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Type 1 diabetes, also called insulin-dependent diabetes, is a disorder that occurs when your body produces little or no insulin. Normally, when you eat carbohydrates, such as bread, pasta, fruits, or vegetables, these foods get broken down into glucose (sugar), your body's favorite fuel. This fuel then travels through your bloodstream until it's "unloaded" into your cells by insulin, which functions a little like a team of chemical dockworkers. But when you have Type 1 diabetes, your immune system goes haywire and attacks the beta cells in your pancreas that produce insulin. Without these chemical dockworkers, the sugar in your blood has no way to get into your cells, so it builds up in your bloodstream. Your cells don't get the fuel they need to function and begin literally starving to death. Untreated, diabetes can lead to heart disease, kidney disease, chronic infections, and other life-threatening conditions. But with treatment, you can control it.

Researchers in the field of endocrinology don't yet know. They do know that diabetes runs in families and sometimes occurs when a viral infection has damaged the pancreas. Certain immune system diseases that destroy the body's insulin-producing cells may also be a factor.

Type 1 diabetes -- lack of insulin -- often appears suddenly, causing increased thirst and frequent urination (which may lead to bed-wetting in children). These are signals that your kidneys are using more water to reduce blood-sugar levels. Lack of insulin also means not being able to use the calories you consume, so you're likely to be very hungry; lose a lot of weight; feel weak, tired, irritable, and possibly sick to your stomach.

It's estimated that up to 2 million Americans have Type 1 diabetes. The disease may apppear at any age but usually begins in childhood or early adulthood, most often among young people with a sibling or parent who also has the disease.

Unfortunately, there is no cure for diabetes. Once it develops, you'll have it for the rest of your life. But that doesn't mean you can't live a mostly healthy, active life. The key is to keep your blood-sugar levels as close to normal as possible. Work with your doctor and a dietitian to develop a plan to balance eating with exercise, and to take insulin, which lowers blood-sugar levels.

Work closely with your doctor and nutritionist or certified diabetes counselor. The more closely you manage your condition, the less likely you are to have complications. And doctors are learning more all the time about how to treat diabetes and control blood sugar better.

Your doctor will start by helping you make sure your body gets the insulin it needs. Because Type 1 diabetics don't produce insulin, you'll have to get it from an injection, once to four times a day, or through a small pump attached to a very thin infusion line and tiny needle that feeds insulin directly into your body (under the skin).

And soon you may not have to stick yourself with insulin. In January 2006, the FDA approved inhaled insulin as a treatment option for Type 1 and Type 2 diabetes. This new type of insulin comes in powder form and is the first new insulin delivery option since the discovery of the hormone in the 1920s. It was briefly marketed as Exubera by Pfizer, who dropped the product in 2008 due to poor sales. Now other drug manufacturers are in the process of developing their own brands of inhaled insulin.

For Type 1 diabetics, inhaled insulin can substitute for short-acting insulin taken with meals. However the drug is not for smokers or people who recently quit smoking, and it is not recommended for people with asthma, bronchitis, or emphysema.

Here are some other ways you can manage your diabetes:

•Watch what you eat. A healthful diet for a person with diabetes is not all that different from a healthful diet for a person without diabetes. Like everyone else, you need a balance of fruits, vegetables, whole grains, cereals, breads, dairy products, and protein such as fish, meat, or beans. Like everyone else, too, you need to limit fat and sugar. But unlike everyone else, you need to be vigilant about staying within your limits. Schedule your meals, insulin shots, and activities to prevent your blood-sugar level from getting too high or too low; eating small frequent meals instead of a few large ones can help.

•Watch your sugar intake, too. For decades, sugar was virtually forbidden to diabetics because it was believed to increase blood sugar more than other carbohydrates such as pasta or potatoes. But new studies show that isn't so. This doesn't mean you can eat all the sweets you want, though. Sugar still counts as a carbohydrate, so if you eat a sugary food, you'll have to forgo another carbohydrate. And because sweets often contain empty calories (and lots of fat), you're likely to forgo valuable nutrients as well. If you have a sweet tooth, consider artificial sweeteners. They satisfy sweet cravings without adding calories or raising blood-sugar levels, so indulging is safer.

•Get regular exercise. Your body uses energy when it's active, so exercise usually causes blood-sugar levels to fall and appears to help insulin work better. But be careful that your blood sugar doesn't get too low while you're exercising. It's always a good idea to check your levels before and after any strenuous activity and to time workouts to fit in with your meals and insulin injections -- which may mean eating a snack or decreasing your insulin before you exercise. Your doctor should help advise you about this.

•Manage stress. Physical stress such as overexertion, illness, or injury can cause your blood-sugar levels to rise. Mental stress can make blood sugar either rise or fall. Either way, being rundown and stressed-out makes diabetes harder to manage, so it's important to get enough rest and learn to relax. Good stress-busting techniques include meditation, deep breathing exercises, physical exercise, and regular massage.

•Test your blood-sugar level. To keep it under control you have to know what it is, and the only way to do that is to test yourself on a regular basis -- generally several times a day. To test your blood, you should use a blood-glucose meter, also known as a Glucometer, to get a reading. (Glucometers are readily available and covered under insurance plans, including Medicare.) Talk to your doctor, too, about other tests you might need, including a yearly eye exam and regular blood and urine tests and foot exams.

•Consider hormonal shifts. If you're a woman, you should also be aware that your menstrual cycle, a pregnancy, and the use of birth control pills or IUDs that use hormones can cause fluctuations in your blood-sugar level, making it harder to control. Talk to your doctor about how to factor these things in so you can better manage your diabetes.

Further Resources

The American Diabetes Association

http://www.diabetes.org

The National Diabetes Information Clearinghouse (NIDC), part of the National Institutes of Health

http://www.niddk.nih.gov/index.htm

Diabetes Care and Education Dietetic Practice Group, a division of the American Dietetic Association

http://www.eatright.org

References

First published November 3, 1998
Last updated February 11, 2008
Copyright © 1998 Consumer Health Interactive

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