Diabetes For Dummies. Rubin Alan L.

be that hormone (especially if you want to understand diabetes). Over the course of your life, the insulin that your body produces or the insulin that you inject into your body (as I describe in Chapter 11) affects whether or not you control the glucose levels in your blood and avoid the complications of the disease.

      Think of your insulin as an insurance agent who lives in San Francisco (which is your pancreas) but travels from there to do business in Seattle (your muscles), Denver (your fat tissue), Los Angeles (your liver), and other places. This insulin insurance agent is insuring your good health.

      Wherever insulin travels in your body, it opens up the cells so that glucose can enter them. After glucose enters, the cells can immediately use it for energy, store it in a storage form of glucose (called glycogen) for rapid use later on, or convert it to fat for use even later as energy.

      After glucose leaves your blood and enters your cells, your blood glucose level falls. Your pancreas can tell when your glucose is falling, and it turns off the release of insulin to prevent hypoglycemia, an unhealthy low level of blood glucose (see Chapter 4). At the same time, your liver begins to release glucose from storage and makes new glucose from amino acids in your blood.

      If your insurance agent (insulin, remember? – stick with me here!) doesn’t show up when you need him (meaning that you have an absence of insulin, as in type 1 diabetes) or he does a poor job when he shows up (such as when you have a resistance to insulin, as in type 2 diabetes), your insurance coverage may be very poor (in which case your blood glucose starts to climb). High blood glucose is the beginning of all your problems.

      Doctors have proven that high blood glucose is bad for you and that keeping the blood glucose as normal as possible prevents the complications of diabetes (which I explain in Part II). Most treatments for diabetes are directed at restoring the blood glucose to normal.

      Understanding Type 1 Diabetes and You

      

John Phillips, a 6-year-old boy, was always very active, and his parents became concerned when the counselors at summer 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.

Identifying symptoms of type 1 diabetes

      

Following are some of the major signs and symptoms of type 1 diabetes. If you find you have any of these symptoms and haven’t already been diagnosed with diabetes, call your doctor.

      ✔ 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.

      

At the same time as fat is breaking down, the child’s blood glucose rises higher. From a normal level of 80 mg/dl (4.4 mmol/L), blood glucose can rise to the unhealthy level of 300 mg/dl (16 mmol/L) and even up to the dangerously high levels of 400 to 600 mg/dl (22.2 to 33.3 mmol/L). At high levels, the child’s blood is like thick maple syrup and doesn’t circulate as freely as normal. The large amount of water leaving the body with the glucose depletes important substances such as sodium and potassium. Vomiting causes the child to lose more fluids and body substances. All these abnormalities cause the child to become very drowsy and possibly lose consciousness. This situation is called diabetic ketoacidosis, and if it isn’t identified and corrected quickly, the child can die. (See Chapter 4 for more details on the symptoms, causes, and treatments of ketoacidosis.)

      

A few special circumstances affect the symptoms that you may see in persons with type 1 diabetes. Remember the following factors:

      ✔ 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.

Investigating the causes of type 1 diabetes

      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.

Getting