This section is for everyone – who is still here!

DIAGNOSIS of TYPE ONE DIABETES

For most children or young people they will find out very quickly after diagnosis that they will need to be on injected insulin for life. Perhaps they will have had symptoms of weight loss, drinking a lot and passing urine a lot.  Others will have become very ill with diabetic ketoacidosis and will have been hospitalised.

More and more often younger people are being diagnosed with metabolic syndrome and type 2 diabetes. This is usually related to being overweight, sedentary and genetic influences.  Women with type 2, gestational or type one diabetes may find themselves being intensively treated with insulin during the planning or carriage of a pregnancy. Outwith pregnancy most people with type 2 diabetes will remain on diet and oral medications to control their diabetes. After about six years around half  of type 2 diabetics will have needed to add insulin to their medication regimes to maintain good control. Diabetics who use certain drugs to stimulate the pancreas to produce more endogenous insulin from their own pancreatic beta cells are more at risk of beta cell failure.

Type one diabetes results when the pancreas can no longer make enough insulin to prevent high blood sugars.  For early onset patients it is an autoimmune disease that used to be a death sentence.  Now that insulin is widely available for most people it is rarely as rapidly fatal. But until a real cure can be found and made available it can still feel like a life sentence.

Insulin is a drug that needs to be used very carefully.  It can rapidly lower blood sugars and cause hypoglycaemia which can cause death if it is very severe and is untreated. Lower levels of hypoglycaemia may not be obvious to drivers or their passengers and yet can cause impaired reaction times and judgement which can lead to accidents.  High blood sugars are less of a worry on the short term but on the long term damage accumulates that can severely affect the nerves, eyes, kidneys and heart.

Pancreatic beta cells start to die in tissue culture at sugar levels of 6.1 or higher. This is not a threshold effect and if blood sugar levels are brought below this level soon enough the cells can start to recover.

At the time of diagnosis and for up to decades afterwards type one diabetics still produce a small amount of insulin. The remaining beta cells are still subject to attack by autoimmune antibodies but can be nursed along for many years if high blood sugars can be avoided.

The more of your own pancreatic beta cells that are still active the easier it is to control your diabetes as the pancreas can still fine control sugar levels in a way that injections cannot. This is a major reason for all new diabetics to strive for normal blood sugars so they can prolong the “honeymoon” phase of diabetes.

Even the most rapidly effective injected insulins eg novorapid and humalog cannot replicate the immediately effective blood sugar lowering effect of the stored insulin from a normal pancreas beta cells. This means that blood sugars will be inappropriately high for at least some time after even small amounts of very fast releasing carbohydrates are eaten in eg bread or fruit. Over the long term these sugar spikes can add up to a lot of damage to body tissues.

We have already discussed what level of control you already have and what level of control may be optimal for certain groups of people in the Type Two Section. Please take a moment or two to review this.

This Type One section aims to give you more specific information on the use of insulin and other information to help you achieve the best health you can.

The insulin users section tends to lean heavily towards younger type ones. I will give some guidance about when older type twos can skip.

Quick Quiz:
1. For insulin users it is safe to go straight onto a low carb diet as long as you have…
a Thrown out all your crisps, breakfast cereals and biscuits.
b Bought a good low carb book to help you.
c Bought in plenty of meat, vegetables and olive oil.
d Planned out a gradual reduction of carbohydrates and appropriate reduction in your insulin.

2. Type One diabetics…
a Make plenty of their own insulin from beta cells in the pancreas.
b Can be sure there will be a cure within the next five years.
c Rely on carefully measured and timed amounts of injected insulin to keep well.
d Can eat whatever they like, when they like.

3. You are an insulin user going into hospital for a planned operation. You need to do three of these….
a Speak to an anaesthetist well before your operation to let them know how you manage your blood sugars.
b Speak to the dietician about your meal choices from the Healthy Diabetic section of the menu.
c Bring in your insulins, testing kit and any special foods or drinks you may need.
d Arrange for a friend to provide, transport, supplies and to liase with clinical staff.

4.Type ones can do three of these things…
a Get other autoimmune diseases.
b On first diagnosis go through a honeymoon period when pancreatic function improves for a period of time.
c Use inhaled insulin to control blood sugars.
d Die rapidly from severe hypoglycaemia.

5. Tests type ones should be having regularly include three of these…
a Amylase which is raised in pancreatitis.
b Thyroid function tests.
c Tissue transglutamase for coeliac disease.
d Albumin creatinine ratio which is a kidney test.

Have you got it?
1. D is correct. You MUST plan and change your diet and insulin doses GRADUALLY. This means more freqent blood sugar testing till you are stable on your new regime.

2. C is correct. If only we could be certain of a widely available and affordable cure within the next five years then we possibly could eat what we want, when we want without paying too much for the consequences. Unfortunately for the forseeable future most certainly DO have to live with the consequences so the tighter the control the better for most diabetics.

3. You need to do ACD. You don’t need to speak to the dietician. You decide yourself from the entire menu.

4. ABD are correct. Inhaled insulin is available now. It comes in 3 unit increments though and this is likely to make it less precise than is required for really tight blood sugar control for type ones. It may have a place for type twos who are still producing some of their own insulin.

5. Tests type ones should be having regularly include three of these…

Thyroid tests, coeliac tests, and kidney tests are all needed. Blood pressure, eye examination or retinal photography and foot examinations are other necessary tests.

Reference Info:

• Acknowlegements to Dr. Bernstein’s Diabetes Solution
• Jenny, now a Bernie forum member, whose blogs about “What your doctor won’t tell you.” were extremely helpful to me when Steven was first diagnosed.

Where to Next?
Please proceed to the section How To: Deal with the Stress of a Newly Diagnosed Child section.