In the United States, an estimated 0. This makes up around 5 percent of people with diabetes. While no full cure for this type is available, the range of management options means that a person with the disorder can lead a full and active life. In this article, we explore what causes type 1 diabetes, how to manage it, and ways to recognize the symptoms. Diabetes occurs when the glucose, or sugar, in the blood is poorly controlled and consistently high.
Type 1 occurs when the body does not produce enough of the hormone that allows cells to absorb and use glucose. This hormone is called insulin. While a person can prevent type 2 by avoiding a sugar-rich diet and inactive lifestyle, preventing type 1 is not possible. The immune system attacks clusters of cells in the pancreas that would normally produce insulin, called islets, stopping or slowing insulin production. A person with type 1 diabetes will need to take insulin for the rest of their life.
Not doing so can result in ever-increasing blood sugar levels and dangerous complications. Refer any clear signs of diabetes to a primary care physician, who will administer tests to confirm that these are a result of diabetes. After receiving a diagnosis of type 1 diabetes, the islet cells responsible for insulin secretion may continue to produce the hormone for a while before ceasing.
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During this time, a person will need fewer insulin shots to maintain healthy levels of blood glucose. Doctors refer to this as the "honeymoon phase" or honeymooning. This phase can lead to a person with type 1 diabetes mistakenly thinking that they are getting better. The honeymoon phase, while giving the impression of recovering symptoms, still requires close monitoring and regular adjustments of insulin dosage. Sticking to the recommended treatment plan is essential while honeymooning. If a person does not manage these symptoms, a range of dangerous complications might develop.
Diabetic retinopathy: Excess glucose leads to a weakening of the walls of the retina, the part of the eye that detects light and color. As retinopathy progresses, small blood vessels may form behind the eyes that might bulge and rupture, causing vision problems. Diabetes is one of the leading causes of blindness among working-age adults.
Diabetic neuropathy: High blood sugar reduces circulation, damaging nerves in the hands and feet and leading to a loss of sensation or abnormal sensations such as burning, tingling, and pain. As diabetes can also reduce the body's ability to heal, minor cuts and injuries can lead to more permanent damage, especially as a person may not immediately notice them.
Diabetic nephropathy, or diabetic kidney disease: The kidneys filter glucose from the blood. Too much glucose can overwork them, and progressively cause kidney failure, which may progress to needing dialysis.
Cardiovascular disease: Diabetes can lead to a range of abnormalities that impair the function of the heart and arteries, including heart attack , stroke , and peripheral vascular disease. Gum disease: Type 1 diabetes can increase the risk of gum disease and tooth loss, meaning that a person with this type should be very careful to maintain dental health. Depression: Diabetes has strong links with depression. Diabetic ketoacidosis DKA is an acute complication of diabetes that occurs when a person does not meet the requirement for insulin, and the body undergoes extreme stress.
Diabetic ketoacidosis leads to very high blood sugars. The body experiences a shift in metabolism and starts breaking down fat instead of sugar, producing ketones as a waste product. Ketones can be harmful to the body and cause acidosis. DKA is a medical emergency that requires hospitalization and treatment with intravenous insulin etc. Carefully managing type 1 diabetes can dramatically reduce the risk of these complications.
A landmark study called the Diabetes Care and Control Trial DCCT has shown that good blood sugar control can significantly reduce the risk of microvascular complications. Many of the initial blood tests indicate the presence of diabetes but do not specify which type of diabetes is present.
While exceptions can occur, people with type 1 diabetes tend to present at a much younger age and are lean. Individuals with type 2 diabetes are typically older and overweight.
Type 1 diabetes
The doctor will then test for autoantibodies against pancreatic cells in the blood. While antibodies would help the immune system combat diseases and infections, autoantibodies occur when the immune system is attacking healthy tissues incorrectly. The doctor can also measure C-peptide, an indicator of how much insulin the body produces. They expect it to be lower in type 1 diabetes, as this relates to the destruction of the insulin-producing cells.
People with type 1 diabetes need to take insulin several times a day, including around mealtimes, as the body no longer produces the hormone. There are several ways to take insulin, such as through multiple daily injections or through a pump. This approach is now generally recommended as the optimum method for blood glucose self- monitoring [ 1 ].
Often, people with type 2 diabetes have not had the necessary education or training to adjust their lifestyle or oral medication even if they are aware that their blood glucose results are abnormal [ 15 ]. As a consequence the debate continues regarding the value of SMBG in people with type 2 diabetes who are not on insulin therapy [ 18 — 22 ]. Throughout the trial, the well-being and satisfaction of participants will also be evaluated.
Type 2 diabetes
The study is an open, multi-centre, randomized controlled trial RCT. The study is being conducted at primary and secondary care sites across Wales and England. Smaller, research active practices were also invited to participate. Diabetologists working in secondary care across Wales were invited to be involved by working in partnership with GP practices i. Patient Identification Centres. In addition, two sites in England, one in primary care and the other in secondary care, expressed an interest in taking part and were accepted, making a total of 16 centres nine primary care sites and seven secondary care sites.
Mental condition rendering the participant unable to understand the nature, scope and possible consequences of the study;. Written informed consent will be given by the participant before any study activities take place. People with type 2 diabetes eligible to take part in the study will receive an invitation letter from their GP or hospital consultant, along with a Participant Information Leaflet and be given an oral explanation about the study from a research professional usually a research nurse.
Following recruitment to the study all participants will be asked to complete the Audit of Diabetes Knowledge ADKnowl questionnaire to record their level of diabetes knowledge. Provision will be made to address any educational gaps through the use of standardised diabetes education materials.
All participants will be given a copy of the Diabetes UK booklet on type 2 diabetes [ 23 — 25 ] that they will keep throughout the study duration to use for their personal reference. Those in the SMBG study arms groups 2 and 3 will also be able to refer to this booklet at clinic visits when care planning with their study nurse.
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Following acceptance into the study, participants will be randomised into one of three treatment groups. Randomisation will be via email using a central database. The study will involve six visits for those randomised to the control group and an additional seventh visit for those randomised to one of the SMBG groups to deliver the SMBG training. At this visit and prior to any participant related activity, written informed consent is provided by the participant.
A blood sample will be taken to ascertain whether the HbA1c level is within the inclusion criteria. At visit two participants will be randomised into one of the three treatment groups.
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Participants will also be asked to complete the ADKnowl questionnaire [ 26 ] to record their current level of diabetes education. Standardised diabetes information DUK Booklet [ 23 — 25 ] will be given to all participants to take away with them. Baseline data will include collection of clinical data e. Participants in all groups will be provided with a participant diary to record any significant events, change of medication and contact with any health care professionals.
Participants randomised to the SMBG groups will attend an individual training session with their study nurse on blood glucose monitoring teaching them how to monitor their blood glucose levels using the Accu-Chek Aviva meter. During these visits the study nurse will carry out a review of the participant similar to Visit 2. Participant diaries will be collected at the final visit. As the study nurses will vary according to their knowledge and expertise, all will attend a standardised training programme delivered by the study team in addition to completing online training covering the safe use of non-insulin therapies in type 2 diabetes.
Throughout the study, participants in the control group Group 1 , will receive routine care with the participant able to contact their diabetes team or GP as they would normally. Group 1 participants will not be provided with a blood glucose meter and training on SMBG will not be given. Glycaemic management will be by their usual health care provider as part of routine clinical care.
Actions taken in response to the blood glucose monitoring will be recorded. At each study visit glycaemic management will be based on SMBG results alone and refresher training will be given on using the blood glucose meter correctly, understanding SMBG profiles and following the algorithm. Additionally the blood glucose meter will be calibrated. Between the 3 monthly study visits the participants will verbally report or upload their SMBG results to the database if using the software for the nurse to review on a monthly basis.