Type 1 Diabetes: What Happens

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What Happens

Type 1 diabetes develops because the body destroys the beta cells in the islet tissue of the pancreas that produce insulin. The rate at which the beta cells are destroyed varies. Infants and children usually develop the disease suddenly because the beta cells are destroyed rapidly. Adults tend to develop the disease slowly because the beta cells are destroyed gradually.

Sometimes people notice diabetes symptoms after an illness, such as the flu. If they do not seek medical care quickly, the lack of insulin can cause the blood sugar level to rise much higher than normal. The body then uses fat and muscle for energy, which causes the release of ketones, or fatty acids. Ketones can lead to a chemical imbalance called diabetic ketoacidosis. It is a medical emergency. Symptoms of diabetic ketoacidosis include confusion; strong, fruity breath; and drowsiness, or even coma.

Sometimes after receiving initial treatment for type 1 diabetes, people have a period of time—from a few weeks to a few months—when the pancreas is again able to produce insulin. This is often called the "honeymoon period." At this time, a person may need to take little or no insulin, depending on how much insulin the pancreas produces. When the honeymoon period is over, the person needs to take insulin for the rest of his or her life.

Every person who has type 1 diabetes requires treatment designed for his or her needs. Treatment involves:

• Taking insulin.
• Eating a healthful diet that spreads carbohydrate throughout the day.
• Getting regular exercise.
• Monitoring blood sugar levels (using a home blood sugar meter).

People with type 1 diabetes often have blood sugar levels outside of their target range. These out-of-range levels happen because injections of insulin cannot control blood sugar as smoothly as natural insulin made by your body. Blood sugar below a normal range (hypoglycemia) can develop quickly and lead to an emergency in only a few minutes. On the other hand, high blood sugar levels (hyperglycemia) usually develop slowly over hours or days. If blood sugar levels continue to rise, diabetic ketoacidosis can develop.

Over time, diabetes can damage the body's tissues. Persistent high blood sugar can damage the eyes (diabetic retinopathy), kidneys (diabetic nephropathy), nerves (diabetic neuropathy), and heart (leading to heart attacks). It also can damage blood vessels, leading to strokes and blockage of other arteries, especially in the legs. People who keep their blood sugar levels as close to normal as possible often can prevent—or at least delay—these complications. But some people still develop complications even with good blood sugar control.

People who work closely with their doctors and follow their prescribed treatment usually feel better and more in control of their lives.

Planning pregnancy when you have type 1 diabetes

Women who want to plan a pregnancy need to talk to their doctors about making sure they have good control of their blood sugar. Higher-than-normal blood sugar levels during the first trimester of pregnancy raise the risk of birth defects. Good preconception care of diabetes appears to reduce the risk of birth defects.

Women with diabetes who do not want to be become pregnant should use birth control. This reduces the risk of birth defects in unplanned pregnancies.

Last updated:	September 17, 2008
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC