Type 1 Diabetes is an autoimmune disease characterized by autoantibodies to pancreatic beta cells. The common age of presentation is around puberty, with a minor peak at 5 -6 years of age. Symptoms of Type 1 Diabetes are present for a very short duration before diagnosis (weeks or days) Classical triad includes:
- Polyuria
- Polydipsia
- Polyphagia
Other symptoms being:
- Weight loss
- Extreme tiredness
- General malaise
- Blurring of vision
- Repeated skin infections and genital infections
- Diabetic Ketoacidosis
Any individual who presents with unexplained weight loss and osmotic symptoms at any age Diabetes mellitus should be suspected.
Osmotic symptoms
Polyuria, polyphagia and polydipsia occur due to osmotic diuresis as a result of hyperglycemia - these symptoms are common to both types of diabetes. Still, they are more severe and present for the shorter duration before diagnosis in Type 1 Diabetes. Nocturia – number of times of passage of urine at night is more helpful for diagnosis and in children sudden onset of bed wetting need to be screened for Diabetes.
Weight loss
- Weight loss strongly indicates insulin deficiency, loss of anabolic action of insulin.
- Muscle wasting is prominent due to protein degradation, as normally insulin inhibits its break down.
General malaise and tiredness
Malaise is due to muscle breakdown, and easy fatiguability is due to dehydration associated with osmotic diuresis.
Blurring of vision
Acute changes in the plasma glucose account for changes in the osmolarity between plasma and eyeball, leading to vision disturbances.
Infections
High blood glucose per se causes impaired immunity leading to individuals with diabetes more prone to infections like
- Vaginal candidiasis common in women
- Balanitis in men
Sometimes above infections may be alone the presenting symptoms, on evaluation found to have diabetes.
- Skin infections -due to common commensals of the skin like Staphylococcal boils, pustules and carbuncles.
- Other Very rare life-threatening infections – Mucormycosis and Necrotizing fasciitis are commonly seen in individuals with diabetes.
Diabetic ketoacidosis
Diabetic ketoacidosis(DKA) is the presenting symptom at the time of diagnosis of Type 1 diabetes. Symptoms of DKA:
- Nausea, vomitings
- Pain abdomen
- Sweet-smelling breath
- Shortness of breath
- Osmotic symptoms
- Severe dehydration
- Altered sensorium
DKA is the life-threatening emergency, which needs to be diagnosed and treated early. With timely intervention, the mortality is around 1-2%. Treatment of Type 1 Diabetes
- Effective management of diabetes is possible only with family involvement. Individuals with diabetes and their family should receive diabetes self-management education and support; they should have individualized medical nutrition therapy based on their culture.
- Recommended physical activity is 60 minutes of moderate to vigorous physical activity and muscle-strengthening exercise -3 days per week.
- Monitoring of blood glucose before and after exercise is required to prevent hypoglycemia and exercise-induced ketosis.
- For effective management, individuals need to have frequent blood glucose monitoring 3-6 times per day with a glucometer or continuous glucose monitor.
- Effective glycemic management is possible with intensive multiple subcutaneous injections or continuous subcutaneous infusion with insulin pumps.
- Sensor augmented insulin delivery with insulin pumps with automatic low glucose suspend and insulin delivery system are useful to achieve stringent glycemic goals with less risk of hypoglycemia.