Type 1 diabetes

Insulin-dependent diabetes; 1uvenile onset diabetes; Diabetes - type 1

Last reviewed: June 28, 2011.
Type 1 diabetes is a liIelong (chronic) disease in which there are high levels oI sugar (glucose) in the blood.
See also:
O Diabetes
O Gestational diabetes
O Type 2 diabetes
auses, incidence, and risk factors
Type 1 diabetes can occur at any age. However, it is most oIten diagnosed in children, adolescents, or young
adults.
Insulin is a hormone produced by special cells, called beta cells, in the pancreas. The pancreas is Iound behind
your stomach. Insulin is needed to move blood sugar (glucose) into cells, where it is stored and later used Ior
energy. In type 1 diabetes, beta cells produce little or no insulin.
Without enough insulin, glucose builds up in the bloodstream instead oI going into the cells. The body is unable
to use this glucose Ior energy. This leads to the symptoms oI type 1 diabetes.
The exact cause oI type 1 diabetes is unknown. Most likely it is an autoimmune disorder. An inIection or some
other trigger causes the body to mistakenly attack the cells in the pancreas that make insulin. This kind oI
disorder can be passed down through Iamilies.
Symptoms
These symptoms may be the Iirst signs oI type 1 diabetes, or may occur when the blood sugar is high:
O Being very thirsty
O Feeling hungry
O Feeling tired or Iatigued
O Having blurry eyesight
O Losing the Ieeling or Ieeling tingling in your Ieet
O Losing weight without trying
O Urinating more oIten
For other people, these warning symptoms may be the Iirst signs oI type 1 diabetes, or they may happen when
the blood sugar is very high (see: diabetic ketoacidosis):
O Deep, rapid breathing
O Dry skin and mouth
O Flushed Iace
O Fruity breath odor
O Nausea or vomiting, inability to keep down Iluids
O Stomach pain
Low blood sugar (hypoglycemia) can develop quickly in people with diabetes who are taking insulin. Symptoms
usually appear when the blood sugar level Ialls below 70 mg/dL. Watch Ior:
O Headache
O Hunger
O Nervousness
O Rapid heartbeat (palpitations)
O Shaking
O Sweating
O Weakness
Signs and tests
Diabetes is diagnosed with the Iollowing blood tests:
O Fasting blood glucose level -- diabetes is diagnosed iI it is higher than 126 mg/dL two times
O Random (nonIasting) blood glucose level -- you may have diabetes iI it is higher than 200 mg/dL,
and you have symptoms such as increased thirst, urination, and Iatigue (this must be conIirmed with
a Iasting test)
O Oral glucose tolerance test -- diabetes is diagnosed iI the glucose level is higher than 200 mg/dL aIter
2 hours
O Hemoglobin A1c test
O Normal: Less than 5.7
O Pre-diabetes: Between 5.7 and 6.4
O Diabetes: 6.5 or higher
Ketone testing is also sometimes used. The ketone test is done using a urine sample or blood sample. Ketone
testing may be done:
O When the blood sugar is higher than 240 mg/dL
O During an illness such as pneumonia, heart attack, or stroke
O When nausea or vomiting occur
O During pregnancy
The Iollowing tests or exams will help you and your doctor monitor your diabetes and prevent problems caused
by diabetes:
O Check the skin and bones on your Ieet and legs.
O Check to see iI your Ieet are getting numb.
O Have your blood pressure checked at least every year (blood pressure goal should be 130/80 mm/Hg
or lower).
O Have your hemoglobin A1c test (HbA1c) done every 6 months iI your diabetes is well controlled;
otherwise, every 3 months.
O Have your cholesterol and triglyceride levels checked yearly (aim Ior LDL cholesterol levels below
70-100 mg/dL).
O Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum
creatinine).
O Visit your eye doctor at least once a year, or more oIten iI you have signs oI diabetic eye disease.
O See the dentist every 6 months Ior a thorough dental cleaning and exam. Make sure your dentist and
hygienist know that you have diabetes.
Treatment
Because type 1 diabetes can start quickly and the symptoms can be severe, people who have just been diagnosed
may need to stay in the hospital.
II you have just been diagnosed with type 1 diabetes, you should probably have a check-up each week until you
have good control over your blood sugar. Your health care provider will review the results oI your home blood
sugar monitoring and urine testing. Your provider will also look at your diary oI meals, snacks, and insulin
injections.
As the disease gets more stable, you will have Iewer Iollow-up visits. Visiting your health care provider is very
important so you can monitor any long-term problems Irom diabetes.
You are the most important person in managing your diabetes. You should know the basic steps to diabetes
management:
O How to recognize and treat low blood sugar (hypoglycemia)
O How to recognize and treat high blood sugar (hyperglycemia)
O Diabetes meal planning
O How to give insulin
O How to check blood glucose and urine ketones
O How to adjust insulin and Iood when you exercise
O How to handle sick days
O Where to buy diabetes supplies and how to store them
INSULIN
Insulin lowers blood sugar by allowing it to leave the bloodstream and enter cells. Everyone with type 1 diabetes
must take insulin every day.
Insulin is usually injected under the skin. In some cases, a pump delivers the insulin all the time. Insulin does
not come in pill Iorm.
Insulin types diIIer in how Iast they start to work and how long they last. The health care provider will choose
the best type oI insulin Ior you and will tell you at what time oI day to use it. More than one type oI insulin may
be mixed together in an injection to get the best blood glucose control. You may need insulin shots Irom one to
Iour times a day.
Your health care provider or diabetes nurse educator will teach you how to give insulin injections. At Iirst, a
child's injections may be given by a parent or other adult. By age 14, most children can give their own
injections.
People with diabetes need to know how to adjust the amount oI insulin they are taking:
O When they exercise
O When they are sick
O When they will be eating more or less Iood and calories
O When they are traveling
DIET AND EXERCISE
People with type 1 diabetes should eat at about the same times each day and try to eat the same kinds oI Ioods.
This helps to prevent blood sugar Irom becoming too high or low. See also:
O Diabetes diet
O Snacking when you have diabetes
The American Diabetes Association and the American Dietetic Association have inIormation Ior planning
healthy, balanced meals. It can help to talk with a registered dietitian or nutrition counselor.
Regular exercise helps control the amount oI sugar in the blood. It also helps burn extra calories and Iat to reach
a healthy weight.
Ask your health care provider beIore starting any exercise program. People with type 1 diabetes must take
special steps beIore, during, and aIter intense physical activity or exercise. See also: Diabetes and exercise
MANAGING YOUR BLOOD SUGAR
Checking your blood sugar levels at home and writing down the results will tell you how well you are managing
your diabetes. Talk to your doctor and diabetes educator about how oIten to check.
A device called a glucometer can read blood sugar levels. There are diIIerent types oI devices. Usually, you
prick your Iinger with a small needle called a lancet to get a tiny drop oI blood. You place the blood on a test
strip and put the strip into the device. You should have results in 30 - 45 seconds.
Keep a record oI your blood sugar Ior yourselI and your doctor or nurse. This will help iI you have problems
managing your diabetes. You and your doctor should set a target goal Ior your blood sugar levels at diIIerent
times during the day. You should also plan what to do when your blood sugar is too low or high.
For more inIormation, see: Managing your blood sugar
Low blood sugar is called hypoglycemia. Blood sugar levels below 70 mg/dL are too low and can harm you.
FOOT CARE
Diabetes damages the blood vessels and nerves. This can make you less able to Ieel pressure on the Ioot. You
may not notice a Ioot injury until you get a severe inIection.
Diabetes can also damage blood vessels. Small sores or breaks in the skin may become deeper skin sores
(ulcers). The aIIected limb may need to be amputated iI these skin ulcers do not heal or become larger or deeper.
To prevent problems with your Ieet:
O Stop smoking iI you smoke.
O Improve control oI your blood sugar.
O Get a Ioot exam by your health care provider at least twice a year and learn whether you have nerve
damage.
O Check and care Ior your Ieet EVERY DAY, especially iI you already have known nerve or blood
vessel damage or current Ioot problems.
O Make sure you are wearing the right kind oI shoes.
PREVENTING COMPLICATIONS
Your doctor may prescribe medications or other treatments to reduce your chances oI developing eye disease,
kidney disease, and other conditions that are more common in people with diabetes.
See also:
O Diabetes -- preventing heart attack and stroke
O Long-term complications oI diabetes
Support Groups
For more inIormation and resources, see diabetes support group.
Expectations (prognosis)
Diabetes is a liIelong disease and there is not yet a cure. However, the outcome Ior people with diabetes varies.
Studies show that tight control oI blood glucose can prevent or delay problems with the eyes, kidneys, nervous
system, and heart in type 1 diabetes. However, problems may occur even in people with good diabetes control.
omplications
II you have diabetes, your risk oI a heart attack is the same as someone who has already had a heart attack. Both
women and men with diabetes are at risk. You may not even have the normal signs oI a heart attack.
AIter many years, diabetes can lead to other serious problems:
O You could have eye problems, including trouble seeing (especially at night) and sensitivity to light.
You could become blind.
O Your Ieet and skin could develop sores and inIections. II you have these sores Ior too long, your Ioot
or leg may need to be removed. InIection can also cause pain and itching.
O Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to heart
attack, stroke, and other problems. It can become harder Ior blood to Ilow to the legs and Ieet.
O Nerves in the body can become damaged, causing pain, tingling, and loss oI Ieeling.
O Because oI nerve damage, you could have problems digesting the Iood you eat. You could Ieel
weakness or have trouble going to the bathroom. Nerve damage can also make it harder Ior men to
have an erection.
O High blood sugar and other problems can lead to kidney damage. The kidneys might not work as
wellas they used to. They may even stop working.
See also: Diabetic ketoacidosis
alling your health care provider
Call 911 iI you have:
O Chest pain or pressure, shortness oI breath, or other signs oI angina
O Loss oI consciousness
O Seizures
Call your health care provider or go to the emergency room iI you have symptoms oI diabetic ketoacidosis.
Also call your doctor iI you have:
O Blood sugar levels that are higher than the goals you and your doctor have set
O Numbness, tingling, or pain in your Ieet or legs
O Problems with your eyesight
O Sores or inIections on your Ieet
O Symptoms that your blood sugar is getting too low (Ieeling weak or tired, trembling, sweating,
Ieeling irritable, having trouble thinking clearly, Iast heartbeat, double or blurry vision, Ieeling
uneasy)
O Symptoms that your blood sugar is too high (being very thirsty, having blurry vision, having dry
skin, Ieeling weak or tired, needing to urinate a lot)
O You are having blood sugar readings below 70 mg/dL
You can treat early signs oI hypoglycemia at home by eating sugar or candy, or by taking glucose tablets. II
your signs oI hypoglycemia continue or your blood glucose levels stay below 60 mg/dL, go to the emergency
room.
!revention
There is no way to prevent type 1 diabetes. There is no screening test Ior type 1 diabetes in people who have no
symptoms.
Stay up-to-date with all oI your vaccinations and get a Ilu shot every year in the Iall.

Type 2 diabetes
Noninsulin-dependent diabetes; Diabetes - type 2; Adult-onset diabetes
Last reviewed: June 28, 2011.
Type 2 diabetes is a liIelong (chronic) disease in which there are high levels oI sugar (glucose) in the blood.
Type 2 diabetes is the most common Iorm oI diabetes.
See also:
O Diabetes
O Gestational diabetes
O Type 1 diabetes
O Metabolic syndrome
auses, incidence, and risk factors
Diabetes is caused by a problem in the way your body makes or uses insulin. Insulin is needed to move blood
sugar (glucose) into cells, where it is stored and later used Ior energy.
When you have type 2 diabetes, your Iat, liver, and muscle cells do not respond correctly to insulin. This is
called insulin resistance. As a result, blood sugar does not get into these cells to be stored Ior energy.
When sugar cannot enter cells, high levels oI sugar build up in the blood. This is called hyperglycemia.
Type 2 diabetes usually occurs slowly over time. Most people with the disease are overweight when they are
diagnosed. Increased Iat makes it harder Ior your body to use insulin the correct way.
Type 2 diabetes can also develop in people who are thin. This is more common in the elderly.
Family history and genes play a large role in type 2 diabetes. Low activity level, poor diet, and excess body
weight around the waist increase your risk. See also: Type 2 diabetes Ior a list oI risk Iactors.
Symptoms
OIten, people with type 2 diabetes have no symptoms at Iirst. They may not have symptoms Ior many years.
The early symptoms oI diabetes may include:
O Bladder, kidney, skin, or other inIections that are more Irequent or heal slowly
O Fatigue
O Hunger
O Increased thirst
O Increased urination
The Iirst symptom may also be:
O Blurred vision
O Erectile dysIunction
O Pain or numbness in the Ieet or hands
Signs and tests
Your health care provider may suspect that you have diabetes iI your blood sugar level is higher than 200
mg/dL. To conIirm the diagnosis, one or more oI the Iollowing tests must be done.
Diabetes blood tests:
O Fasting blood glucose level -- diabetes is diagnosed iI it is higher than 126 mg/dL two times
O Hemoglobin A1c test --
O Normal: Less than 5.7
O Pre-diabetes: 5.7 - 6.4
O Diabetes: 6.5 or higher
O Oral glucose tolerance test -- diabetes is diagnosed iI glucose level is higher than 200 mg/dL aIter 2
hours
Diabetes screening is recommended Ior:
O Overweight children who have other risk Iactors Ior diabetes, starting at age 10 and repeated every 2
years
O Overweight adults (BMI greater than 25) who have other risk Iactors
O Adults over age 45 every 3 years
You should see your health care provider every 3 months. At these visits, you can expect your health care
provider to:
O Check your blood pressure
O Check the skin and bones on your Ieet and legs
O Check to see iI your Ieet are becoming numb
O Examine the back part oI the eye with a special lighted instrument called an ophthalmoscope
The Iollowing tests will help you and your doctor monitor your diabetes and prevent problems:
O Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg
or lower).
O Have your hemoglobin A1c test (HbA1c) every 6 months iI your diabetes is well controlled;
otherwise every 3 months.
O Have your cholesterol and triglyceride levels checked yearly (aim Ior LDL levels below 70-100
mg/dL).
O Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum
creatinine).
O Visit your eye doctor at least once a year, or more oIten iI you have signs oI diabetic eye disease.
O See the dentist every 6 months Ior a thorough dental cleaning and exam. Make sure your dentist and
hygienist know that you have diabetes.
Treatment
The goal oI treatment at Iirst is to lower high blood glucose levels. The long-term goals oI treatment are to
prevent problems Irom diabetes.
The main treatment Ior type 2 diabetes is exercise and diet.
LEARN THESE SKILLS
You should learn basic diabetes management skills. They will help prevent problems and the need Ior medical
care. These skills include:
O How to test and record your blood glucose (See: Blood glucose monitoring)
O What to eat and when
O How to take medications, iI needed
O How to recognize and treat low and high blood sugar
O How to handle sick days
O Where to buy diabetes supplies and how to store them
It may take several months to learn the basic skills. Always keep learning about diabetes, its complications, and
how to control and live with the disease. Stay up-to-date on new research and treatments.
MANAGING YOUR BLOOD SUGAR
SelI testing means that you check your blood sugar at home yourselI. Checking your blood sugar levels at home
and writing down the results will tell you how well you are managing your diabetes.
A device called a glucometer can give you an exact blood sugar reading. There are diIIerent types oI devices.
Usually, you prick your Iinger with a small needle called a lancet. This gives you a tiny drop oI blood. You
place the blood on a test strip and put the strip into the device. Results are given in 30 - 45 seconds.
A health care provider or diabetes educator will help set up an at-home testing schedule Ior you. Your doctor
will help you set your blood sugar goals.
O Most people with type 2 diabetes only need to check their blood sugar once or twice a day.
O II your blood sugar levels are under control, you may only need to check them a Iew times a week.
O You may test yourselI when you wake up, beIore meals, and at bedtime.
O You may need to test more oIten when you are sick or under stress.
The results oI the test can be used to change your meals, activity, or medications to keep your blood sugar levels
in the right range. Testing can identiIy high and low blood sugar levels beIore you have serious problems.
Keep a record oI your blood sugar Ior yourselI and your health care provider. This will help iI you are having
trouble managing your diabetes.
DIET AND WEIGHT CONTROL
Work closely with your doctor, nurse, and dietitian to learn how much Iat, protein, and carbohydrates you need
in your diet. Your meal plans should Iit your daily liIestyle and habits, and should try to include Ioods that you
like.
Managing your weight and eating a well-balanced diet are important. Some people with type 2 diabetes can stop
taking medications aIter losing weight (although they still have diabetes).
See also:
O Diabetes diet
O Snacking when you have diabetes
Very overweight patients whose diabetes is not well managed with diet and medicine may consider bariatric
(weight loss) surgery.
See:
O Gastric bypass surgery
O Laparoscopic gastric banding
REGULAR PHYSICAL ACTIVITY
Regular exercise is important Ior everyone. It is even more important you have diabetes. Exercise in which your
heart beats Iaster and you breathe Iaster helps lower your blood sugar level without medication. It also burns
extra calories and Iat so you can manage your weight.
Exercise can help your health by improving blood Ilow and blood pressure. Exercise also increases the body's
energy level, lowers tension, and improves your ability to handle stress.
Ask your health care provider beIore starting any exercise program. People with type 2 diabetes must take
special steps beIore, during, and aIter intense physical activity or exercise. See also: Diabetes and exercise
MEDICATIONS TO TREAT DIABETES
II diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may
prescribe medication. Since these drugs help lower your blood sugar levels in diIIerent ways, your doctor may
have you take more than one drug.
Some oI the most common types oI medication are listed below. They are taken by mouth or injection.
O Alpha-glucosidase inhibitors (such as acarbose)
O Biguanides (MetIormin)
O Injectable medicines (including exenatide, mitiglinide, pramlintide, sitagliptin, and saxagliptin)
O Meglitinides (including repaglinide and nateglinide)
O SulIonylureas (like glimepiride, glyburide, and tolazamide)
O Thiazolidinediones (such as rosiglitazone and pioglitazone). (Rosiglitazone may increase the risk oI
heart problems. Talk to your doctor.)
These drugs may be given with insulin, or insulin may be used alone. You may need insulin iI you continue to
have poor blood glucose control. It must be injected under the skin using a syringe or insulin pen device. It
cannot be taken by mouth. See also: Type 1 diabetes
It is not known whether hyperglycemia medications taken by mouth are saIe Ior use in pregnancy. Women who
have type 2 diabetes and become pregnant may be switched to insulin during their pregnancy and while breast-
Ieeding.
PREVENTING COMPLICATIONS
Your doctor may prescribe medications or other treatments to reduce your chances oI developing eye disease,
kidney disease, and other conditions that are more common in people with diabetes.
See also:
O Diabetes -- preventing heart attack and stroke
O Long-term complications oI diabetes
FOOT CARE
People with diabetes are more likely to have Ioot problems. Diabetes can damage nerves, which means you may
not Ieel an injury to the Ioot until you get a large sore or inIection. Diabetes can also damage blood vessels.
Diabetes also decreases the body's ability to Iight inIection. Small inIections can quickly get worse and cause
the death oI skin and other tissues.
To prevent injury to your Ieet, check and care Ior your Ieet every day. See also: Diabetes Ioot care
Support Groups
For more inIormation, see diabetes resources.
Expectations (prognosis)
AIter many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, heart, blood vessels, or
other areas in your body.
II you have diabetes, your risk oI a heart attack is the same as that oI someone who has already had a heart
attack. Both women and men with diabetes are at risk. You may not even have the normal signs oI a heart
attack.
II you control your blood sugar and blood pressure, you can reduce your risk oI death, stroke, heart Iailure, and
other diabetes problems.
Some people with type 2 diabetes no longer need medicine iI they lose weight and become more active. When
they reach their ideal weight, their body's own insulin and a healthy diet can control their blood sugar levels.
omplications
AIter many years, diabetes can lead to serious problems:
O You could have eye problems, including trouble seeing (especially at night), and light sensitivity.
You could become blind.
O Your Ieet and skin can develop sores and inIections. AIter a long time, your Ioot or leg may need to
be removed. InIection can also cause pain and itching in other parts oI the body.
O Diabetes may make it harder to control your blood pressure and cholesterol. This can lead to a heart
attack, storke, and other problems. It can become harder Ior blood to Ilow to your legs and Ieet.
O Nerves in your body can get damaged, causing pain, tingling, and a loss oI Ieeling.
O Because oI nerve damage, you could have problems digesting the Iood you eat. You could Ieel
weakness or have trouble going to the bathroom. Nerve damage can make it harder Ior men to have
an erection.
O High blood sugar and other problems can lead to kidney damage. Your kidneys may not work as
well, and they may even stop working.
InIections oI the skin, Iemale genital tract, and urinary tract are also more common.
To prevent problems Irom diabetes, visit your health care provider or diabetes educator at least Iour times a
year. Talk about any problems you are having.
alling your health care provider
Call 911 right away iI you have:
O Chest pain or pressure
O Fainting or unconsciousness
O Seizure
O Shortness oI breath
These symptoms can quickly get worse and become emergency conditions (such as convulsions or
hypoglycemic coma).
Call your doctor iI you have:
O Numbness, tingling, or pain in your Ieet or legs
O Problems with your eyesight
O Sores or inIections on your Ieet
O Symptoms oI high blood sugar (being very thirsty, having blurry vision, having dry skin, Ieeling
weak or tired, needing to urinate a lot)
O Symptoms oI low blood sugar (Ieeling weak or tired, trembling, sweating, Ieeling irritable, having
trouble thinking clearly, Iast heartbeat, double or blurry vision, Ieeling uneasy)
!revention
You can help prevent type 2 diabetes by keeping a healthy body weight and an active liIestyle.
Stay up-to-date with all your vaccinations and get a Ilu shot every year.