as the diagnosis is confirmed. Insulin therapy includes multiple daily injections, use of insulin pens or pumps and, possibly, mixing multiple types of insulin in order to achieve the best control of blood glucose

A major component of insulin therapy is knowing how to self-check blood sugar levels since blood sugar tests indicate how well insulin dose, meal plan, and activity are balanced.

•  Meal planning
Carbohydrate counting is the most common approach to meal planning for type 1 diabetes patients. Insulin is then given to balance with the carbs to regulate blood glucose levels. If carbs and insulin are out of balance, extreme variations in blood glucose can occur. Consultation with a registered dietitian or nutrition counselor is an essential tool for meal planning and dietary control for diabetics. Health care providers and organizations such as the American Diabetes Association and the American Dietetic Association also offer classes and advice on meal planning and general diabetes management.

•  Activity
Regular exercise helps lower the amount of sugar in the blood and helps burn excess calories and fat to achieve optimal weight. Get advice and medical approval from a health care provider before beginning any exercise program. People with type 1 diabetes must take special precautions before, during and after participation in intense physical activity or exercise.

•  Education
Learning to manage and live with diabetes are necessary to avoid developing short-term complications such as hypoglycemia and hyperglycemia and to delay or slow the onset of long-term complications such as diabetic retinopathy (eye disease) or nephropathy (kidney disease).

Education classes are available through the University of Michigan Health System, the local American Diabetes Association, and others. Talk to a health care provider for details.

•  Foot Care
Since diabetes causes damage to the blood vessels and nerves which can result in a decreased ability to sense trauma or pressure on the foot, people with diabetes are prone to foot problems. A foot injury could go unnoticed until severe infection develops. Additionally, diabetes alters the body's immune system and decreases the body's ability to fight infection. Small infections can rapidly progress to the death of skin and other tissues. The result could be amputation of the affected limb. Examining feet each day for signs of injury, wearing well-fitting shoes, and treating problems quickly can dramatically lower risk.

•  Emotional Care
Whether you are newly diagnosed or you have had type 1 diabetes for some time, it is common to have many thoughts and feelings about this disease and all that needs to be done to manage it successfully. Some very common feelings are anger, fear, sadness, and “why me?” One of the most helpful things you can do is find a good listener – someone you can talk with about your feelings and who will listen without making judgments or offering advice. Your spouse, health care provider or diabetes educator, a family member, or a good friend may be this person for you. Some people find it helpful to go to a support group made up of people with diabetes and their family members. They understand what you are going through and often have experiences to share that will benefit you.

While some negative feelings are to be expected, if these feelings become overwhelming or are affecting your ability to care for yourself or participate in your usual activities, talk with your provider, even if you aren't asked about this issue. There are treatments available that work and will help.

Next - Type 2 Diabetes >>

Sources: U-M, National Institutes of Health and the American Diabetes Association