Type 1 diabetes

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**Type 1 diabetes**, also called **diabetes mellitus type 1**, is an autoimmune disease that results in high blood sugar (hyperglycemia). It causes hyperglycemia because the body cannot create enough insulin. Insulin is a hormone that is made in the pancreas that lowers blood sugar. People with this autoimmune disease are called diabetics.  

People with type 1 diabetes need to take insulin injections to stay healthy and have a normal or safe level of sugar (glucose) in their blood. Diabetics that do not get enough insulin can become very sick or even die if it goes unchecked. People with type 1 diabetes have an higher risk of developing neuropathy (nerve pain), kidney disease, retinopathy (which affects sight), depression as well as diseases involving blood vessels such as stroke, heart disease or gangrene. 

There are two types of diabetes. About 5-10% of people with diabetes have type 1. In addition to type 1 and 2 diabetes mellitus there is diabetes insipidus.

## Cause 
Type 1 diabetes is a condition caused by a lack of insulin in the body. Insulin is a hormone produced by beta (B) cells in the pancreas. Insulin is responsible for moving sugars out of the blood and into cells to be used by the body for energy. If insulin is not made, the body will search for other ways to get the sugars needed to feed the cells, including breaking down muscle and fat, leading to a loss of weight and the production of ketones in the body, which can cause ketoacidosis.

In type 1 diabetes, insulin not produced in the pancreas due to an autoimmune condition, where it attacks its own cells. The immune system attacks the cells responsible for producing insulin in the pancreas, called beta cells. The beta cells are damaged in a way that prevents them from producing more insulin. As more and more of these cells are damaged, less insulin is produced in the body. This means that more sugar remains in the bloodstream rather than being moved into cells. This high blood sugar causes the symptoms seen in type 1 diabetes.

The disease is thought to be strongly linked to genetic factors, but the trigger that starts the autoimmune disease is not currently known.

Although type 1 diabetes can now be diagnosed at any age, it is one of the most common chronic conditions in children and young adults. Being diagnosed at ages 5–7 or at the start of puberty is the most common. Type 1 diabetes is also slightly more common in boys.

Cases of type 1 diabetes have been increasing across the world for several decades. Approximately 1 in 300 people are diagnosed with type 1 diabetes by the age of 18 in the United States.

## Symptoms 
In type 1 diabetes, symptoms generally develop over a few days or weeks, though may take longer in adults. The main symptoms are:
* Feeling very thirsty (polydipsia)
* Urinating more often than normal
* Exhaustion
* Loss of weight
* Bedwetting (especially in children)
* Blurring of sight
* Slow healing of wounds and cuts

Nausea, vomiting (being sick) and heavy breathing are more serious symptoms that occur at a later stage in the disease. This may lead to various other symptoms, including confusion, loss of consciousness, clumsiness, seizures or death.

#### Diabetic ketoacidosis 
Diabetic ketoacidosis (DKA) is a very serious complication of type 1 diabetes. It is a medical emergency and requires rapid medical attention to prevent further damage to diabetic, because when it is left untreated it can potentially lead to death. DKA occurs when there is not enough insulin in the body to supply sugars to the cells. In order to give its cells enough energy to survive, the body begins to produce acidic ketones which are then used to feed energy to the cells.

If too many ketone bodies build up the blood becomes acidic, damaging the body and leading to the symptoms:

### Long-term complications 
If diabetes is not treated, even mildly raised blood sugar levels can damage nerves, organs and blood vessels in the body.

#### Small blood vessel complications 
* Diabetic retinopathy, damage to the blood vessels prevent enough blood from reaching the eye. This can lead the retina being damaged, resulting in loss of vision or blindness
* Diabetic neuropathy, damage to blood vessels near nerves can result in reduced blood flow. This can damage the nerves, leading to a loss in the sense of touch (tactile feel), normally starting from the hands or feet, before spreading up the body.
* Diabetic nephropathy, blood vessels in the kidney become damaged, making the kidney work less effectively. In severe cases. this can result in kidney failure
* Sexual dysfunction

#### Large blood vessel complications 
* Increased risk of heart disease and stroke
* Narrowing of blood vessels (peripheral arterial disease or PAD for short)
* Diabetic footː narrowing of blood vessels reduces sensitivity and slows wound healing in the foot. If not managed appropriately, can lead to ulceration and gangrene in the foot. In very severe cases, amputation may be required

## Management 
There is no known cure for diabetes. Instead, treatment is designed to help keep blood sugar levels normal in order to reduce the chances of complications developing as the disease progresses. There are two main method that are combined to manage diabetes type 1:

### Lifestyle 
* Healthy eating: eating a diet focused on fruit and vegetables, whilst limiting fats, salt, and sugar helps keep blood sugar levels in check
* Exercise: regular physical activity helps to lower blood sugar level to normal. A good goal to aim for is 150 minutes of exercise a week
* Stopping smoking: smoking further increases the risk of heart disease, peripheral arterial disease (PAD), and stroke. Stopping or reducing smoking will reduce the risk of these complications
* Reducing alcohol: alcohol can either raise or lower blood sugar, and makes it difficult to monitor your own blood sugar levels. Drinking less alcohol can reduce these risks

### Insulin injections 
Type 1 diabetes occurs due to the bodies inability to produce its own insulin. To counter this, insulin can be injected into the blood manually. When diabetes is first diagnosed, a plan should be made for insulin treatment in order to not under or overdose, which can lead to serious complications. A diabetic should monitor their own blood sugar levels continuously to know whether they need a dose of insulin to lower their blood sugar.

There are different kinds of insulin that can be taken: 
* Rapid-acting insulin and short-acting insulin get insulin into the bloodstream very quickly. They are typically taken before a meal to prepare for the rise in blood sugar that follows eating food
* Long acting insulin provides insulin in the system for up to 24 hours. It is generally taken once a day

## References