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The way to deal with the devil of obesity and diabetes is literally one day at a time

Stephen Furst

Diabetes mellitus, commonly known as diabetes, is a group of metabolic disorders accompanied by excessive sugar in the blood. This chronic disease can lead to vascular problems if not controlled over a prolonged period. 

Type 1 Diabetics mellitus
Type 1 Diabetics mellitus

1. Types of Diabetes

The common types of diabetes are:

  • Type 1 diabetes (DM1 or DMT1)
  • Type 2 diabetes (DM2 or DMT2)
  • Gestational Diabetes

The two main types of diabetes, I,e type 1 diabetes (DM1 or DMT1) and type 2 diabetes (DM2 or DMT2), differ in initial symptoms, therapy, and the ability to prevent. 

A. Type 1 diabetes

Insulin is a hormone that regulates the amount of glucose in the body, and it helps the cells to absorb the sugar present in the blood, where it is used as an energy source. The pancreas cells are responsible for producing and releasing insulin into the bloodstream. 

The immune system of affected people with Type 1 Diabetes Mellitus attacks and destroys the beta cells of the pancreas, mistakenly recognizing them as foreign, which leads to a deficiency of insulin.

Insulin deficiency leads to excess sugars in the blood, causing more or less fundamental problems depending on the stage of the disease and its severity. 

Type 1 Diabetes Mellitus is an autoimmune disease. Type 1 diabetes mellitus is known as “childhood diabetes” or “juvenile diabetes” because it occurs mainly in children and adolescents.

This name is no longer in use because, although it primarily affects people under 30, type 1 diabetes can also affect adults and the elderly.

B. Type 2 Diabetics

Patients with type 1 diabetes mellitus represent approximately 5-10% of the total number of diabetics. Most diabetics are affected by type 2 diabetes mellitus. Unlike Type 1 diabetics, people with type 2 diabetes generally occur with advancing age. 

The leading causes of Type 2 diabetics are

  1. Reduced insulin production
  2. The inability of the body to recognize and respond to its Insulin correctly (insulin resistance). 
  3. hereditary factors 
  4. Assumption of incorrect lifestyles.

C. Gestational Diabetes

Another widespread form of diabetes is gestational diabetes, which occurs during pregnancy and is transient.

2. Who Is Affected by Type 1 Diabetes?

The prevalence of type 1 diabetes mellitus is approximately 0.5%. It affects about 1 in 200 people, equally males and females. It generally begins in young people under the age of 30 (for which it is also commonly called Juvenile Diabetes).

It is one of the most common chronic childhood diseases. It most often affects children around the age of 5 or 12, but it can also occur in infants, adolescents, and adults. Overall, in the USA, people with type 1 diabetes are about 300 thousand (about 0.5% of the Italian population).

The Sardinia region is the second area globally, immediately after Finland, with the highest incidence of this pathology. Worldwide, the presence of DMT1 is on the rise. It is sometimes associated with other autoimmune diseases such as:

  • Graves-Basedow’s disease, 
  • Autoimmune thyroiditis such as Hashimoto’s thyroiditis
  • Myasthenia gravis, 
  • Vitiligo
  • Celiac disease.

3. Causes of Type 1 Diabetes

Type 1 diabetes is a so-called multifactorial disease: several factors, both hereditary and environmental, contribute to the dysregulation of the immune response, which leads to reduced production of Insulin. In most cases, they are not preventable. The risk factors for developing type 1 diabetes mellitus are:

  • Genetic predisposition: It is possible to inherit DMT1 from a parent. In 5-10% of cases, the siblings share the pathology; the percentage rises to 50% in monozygotic twins.
  • Vitamin D deficiency:  Low levels of Vitamin D in pregnancy and early life could disrupt part of the immune system and facilitate the onset of the disease. For this reason, pregnant women are advised to take foods rich in vitamin D, such as fish, liver, and mushrooms. It is the only preventable risk factor for DB1.
  • Pathogens: cytomegalovirus, coxsackie B viruses, Epstein-Barr virus, mumps, and encephalomyocarditis viruses produce molecules similar to Insulin. The similarity of these substances to Insulin, causes the immune cells to become confused. Our immune system recognizes them as an outsider and then attacks them, leading to the condition of autoimmune diabetes;
  • Geographical location: the incidence of the disease increases the further one is from the equator.

4. Symptoms and complications of type 1 diabetes

Symptoms of Diabetes vary depending upon the level of blood sugar. In type 1 diabetes, symptoms tend to arise more quickly and severely than in type 2 diabetes. Symptoms related to diabetes 1 manifest themselves with:

  • tiredness
  • aumento della sete (polydipsia)
  • increased urine output (polyuria)
  • unwanted weight loss despite hyperphagia (increased appetite)
  • malaise
  • abdominal pain

In the most severe cases, mental confusion and loss of consciousness may also occur. The significant complications deriving from diabetes can cause the patient even considerable damage to the neurological, renal, ocular, and cardio-cerebrovascular levels.

5. Diagnosis and Prognosis of Type 1 Diabetes

People at risk of developing type 1 diabetes should be screened regularly, especially for family members having diabetes. 

For diagnostics purposes, doctors look for antibodies against the beta cells of the pancreas. The antibodies in beta cells predict the appearance of DMT1.

The diagnosis is made after a medical examination and subsequent investigations examinations. The doctor first of all inquiries about the signs, familiarity, and other risk factors of type 1 diabetes.

He then investigates the presence of symptoms and prescribes diagnostic tests to confirm or exclude the diagnosis of DMT1. The tests are:

  • Control of blood glucose (the glucose level in the blood): This can be done with a Reflectometer. It is an instrument that makes a small hole in a fingertip to take a drop of blood for analysis. The blood glucose value that suggests the presence of type 1 diabetes is above 200 mg/dl. In case of doubt, fasting blood glucose is measured, which indicates the presence of DMT1 if it is greater than 126 mg/dl;
  • Blood tests:  They help find antibodies specific to pancreatic beta cells to confirm the presence of DMT1. They also make it possible to identify the C peptide, a molecule that makes up Insulin: in this way, it is likely to evaluate the presence of Insulin in the blood;
  • Urine tests: Urine tests are used to discover and measure the presence of sugars and ketones in the urine. It indicates the severity of the disease at the time of the examination.
  • There is also a glycemic stick placed in the mouth, but it is not as reliable as the other methods.

We cannot cure type 1 diabetics, but keeping it under control is possible. Life expectancy for people with type 1 diabetes is about ten years shorter than for other people, and this is because the disease exposes you to cardiovascular problems.

People with diabetes have a five times greater risk of suffering from heart disease than non-diabetic people. However, following a correct lifestyle and the prescribed therapy makes it possible to lead an utterly everyday life.  

6. Type 1 Diabetes Mellitus Screening

People diagnosed with type 1 diabetes mellitus must follow a series of monitoring practices to prevent complications. In addition to checking their blood sugar daily and using the appropriate tools, they must manage oral hygiene.

Frequent monitoring of cholesterol and blood pressure is also recommended. Those who have had DT1 for over ten years should also have their feet thoroughly examined every day for injuries.

Patients with T1DM also need to undergo periodic check-ups to prevent complications from developing.

  • Foot examination: The doctor examines the integrity of the skin and the sensitivity of the feet. For this examination, he uses a monofilament esthesiometer, a plastic tube from which a nylon thread comes out and retracts when pressed against a surface;
  • Fundus examination: This test is performed by an ophthalmologist with a frequency that depends on the integrity of the eye: when this is healthy, screening must be carried out every two years; with the onset of problems, controls increase;
  • Urinalysis: Performed annually, it allows for to evaluate of renal function thanks to the detection of specific molecules;
  • Regular checkups at the dentist are also recommended because diabetes increases the risk of gum infections;
  • The Italian Celiac Association (AIC) recommends periodic checks (about 1-2 times a year) for the presence of celiac disease in all people affected by type 1 diabetes. Celiac disease is present in about 5-15 % of diabetics, although often asymptomatic.

7. Type 1 Diabetes Therapy Treatment and Cure

The therapy consists of 

  • The administration of drugs (different types of Insulin each with an additional onset time and duration of action) 
  • The education on self-management in the taking of drugs 
  • The need to follow a food plan
  • Lifestyle is an essential factor in the treatment of diabetes and the prevention of its complications.  

DMT1 is also commonly referred to as insulin-dependent diabetes. Patients with type 1 diabetes mellitus require an external supply of Insulin (exogenous Insulin) compared to that produced by the body (endogenous).

This insulin supplement can be delivered by injection under the skin (using a pen-like device with cartridges) or by a pump (a small device that, through a tube placed under the skin, releases a few units of Insulin throughout the day).

The amount of insulin doses to be administered is measured by daily blood sugar levels (glycemia). People with type 1 diabetes mellitus should learn to self-monitor and log blood glucose levels via personal devices such as:

  • Reflectometers: It is small instruments that state the blood sugar value from a drop of blood extracted from a fingertip with a small needle;
  • Continuous monitoring: A small sensor with a needle is placed under the skin. It reads your blood sugar automatically every few minutes. 

8. Medical Nutrition Therapy

It is a therapy where blood pressure is controlled using a balanced diet. Eat a balanced diet with moderate carbohydrate content, low cholesterol, and saturated fatty acids is essential.

In this way, it is possible to reduce the possibility of complications. These diets allow for maintaining good glucose, lipids, and blood pressure levels. 

For an appropriate personalized diet, it is necessary to consider several factors such as age, weight, height, lifestyle conducted by the individual, and all the other elements that can influence the energy demands of the patient’s organism. In general, the indications for proper nutrition in case of type 1 diabetes are the following:

  • Avoid sucrose. Or it is to be replaced with sweeteners;
  • Rather than simple sugars such as those contained in sweets, I prefer complex carbohydrates derived from fruit, vegetables, wheat, legumes, and skimmed milk. The dose should not exceed 130 grams of carbohydrates per day;
  • Consume less than 7% fat compared to daily calories;
  • Get a lot of fibre;

Foods that are often credited with healing properties, such as ginger and turmeric, help fight DMT1 and other diseases through their antioxidant abilities. These can also play an essential role as a substitute for flavours that contain animal fats. 

9. Frequently Asked Questions (FAQ)

1. When does type 1 diabetes occur?

This pathology mainly affects young people. It most often occurs in children around the age of 5 or 12, but it can also occur in infants, adolescents, and adults.

2. How is type 1 diabetes recognized, and how is the diagnosis made?

Symptoms of Diabetes include increased need to urinate, even at night; intense thirst; increased hunger; feeling tired; slimming. Diagnosis requires a doctor’s consultation and tests such as blood glucose checks, blood tests, and urine tests.

3. Is diabetes mellitus type 1 or 2?

The two main types of diabetics, I,e type 1 diabetes (DM1 or DMT1) and type 2 diabetes (DM2 or DMT2), differ in initial symptoms, therapy, and the ability to prevent. Type 1 prevalence rate is 0.5% and mainly occurs in people below 30, and type 2 prevalence rate is 98%.

10. References

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