Type 1 diabetes is a lifelong disease that arises mainly after the autoimmune destruction of insulin-producing structures in the pancreas called beta cells, which lead to high blood glucose levels.

The disease is mostly diagnosed in children and adolescents, usually presenting with three main symptoms: polydipsia, polyphagia and polyuria. This condition necessitates urgent need for exogenous insulin hormone.

Insulin injections or infusion allow a person with Type 1 diabetes to stay alive. They do not cure the disease, nor do they necessarily prevent the possible serious effects, which may include: kidney failure, blindness, nerve damage, heart attack and stroke.

Formerly named juvenile diabetes or insulin-dependent diabetes, Type 1 diabetes is a chronic disease in which the pancreas doesn’t produce insulin ultimately or make it in little amounts that do not cover the body needs for this hormone that enables glucose from interring the cells to fulfill their energy requirement. The result is noticeable high blood sugar levels.

The literal cause of type 1 diabetes is unknown, but likely enough it is an autoimmune disorder, in which the body's own immune system mistakenly destroys insulin-producing cells in the pancreas. The tendency to develop this disease can be boosted by genetic and environmental factors. The remnant cases are considered as idiopathic, in which the specific pathogenesis remains unclear.

• Family history. For the majority of cases, People need to inherit a predisposition to the disease from both parents.
• Race. White people are more prone to have type 1 diabetes than black, Asian, or Hispanic people.
• Genetics. The presence of certain genes like Human Leukocyte Antigen (HLA) complex indicates an increased risk of developing type 1 diabetes.
• Certain viral infections. Some infectious diseases caused by viruses like Epstein-Barr, Coxsackie, mumps and cytomegalovirus, may turn immune response to be directed against the body.
• Geographical factor. Chances of having type 1 diabetes heighten perceptibly with Moving toward north from the equinoctial line.
• Age. The disease appears at two noticeable peaks: 4-7 years old, and 10-14 years old. However, type 1 diabetes can come out at any age.
• Early Diet: introduction of cow's milk, cereal and gluten into a baby's diet before 4 months may slightly increase the chances to develop type 1 diabetes.
• Drinking water acidity. In a study at Norwegian Institute of Public Health and Diabetes Research Center, Oslo, Norway, tap water pH 6.2–6.9 was associated with a four times higher risk of type 1 diabetes compared with pH ≥7.7.

Insulin is a hormone secreted from beta cells in the pancreas into the blood stream. It works to assist glucose that came from diet or liver to inter the cells in order to be used as an energy source, which lead to a decrease in blood glucose levels. This process is disrupted in diabetes. Up to 90% of people with Type 1 diabetes have autoantibodies to at least one of 3 pancreatic antigens. This false immune response lead to inflammation of beta cells for months to years until 80-90% of these cells damaged, then hyperglycemia will be developed.

Awareness of having Type 1 diabetes is more remarkable than in type 2 as the symptoms develop suddenly and are more aggressive due to sever insulin shortage. They include:

• Excessive thirst (polydipsia): Fluid may be pulled from the tissue under the effect of glucose build up in bloodstream that may lead to feeling thirsty.
• Excessive urination (polyuria): The need to urinate more than usual. Affected people could notice that they wake up to void during the night.
• Excessive hunger (polyphagia): Muscles and organs don’t get their need of energy source due to disrupted insulin work. This nourishes the desire of eating.
• Weight loss: The body uses alternative energy source stored in muscle and fat, which burns more calories. In addition, some glucose is lost in the urine.
• Feeling of tiredness: If cells are deprived of sugar, the person may become exhausted and lacked of energy for daily living.
• Blurred vision: Hyperglycemia may cause Fluid to be pulled from the lenses of the eyes. This may affect sharpness of eyesight.
• Frequent infections: High glucose levels provide a suitable medium for bacteria to grow and proliferate.
• Slow wound healing: Decreased blood flow from diabetes complications can delay healing process and aggravate the situation.

Rapid and intensive development of the symptoms points to diabetes type I. The situation usually is severe enough to require hospitalization. Tests that may be used to confirm the disease:

• Fasting Plasma Glucose Test (FPG): Considered the most common test used for diagnosing diabetes by measuring blood glucose after fasting for at least 8 hours. It is most reliable when administered in the morning.
• Oral Glucose Tolerance Test (OGTT): A more sensitive test than the FPG test, but less convenient to have. It Measures blood glucose after at least 8 hours of fasting and 2 hours after drinking a liquid containing 75 grams of glucose dissolved in water.
• Random Blood Glucose test (RPG): A blood sample will be taken at any time to be analyzed which used sometimes to diagnose diabetes during a regular health checkup when the result is 200 mg/dl or above and the individual also have symptoms of diabetes.
• Glycated hemoglobin (A1C) Test: Even this test is not recommended for diagnosis of type 1 diabetes, it can be used after conformation to know the degree of diabetes control as it reflects the average of blood glucose levels along the past 2-3 months without showing daily fluctuations.

• The ketone test: A urine or blood test that measures the levels of ketones - a byproduct of fat metabolism. It may be done in cases like: Blood sugar exceeded 240 mg/dl, during pregnancy, during an illness such as pneumonia and cases with nausea or vomiting.

Noticing signs and symptoms of the disease should force the person to undergo diagnostic tests. It is worth mentioning that finger-stick devices are not accurate enough for diagnosis of diabetes, but may be used as a quick indicator of hyperglycemia.

The goal of diabetes treatment is to keep blood sugar within targeted levels and to work on delaying disease complications. The treatment is based on the following:

• Insulin therapy

Insulin is considered the first line of treatment in cases of type 1 diabetes. All people with this disease need to take that hormone every day. It persists in different types including:

Insulin is mainly given in the subcutaneous tissue - a fatty layer just beneath the skin. A Pre-Mixed type of insulin is available and helpful to reduce number of injections (Types explained in the next chart). People who use insulin are advised to change the site of injection every time they use it In order to protect the skin from the effects of multiple injections. Sites suitable for that include: the abdomen, back of the upper arms, upper buttocks and the outer side of thighs.

Insulin pump is a choice that can be used to give constant doses automatically and others given as bolus to cover food eaten in daily meals. This technique is considered better than injections as long as well-used. The most recent method – which is still under experiment – is what called "artificial pancreas", where insulin is given automatically in the correct amount based on the real need that manifested by continuous monitoring of blood sugar. Clinical trials show promising results, especially with less risk of hypoglycemia.

An oral drug called "Pramlintide" may be used with mealtime insulin for those whose blood sugar levels cannot be controlled with insulin alone. It slows the movement of food through gastrointestinal tract and prevent sharp increase in blood sugar level, but with a possibility to cause hypoglycemia that should call the attention.

• Blood sugar monitoring

The number of blood glucose level checkups is subject to the degree of disease control, type and frequency of insulin used and the person’s life style. There may be a need for checking blood glucose levels 4 times daily or even more based on the condition. Usual times for self-testing includes:

• Before eating.
• Before going to bed.
• With symptoms of hypoglycemia, like tremors and sweating.
• Before exercising or driving.

Continuous glucose monitoring (CGM) is considered the most recent way to track glucose levels. The machine attached to the body by a fine needle under the skin to checks blood glucose level every few minutes. This may be more helpful in preventing hypoglycemia and getting better control over diabetes.

• Follow-up care

People who have just been diagnosed with diabetes type 1 may need hospitalization as the disease can start suddenly and severely. Newly diagnosed people may need to have a doctor checkup each week until they have good blood sugar control. The doctor will review the results of home testing and compare it with diet, exercise and insulin injections.

It might take a few weeks to match the insulin doses to meal and activity schedules. Monitoring long-term diabetes complications through regular doctor visits is very important. The patient could also need to meet with a dietitian, clinical pharmacist, and diabetes nurse educator.

• Transplants

Pioneering ways to treat diabetes are ‎on probation and under development in order to reach good and trusty results. From these hopeful therapies:

• Pancreas transplant.
• Beta cells transplant.
• Stem cells transplant.

The main problem with these treatments are poor success rates as the body tends to reject these transplants that imposed to immune system attack and destruction. People who undergo these treatments require taking immunosuppressive drugs for a long period, which may put them under the risk of recurrent infections.

• Healthy Diet

Learning what to eat, how much to eat and when to eat can give the patient a good health and help managing his condition. Coordination between the physician, patient and registered dietitian can help to put together a meal plan that fits health goals, food preferences and lifestyle.

In general, people with diabetes are advised to

• Increase their intake of foods rich in fibers, like vegetables and fruits.
• Consume whole grains instead of refined forms.
• Limit consumption of meat, sugar and processed foods.

In addition to the usual dietary recommendations, people with type 1 diabetes are advised not to skip scheduled meal in order to prevent hypoglycemia. They have to know calculating the amount of carbohydrates in foods to take appropriate dose of insulin for metabolizing them.

• Physical activity

Regular exercising can improve general health for all people, including those with type 1 diabetes. This participates in controlling the disease and driving away its complications. It is recommended to consult the doctor before starting exercise regimen to know if there is a need to take special steps before, during, and after workout. The goal for children is at least 60 minutes of activity a day. This target can be achieved gradually.

Patient may need to check blood sugar before and after exercise. He/she also recommended to warm up before and cool down at the end. Drinking enough amount of water is integral for healthy functioning. There may be a need for adjusting meals or insulin doses to be correspondent with the increased activity concerning avoiding blood sugar dropping below normal levels.

Diabetes can cause damage in nerves and small, large blood vessels. These conditions develop over a period of time with poor Diabetes management. As most cases of Diabetes type 1 start in childhood, they have more chances to develop complications along their lives, also some complications may happen in short period with improper use of insulin and not adhering to treatment plan.

• Long-term complications
  • Diabetic retinopathy (eye disease): Considered the top cause of blindness and visual disability. It arises from small blood vessel damage in the retina that can be early detected through regular eye examinations.
  • Diabetic Nephropathy (kidney disease): It is the leading cause of dialysis and kidney transplant in developed countries. It happens when the functioning units of the kidney are destroyed by damaged blood vessels in that organ. Kidney function test and urine test for protein can help early detection.
  • Cardiovascular disease: Hyperglycemia works in narrowing arteries on the long-term through hastening a process called atherosclerosis. This could lead to life threatening conditions such as heart attack and stroke.
  • Diabetic Neuropathy (nerve disease): It is the most common complication of diabetes. It originates from nerve damage by hyperglycemia and decreased blood flow to the nerve cells. This can lead to loss of sensation, damage to the limbs and impotence among men.
  • Diabetic foot: Disrupted neural functions and poor circulation in the feet can increase the risk of ulceration, infection of them. People with diabetes face a 25 times greater risk of amputation than people without this disease.
  • Periodontal disease: Poor glucose control increases the risk of inflammation of the tissue surrounding the teeth. This condition called Periodontitis and considered a major cause of teeth loss, also associated with an increased risk of cardiovascular disease.
• Short-term complications
  • Hypoglycemia: People who treated for diabetes have the potential of their blood glucose to drop below normal levels (less than 70 mg/dl), particularly those who use insulin. This may take place for skipping a regular meal, having more insulin than usual or doing more physical activity than normal. It is considered a serious complication that may lead -if untreated- to comma or even death. It can be manifested by: tremor, sweating, headache and fatigue.
  • Diabetic Ketoacidosis (DKA): A life-threatening condition that mainly affects type 1 diabetes. It develops when body starves for glucose and starts using fat as energy source, which result in forming ketones that reach the blood stream and lead to chemical imbalances. It can be noticed by excessive thirst and urination, confusion, abdominal pain, vomiting and fruity breath odor. It can be confirmed by a self-testing through a ketone strip that will turn a deep purple if excess ketones are in the body.
  • Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS): A serious condition most frequently seen in older patients, especially with type 2 diabetes, but can affect those with type I of the disease and often preceded by an illness or infection. It is caused by sharp elevation in blood sugar that reaches 600 mg/dl and leads to excessive urination and dehydration. Mental status may be affected and consciousness may be lost if not treated rapidly.

Having diabetes type 1 looks to be inevitable, as there is no proven way to prevent this disease until now. However, researchers are working on serving the remnant insulin secreting cells in early detected people. Some researches suggest that many factors may help in lowering the risk of developing type one diabetes, such as breastfeeding and avoiding early introduction of solid foods. Having adequate vitamin D levels during young adulthood may lower the risk of adult-onset type 1 diabetes.

• Complication prevention: For those who already have type 1 diabetes, several ways are available and recommended to delay the development of its upsetting complications. These include:
  • Adhering to the planned treatment and commitment to a healthy life style as much as possible.
  • Undergoing scheduled tests, like yearly eye examination and (A1C) test every 3 months or as ordered by the doctor.
  • Getting the recommended immunization, like flu vaccine, as high blood sugar can weaken the immune system.
  • Doing Routine mouth care such as brushing twice a day and visiting the dentist every 6 months or when needed, to check and treat gum and teeth problems.
  • Looking after the feet by daily checkup and cleaning with lukewarm water, then drying gently before applying lotion except for between toes. Careful nail cut and suitable shoes are also recommended.
  • Controlling hypertension and dyslipidemia, which can be achieved through limiting sodium and unhealthy fat consumption, physical activity and taking prescribed medications.
  • Quitting smoking and limiting alcohol drinking as they participate - separately or in combination - in the progression of life-threatening diabetes complications, such as heart attack.

There's no cure for diabetes. Having type 1 diabetes needs careful look after in order to control symptoms and delaying serious health problems later in life. In a study at University of Dundee, Scotland, people with type 1 diabetes lose about 11 years of life expectancy for men and 13 years for women, compared to those without the disease.

Diabetes type 1 management requires a lot of time and effort, especially in the beginning. Concern about health and adherence to care plan will make controlling diabetes easier and minimize the risk of developing complications. This may increase life expectancy and quality. Many ways of favorable treatment are under processing. The coming years may carry pleasant news for diabetes patient.

Diabetes is considered by International diabetes federation (IDF) as one of the largest global health emergencies of 21th century. World Health Organization (WHO) estimates that globally, high blood glucose is the third highest risk factor for premature mortality. In almost all high-income countries, diabetes is a leading cause of cardiovascular disease, blindness, kidney failure and lower-limb amputation.

Type 1 diabetes is less common than type 2 and is increasing by nearly three percent each year, particularly among children. In high-income countries, a few studies have estimated that approximately 7% to 12% of all people with diabetes are guessed to have type 1 diabetes.

Globally, it is estimated that 542,000 children under 15 have type 1 diabetes and nearly 86,000 new cases develop each year among this age group. When insulin is not in hand as in some areas, the lives of affected children are at risk. There are strong landmarks of differences in trends between geographical areas, as the sharp increase of cases among some countries in Central and Eastern Europe. The disease is also more prevalent among white people.