Type 1 Diabetes
Key points
  • Diabetes mellitus is a severe chronic disease that occurs in the production of insulin by the body, or a violation of its effective use against the background of sufficient production. There are 3 main types of diabetes mellitus: type 1 diabetes mellitus, type 2 diabetes mellitus and gestational diabetes mellitus.
  • Type 1 diabetes most often occurs in childhood but can occur at any age. At this time, it cannot be prevented. People with type 1 diabetes can only live full lives with an uninterrupted supply of insulin, sufficient awareness, support, and the availability of blood glucose testing equipment.
  • Type 2 diabetes mellitus accounts for the vast majority (about 90%) of diabetes worldwide. It is possible to effectively influence its occurrence and course through education, support and adoption of a healthy lifestyle in combination with medication, if necessary.
  • "Prediabetes" is a term that is increasingly used for people with impaired glucose tolerance and / or with impaired fasting glucose. It determines the risk of future development of type 2 diabetes and diabetes-related complications.
  • Pregnant women with gestational diabetes may have high blood sugar, blood pressure, and high birth weight in babies as a result of gestational diabetes, which increases the risk of pregnancy and childbirth complications for both mother and baby.
Type 1 diabetes is caused by an autoimmune reaction in which the body's immune system attacks insulin-producing β cells in the pancreas. As a result, the body reduces or stops producing insulin altogether. The causes of this disruptive process are not fully understood, but the likely explanation is that a combination of genetic susceptibility (granted by a large number of genes) and an external trigger (such as a viral infection) initiates an autoimmune response. Toxins or some dietary factors also have an impact on this process.

The disease can develop at any age, although type 1 diabetes is most common in children and young adults. Type 1 diabetes mellitus is one of the most common chronic diseases in childhood, although type 2 diabetes is also seen in older children, and it increases due to overweight and obesity in childhood.

People with type 1 diabetes need daily insulin injections to keep their glucose levels within appropriate limits. With proper daily insulin treatment, regular monitoring of blood glucose levels, sufficient awareness and support, such patients can live a normal life, avoid many complications associated with diabetes mellitus.

Following a structured self-management plan that includes insulin use, blood glucose monitoring, physical activity, and a healthy diet is especially difficult in early childhood as well as adolescence. In many countries, especially low-income families, access to insulin and self-care tools, including structured diabetes education, may be limited. This is most often fatal due to the accumulation of harmful substances known as "ketones" in the body (diabetic ketoacidosis, DKA).

Type 1 diabetes mellitus remains a problem even in countries where patients have established access to multiple daily injections or insulin pumps, glucose control, structured diabetes education, and skilled medical care. In addition to the acute complications of hypoglycemia (abnormally low blood glucose) and DKA, poor metabolic control can lead to impaired development in children and early onset of circulatory complications (vascular involvement).

The classic clinical picture of excessive thirst (polydipsia), frequent urination (polyuria), and weight loss may be absent, and diagnosis may be delayed or even completely missed.
Typical symptoms of type 1 diabetes are:
  • Excessive thirst
  • Blurred vision
  • Frequent urination
  • Lack of energy, fatigue
  • Constant hunger
  • Sudden weight loss
Even in countries with full universal health coverage (UHC), the diagnosis of type 1 diabetes can be delayed until the first DKA hospitalization, sometimes with fatal outcomes.

In the UK, around a quarter of first diagnoses of type 1 diabetes are made in the presence of DKA. Similar situations have been observed in France, Poland, the United States of America and many other countries, prompting campaigns to raise awareness about type 1 diabetes among parents, school teachers and health professionals. The latter include the promotion of on-site glucose measurement in a sick child without an explicit diagnosis. The incidence of delayed diagnosis to the first episode of DKA in non-UHC countries is unknown, but is likely to be worse than documented examples. It is believed that many children who have a different condition die with a misdiagnosis.

Diabetes should be diagnosed
if one or more of the following signs are noted
  • Fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dL)
  • Two-hour plasma glucose after oral glucose 75 g (oral glucose tolerance test (OGTT)) ≥ 11.1 mmol/L (200 mg/dL)
  • HbA1c ≥ 48 mmol / mol (equivalent to 6.5%)
  • Random plasma glucose in the presence of symptoms of hyperglycemia> 11.1 mmol/L (200 mg/dL)
However, diagnosing type diabetes can sometimes be difficult, and additional testing may also be needed to distinguish between type 1 and type 2 diabetes and other forms of diabetes, especially so-called monogenic types. The incidence of type 1 diabetes is increasing worldwide, however, there are significant differences in different regions. The reasons for this are unclear, but rapid growth over time must be due to non-genetic, probably external factors (environmental changes, lifestyle, rapid weight gain, malfeeding in infancy.
According to the materials IDF DIABETES ATLAS 10th edition 2021