Health Gazette

Also called insulin-dependent diabetes, this disease causes poor regulation of blood sugar levels—an imbalance with potentially dire consequences.

Diabetes is a disease characterized by an increase in the level of sugar in the blood. Usually, this blood sugar is regulated by a hormone secreted by the body called insulin. In people with type 1 diabetes, insulin production is too low or even zero. It must then be injected regularly in the form of medication.

Why does insulin production malfunction?

Insulin is made by specialized cells located in the pancreas. They are called the β cells of the islets of Langerhans. In patients who declare type 1 diabetes, these cells are attacked and gradually destroyed, causing a gradual drop in insulin production until it stops when the cells have disappeared. This destruction is caused by an autoimmune reaction: the patient's T lymphocytes, cells belonging to the immune system, mistakenly attack the ß cells.

The onset of this autoimmune disease usually occurs in childhood, but it can occur at any age. It is linked to both genetic (specific genes predispose to type 1 diabetes) and environmental factors. The latest research shows that infection with an enterovirus-like virus, for example, is often involved in the development of type 1 diabetes in genetically predisposed people.

Why is the lack of insulin so serious?

Insulin is a hormone that circulates in the blood and works to get blood glucose into the cells to use it and function properly. It allows, in particular, the supply of muscle cells, fat cells (adipocytes), and liver cells (hepatocytes).

In the short term, lack of insulin can cause death from ketoacidosis. Indeed, without insulin and entry of sugar into the cells, the body must find another solution to supply the organs with energy. It will then degrade fat via a chain of reactions leading to the production of ketone bodies.

Unfortunately, this alternative way of functioning, considered an emergency solution from a physiological point of view, causes the accumulation of toxic “ketone bodies,” including acetone. These wastes make the blood too acidic, cause abdominal pain, and can lead, if too much production, to a coma called diabetic ketoacidosis. It's a medical emergency.

In the long term, the absence of insulin causes long-lasting hyperglycemia (too high blood sugar levels) with negative consequences for the body. Both small and large blood vessels (arteries) can be affected. Diabetes is a cardiovascular risk factor: it increases the likelihood of myocardial infarction or stroke, in particular. The retina and lens can also be damaged, as can the kidney. Nerves can also be damaged, causing neuropathy that disrupts pain sensitivity. Patients can then become insensitive to pain (which can lead to dramatic situations because their wounds evolve without realizing it). On the contrary, the slightest scratching of the skin can cause severe pain.

How do you know if you have type 1 diabetes?

A simple measurement of fasting blood sugar can detect diabetes. Regular fasting blood sugar is around 1g of glucose per liter of blood. When a measure shows that it is between 1.10 to 1.26g/lb., we speak of pre-diabetes, and the patient must monitor the evolution of his blood sugar. If it exceeds 1.26g/ lb., the diagnosis of diabetes is very strongly suspected: very rapid treatment is then required to avoid any medical emergency. You can also test the urine for ketone bodies. If in doubt, consult very quickly.

What symptoms should alert?

Poor regulation of blood glucose levels causes symptoms that are relatively easy to spot, although they may go unnoticed at first. Thus, a powerful thirst with a persistent urge to urinate should alert. This can result in particular in waking up at night to go to the toilet or drink, or even bedwetting in children who were, however, clean. Weight loss despite a regular diet should also question.

What is the treatment for type 1 diabetes?

To fight against the symptoms of type 1 diabetes, we will inject insulin whenever necessary to compensate for the lack of production of this hormone by the body. Insulin comes in the form of a liquid and is produced by pharmaceutical companies using genetically modified bacteria.

Stuart Maloney from XLPharmacy states; “two types of insulins are available: fast and slow, also called basal. They are usually combined during the day”. The patient injects himself subcutaneously, adjusting the volume according to what he has eaten and his blood sugar that he tested just before.

If this treatment makes it possible to live with diabetes, it does not, however, make it possible to cure the disease. Researchers are currently taking different avenues, exploring the islet of Langerhans transplant and the fight against the autoimmune phenomenon.