Monday 9 January 2023

Doctors Say These are the Signs of Type 1 Diabetes, Including Fatigue

 Chances are you or someone you know has diabetes. The American Diabetes Association states, "In 2019, 37.3 million Americans, or 11.3% of the population, had diabetes. Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents." As if the statistics weren't alarming enough, type 1 diabetes is on the rise, according to data released in 2020 by the Centers for Disease Control and Prevention, but the reasons why aren't clear.  A study published in the National Library of Medicine states, "Genetic factors alone cannot explain such a rapid increase in incidence; therefore, environmental factors must be implicated. Lifestyle factors have been classically associated with type 2 diabetes. However, there are data implicating obesity and insulin resistance to type 1 diabetes as well (accelerator hypothesis). Cholesterol has also been shown to be correlated with the incidence of type 1 diabetes; this may be mediated by immunomodulatory effects of cholesterol. There is considerable interest in early life factors, including maternal diet, mode of delivery, infant feeding, childhood diet, microbial exposure (hygiene hypothesis), and use of anti-microbials in early childhood. Distance from the sea has recently been shown to be negatively correlated with the incidence of type 1 diabetes." A lack of exposure to sunshine and low vitamin D levels are being looked at as possible contributing factors for an increase of type 1 diabetes. However, those aren't the only areas. In addition, the gut microbiome is also a concern. The study states, "The microbiome is affected by many of the factors mentioned above, including the mode of delivery, infant feeding, exposure to microbes, antibiotic use, and dietary habits." To learn more about type 1 diabetes, read what experts tell Eat This, Not That! Health about the chronic condition. 


What to Know About Type 1 Diabetes

Young sick girl with insulin pump injection on arm

Jennifer Sherr, MD, PhD, Yale Medicine Pediatrics, Pediatric Endocrinology & Diabetes tells us, "Type 1 diabetes is an autoimmune condition.  This means that the body attacks the insulin producing beta cells of the pancreas and this makes someone with type 1 diabetes reliant on exogenously administered insulin.  While previously known as juvenile diabetes, both children and adults can be diagnosed with the condition. Insulin was discovered a century ago and with use of insulin therapy, type 1 diabetes is now a chronic condition that can be managed with insulin therapy.  More recently, the advent of various diabetes technologies have greatly improved care for people with type 1 diabetes. Having type 1 diabetes means individuals with the condition, and their families, need to consider a variety of factors to keep their glucose levels stable: food that they eat, physical activity, and stress can all make glucose more variable.  Newer technology is helping to offset some of this burden. The goal in treatment is to have the person with diabetes control the condition rather than letting type 1 control them.  People with type 1 diabetes can do anything. Dana Ellis Hunnes PhD, MPH, RD is a senior dietitian at UCLA medical center, assistant professor at UCLA Fielding school of public health, and author with Cambridge university Press, of the new book, RECIPE FOR SURVIVAL adds, "Type 1 diabetes is an autoimmune disorder where your own body destroys all its insulin-producing cells, the beta cells, within the pancreas. Without insulin, we cannot remove the glucose in our blood and use it within our cells, and this can lead to very detrimental effects in people who have type one diabetes."


The Difference Between Type 1 and Type 2 Diabetes


Dr. Sherr explains, "Type 1 diabetes is an autoimmune condition where someone's ability to make their own insulin decreases over time as the insulin producing cells of the pancreas are destroyed.  With type 2 diabetes, individuals with that condition continue to produce insulin and the underlying issue is primarily one of insulin resistance.  This is why for those with type 2, therapies other than insulin, which needs to be injected can be used.  This includes oral medications as well as other agents that can be given weekly. It is important to understand that there is no "bad" form of diabetes.  In the end, both require trying to keep glucose levels as close to normal as possible to avoid long term complications that can occur with persistently elevated glucose levels." Hunnes says, " Type one diabetes is an autoimmune disorder. Type two diabetes is almost exclusively caused by environmental aspects of our lives, namely, carrying too much fat and eating an unhealthy diet with too many processed foods, and especially too many processed carbohydrates. And type two diabetes our pancreas still produces insulin. We are just unable to utilize it effectively, and a type one diabetes pancreas cannot produce any insulin."


Signs of Type 1 Diabetes

with closed eyes drinking clean mineral water close up, young woman holding glass

Dr. Sherr says, "As someone's body either does not make enough insulin (type 1) or has insulin resistance that leads to high blood glucose levels (type 2), similar symptoms are seen.  These include:

Frequent urination (including the need to wake overnight to void)

Increased thirst


Weight loss

Upset stomach/nausea/vomiting

Increased hunger


 Especially if someone has increased thirst or urination, they should be evaluated for diabetes."

Robert Alesiani, PharmD, BCGP, Chief Pharmacotherapy Officer at Tabula Rasa HealthCare says the following are signs to be aware of. 

"Increased thirst

Increased urination

Increased hunger

Blurred vision

Weight loss

Irritability or agitation

Increased feelings of sedation and weakness."


Complications of Type 1 Diabetes


According to Dr. Sherr, "Complications of diabetes include both acute and long-term complications. Acute complications include risk of severe hypoglycemia, this means the glucose level is very low and the person with diabetes needs assistance from someone to treat.  This can lead to the person with diabetes passing out or having a seizure. Additionally, people with diabetes can develop diabetic ketoacidosis.  This occurs if there is not enough insulin and glucose levels remain high for a long period of time.  Because insulin is required for your body to use the sugars and carbs we consume, the body seeks alternative sources of fuel.  The fuel that is used comes from breaking down our fat cells.  As fat cells are broken down, this can make the pH of the blood acidic, and lead to repeated episodes of vomiting and changes in mental status.  For people with diabetes, it is essential to remain on insulin via injections or pumps to avoid this issue. Living with a chronic medical condition also places those with diabetes at higher risk for having depression and or anxiety.  Studies have also shown increased rates of eating disorders in those with diabetes. Long term complications of diabetes include kidney disease (nephropathy), damage to the nerves (neuropathy), and eye damage (retinopathy). Further, people with diabetes are at increased risk for cardiovascular events, stroke and heart attacks.  However, by keeping glucose levels as close to normal as possible, studies have clearly shown the risk of these long term complications can be vastly mitigated." 


The Role of Insulin and Glucose

man eating breakfast

Dr. Sherr states, "Glucose and insulin are closely tied together.  Whenever we eat carbohydrates or sugars, the body breaks it down into glucose.  Glucose then needs to enter our cells.  Insulin is the key to allowing insulin to enter these cells.  For people with type 1, we need to replace insulin by giving it subcutaneously (either via injection or an insulin pump)." Hunnes tells us, "Insulin is not an option. It is a necessity. Everyone needs glucose for optimal health, and the role of glucose and type 1 diabetes is if someone has given themselves too much insulin and their blood sugar level is low. They may need to consume a glucose tab to increase their blood sugar to a normal level." 

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