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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Illustration
Illustration
Type 1 Diabetes Mellitus
What is type 1 diabetes mellitus?
Type 1 diabetes is a disorder that occurs when your body
produces little or no insulin.
Insulin is a hormone produced by the pancreas. (The
pancreas is the large gland that lies behind the stomach.)
When you digest food, your body breaks down much of the food
into sugar (glucose). Your blood carries the sugar to the
cells of your body for energy. Insulin helps the sugar
leave the bloodstream and enter the cells. This is how
insulin lowers the level of sugar in your blood.
When your body does not have enough insulin, the cells of
your body cannot get enough sugar from your blood. As a
result, you have high levels of sugar in your blood. When
you have too much sugar in your blood, many problems begin
to occur. These problems can be life-threatening if they
are not treated. However, proper treatment can control your
blood-sugar level.
Type 1 diabetes is also called insulin-dependent diabetes.
This type of diabetes usually develops in childhood or early
adulthood.
How does it occur?
Type 1 diabetes occurs when most of the insulin-producing
cells in the pancreas have been destroyed. Usually the
cause of this type of diabetes is not known. Sometimes the
diabetes may be the result of a viral infection or injury of
the pancreas. It may also result from an immune system
disorder.
What are the symptoms?
Symptoms may develop suddenly. Or they may develop
gradually over days to weeks. Symptoms vary widely from
person to person. Common symptoms include:
- increased urination
- excessive thirst, dry mouth, and the drinking of a lot of
fluids
- increased appetite or loss of appetite
- visible weight loss
- muscle wasting
- loss of fat
- blurred vision
- skin infections
- vaginal infections
- tiredness
- fruity odor to breath
- abnormal feelings of prickling, burning, or itching of
the skin, usually on the hands or feet.
If diabetes is not treated, you could develop a
life-threatening chemical imbalance called ketoacidosis and
possibly go into a coma.
How is it diagnosed?
Your health care provider will ask about your medical
history and your symptoms and examine you. He or she will
test the level of sugar in your blood. If your morning
fasting blood sugar (before breakfast) is above 126
milligrams per deciliter (mg/dL), you are diabetic.
Sometimes another test called a glucose tolerance test is
done. For this test a sample of your blood is taken when
you have not eaten anything since the night before. Then
you drink a sugar drink and your blood is tested 2 hours
later. If after 2 hours your blood sugar level is over 200
mg/dL, you are diabetic.
Your health care provider may also test a sample of your
urine for sugar.
How is it treated?
Giving your body more insulin is the primary treatment for
type 1 diabetes. In addition you will learn how to control
your blood sugar through diet and exercise. The goal is for
you to be able to lead as normal a life as possible.
- Insulin therapy
You will start having insulin shots as soon as the
diagnosis is confirmed. Insulin is available in
different forms: short-acting (regular),
intermediate-acting (NPH, lente), and long-acting (ultralente). At
first you may use short-acting insulin several times a
day until your blood sugar is under good control. It is
common to combine short-acting and long-acting forms in
one dose (in one syringe).
Insulin may be given by injection under the skin of the
thigh or trunk 1 to 4 times a day. You will learn how to
measure your insulin dose, clean your skin, and give
yourself shots.
The insulin pump is a new way of giving the body insulin.
The pump is worn like a pager. A tube connected to the
pump is inserted under the skin. The device is worn like
a pager. As your blood sugar level changes, you can
adjust the amount of insulin pumped through the tube.
Because you are using insulin to lower your blood sugar,
you must carefully follow your health care provider's
directions for checking your blood sugar. This will not
only help you achieve good blood sugar control to prevent
the complications of diabetes, but it will also help you
prevent possibly life-threatening low levels of blood
sugar (hypoglycemia).
If the insulin doesn't seem to be working, your health
care provider will check for the following:
- a change in your work habits or level of exercise
- another medical problem, such as infection
- improper technique of insulin injection
- improperly stored insulin
- failure to follow your diet plan
- interaction of the insulin with another medicine
you are taking.
- Diet
The main goal of your diet plan is to maintain a normal
blood-sugar level. You will be given guidelines about
which foods you should eat and how many calories you
should eat each day. The number of calories you are
allowed is determined by whether you need to maintain,
lose, or gain weight. You will also learn how to space
your meals so you avoid going too long without food.
Your health care provider may refer you to a dietitian
for help with diet planning and meal management. A
dietitian can help you design a meal plan that fits your
lifestyle. Your prescribed diet will include a lot of
lean protein, complex carbohydrates (such as pasta,
breads, and cereals), and foods with high fiber. Your
diet should not include sugar-rich food such as soft
drinks, candy, and desserts.
- Exercise
Exercise is very important. A good activity plan can
help control your blood-sugar level. Talk to your health
care provider about making an activity plan for you.
- Education
There is a lot you will need to learn. You should
attend diabetes classes or talk to your health care
provider about how you can learn all you need to know.
You can also check with the local American Diabetes
Association chapter, hospital, or health department about
classes in your area.
You will keep a log of your blood sugar measurements. Your
health care provider will check the log to see how well your
treatment is working. Also, a test called hemoglobin A1c
can tell you and your provider what your average blood sugar
has been over the past 3 months. Your provider may do this
test every 3 to 6 months to check your overall control of
your blood sugar level.
How long will the effects last?
Type 1 diabetes is a lifelong condition. Its symptoms
increase or decrease depending on your response to the
insulin and your new diet and on how well you are able to
control your blood-sugar level.
How can I take care of myself?
Taking good care of yourself to avoid complications is
especially important with diabetes. Possible diabetic
complications include heart disease, stroke, blindness,
kidney failure, and nerve damage, especially to your feet
and legs. Carefully controlling your blood sugar will delay
or prevent these complications.
Guidelines for eating:
- Choose foods with lean protein, complex carbohydrates,
and lots of fiber. Choose foods low in saturated fats.
Read labels.
- Distribute your total calories evenly throughout the day.
- Time your meals to balance peak insulin effects and
scheduled activities. Try to always have your meals and
snacks at the same time each day.
- When you increase your activity, eat more or decrease the
insulin you are taking. This will help prevent low blood
sugar.
- Learn how to make proper food choices when you eat out.
- Ask for diabetic meals when you travel (for example, in
hotels and on planes). Order your meals ahead of time.
Guidelines for managing calories:
- Avoid compulsive eating.
- Drink water or other noncaloric drinks when you feel an
urge to eat between meals.
- Limit the amount of alcohol you drink.
- Buy only the types of food allowed by your diet plan.
- Eat on a regular schedule.
- Eat slowly and chew food thoroughly.
Guidelines for managing insulin:
- Follow your health care provider's instructions for
giving yourself insulin.
- Ask your health care provider what causes low blood sugar
and what to do when you have low blood sugar.
- Know when and how to test your blood.
- Follow your health care provider's instructions for
adjusting your insulin dosage according to the results of
blood tests.
- Carry some form of sugar at all times, so you can treat
low blood sugar quickly.
- Carry a protein snack, such as cheese and crackers, to
make sure you eat as often as you should.
Guidelines for seeing your health care provider:
- Follow your health care provider's recommendations for
frequent follow-up visits until your diabetes is under
good control.
- When your diabetes is under control, see your health care
provider every 3 to 6 months.
- Be sure to have an eye exam every year, or more often if
suggested by your health care provider.
Other guidelines for managing diabetes:
- Learn how to do proper skin and foot care every day.
Wear comfortable, well-fitting shoes to help prevent foot
injury. Break in new shoes gradually.
- Exercise regularly according to your health care
provider's advice. Exercise helps the insulin do its job
better. It also helps you to maintain a normal blood
pressure and a healthy heart.
- Carry identification (such as a card or bracelet) that
says you have diabetes, in case of an emergency.
Learn about diabetes and its complications so you can make
the correct decisions to control your blood-sugar levels.
Many hospitals have diabetes educators and dietitians who
can help you. Ask your health care provider to refer you to
these people.
You can get diabetic cookbooks and written information about
diabetes from:
The American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 800-DIABETES (800-342-2383)
http://www.diabetes.org
How can I help prevent type 1 diabetes?
Type 1 diabetes cannot be prevented. However, many of the
problems associated with the disease can be eliminated or
reduced if you:
- Follow the guidelines your health care provider gives
you.
- Maintain a normal blood-sugar level.
- Learn how to inject insulin correctly, including where to
inject it.
- Learn how to test your blood sugar.
- Know when to adjust your medication.
- Stop smoking.
- Have other medical problems treated, especially high
blood pressure.
- Keep your appointments with your health care provider.
- Call your health care provider if you have any questions.
Reviewed and approved by the Wilmer Eye Institute of The Johns Hopkins
Medical Institutions, Baltimore, MD. Web site: http://www.wilmer.jhu.edu
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