Type 1 diabetes: Dr Joe Kosterich

Diabetes is a common, chronic condition that affects the body’s ability to control sugar levels.

We hear a lot about the increasing rates of diabetes. Most of that is with Type 2 Diabetes, which comes on later in life. Today we are going to talk about Type 1 Diabetes.

Hi, I’m Dr. Joe.

Even though the name “diabetes” is the same, these 2 conditions are really quite different and distinct. In Type 2, it’s an issue where the body is getting a bit resistant to the effects of insulin, which is the hormone that controls blood sugar, it’s not a lack of insulin. Type 1 Diabetes is quite different. In people with Type 1 Diabetes, their body is not producing enough insulin.

Let me talk, briefly, about what insulin does. Whenever we have something to eat, the body releases insulin to get sugar, or glucose, out of the blood stream, after it’s been absorbed by the body, and into the cells of the body. The human body likes everything controlled within a reasonably narrow range: our pulse, our blood pressure, our breathing rate, our temperature, and our blood sugar level. So when we don’t have enough insulin our blood sugar level rises.

Now, Type 1 Diabetes tends to affect a younger age group. We’re talking about children through to teenagers is when, generally, the diagnosis will appear. And, again, it’s because the body is not producing enough insulin.

What are the symptoms?

They’re not necessarily specific. The most common ones are tiredness, feeling more thirsty than usual, and often going to the toilet more often than usual. And as you can guess those last two are connected. Sometimes the child may be a little bit sluggish, maybe a little bit of a headache, a little bit out of sorts, maybe loss of appetite. But I’ve got to stress that none of these things are absolutely specific. It can even be a child that has been dry at nighttime and starts wetting the bed again. So nothing specific; the symptoms can be vague.

Probably thirst, going to the toilet more often and tiredness being the 3 key hallmark symptoms.

Now, not every child that has that will have Type 1 Diabetes. So it is about trying to establish a diagnosis. For that, you obviously need to go and see your doctor. On the plus side, diagnosis is not difficult. It does involve a blood test. And that blood test is to check blood sugar. Initially, a finger prick test can be done but the best time to do a test for sugar is in the morning, as a fasting level.

Now some of you are going to say, “hang on, how am I going to get my child to fast?” All you need to do is have your tests done before breakfast. So they go to bed at their normal time, get up, but instead of having breakfast you’d go and get the blood test done. Again, this is after you’ve been to your doctor and been assessed.

You can do urine tests, they may also show sugar in the urine and that’s a very strong pointer but a formal blood test is the definitive one.

If the diagnosis is made, that’s when life is going to change a little bit. There are a number of issues in terms of managing and living with Type 1 Diabetes, but it’s very important to say that people do live with it for a very long time. And whilst there can be complications, if the condition is managed well, and most people do this, then one can still expect to have a reasonably long, normal and fairly healthy life.

The 2 key aspects of living with Type 1 Diabetes are obviously aspects to do with diet and one needs to be on a diabetic, low-sugar type diet. We haven’t got the time to go through all the details of that in this video but you can get information about diabetic diets and that’s very important. It’s also important for your child to be reasonably active and do regular exercise or activity. Basic 101 stuff.

People with Type 1 Diabetes will require insulin. There are no tablets that are going to work, the same as for Type 2 Diabetes. Insulin does need to be administered by injection, and may need to be administered 3 or 4 times a day; there are different regimes for different people. But the basics are the same: it will be injections of insulin. The dosage will vary and that depends on the individual person and also what they’re doing.

Monitoring blood sugar is also very important. That is something you can do at home with home testing strips and a blood glucose monitor. And as one goes over months and years, parents, and as they get older their children and teenagers, start to become quite adept at being able to adjust their insulin dose to what they’re doing and obviously monitor their sugar.

With doing all of that, and as I said before and this is quite important, one can live a pretty much normal life. You can do normal activities. You can get involved in sports. You can go out and eat, you obviously have to watch what you’re eating, but again when well controlled, it is quite compatible with normal life. Sure, there is that difference where you need to do the injections.

For school, you’ll need to have a chat with them about how they run their procedures because a child with diabetes will need to have insulin injections through the day. Most children, as they reach an age of 7, 8, 9, it does depend, they can become quite capable of administering their own insulin but in younger age groups, or depending upon your child, it may need to be done by a teacher or supervisor. As they get older, obviously it’s something they do themselves.

The injections are generally done into the abdomen, and it’s a thing that is rotated around so that it’s not always on the same point.

To sum up. Type 1 Diabetes is where we don’t produce enough insulin. There are no real pre-disposing or risk factors, it’s unfortunately not something that you can absolutely prevent. It’s thought to be a genetic tendency. If it is in the family it doesn’t automatically follow that you are going to get it; and even if one child has it, it does not automatically follow that others will have it as well. There are genetic tendencies but the inheritance is not that completely understood.

Diagnosis is relatively straightforward with a blood test for blood sugar. Symptoms, whilst not specific, can give you a little bit of a clue as we’ve said before. And then management is about lifestyle measures with being on a good low-sugar diet and regular activity, plus obviously blood glucose monitoring and use of insulin.

You will need to be under the care of your GP and a specialist, and there will be regular visits – depending – every 2, 3 months, or so, according to individuals.

Parents will often ask: What about birthday parties? What about play dates? What about school? What about sport?

We can’t give specific information about any one of those circumstances. It’s going to be different for different people. The broad overarching principle is that we want to keep the blood sugars within the normal range. We monitor the blood sugar and adjust insulin dose accordingly. So if you can keep that broad principle in mind, then regardless of what your child is doing or where they’re going, that principle is the one: you monitor the blood glucose and they use their insulin, and the dose is a little bit informed by what you find upon testing.

Now, in one breath you can say that having to live with Type 1 Diabetes is not “normal” because not everybody does it, but in another breath I think one can say that it is a thing that you can live with quite normally.

Parents will always get a jolt or a shock when a child is diagnosed with any illness. And I suppose that might be a little more so if it’s an illness where there is ongoing management required.

A child looks very much to their parents for guidance, so in terms of helping your child live and manage Type 1 Diabetes, it is about normalising things as much as possible. Focus more on the child having a condition rather than it is the condition. So rather than ‘you are a diabetic,’ ‘you are a child who has diabetes.’ It’s something that’s part of your life, yes, obviously the child has to live with it and as parents you do as well, but it’s not the total focus. It is about being normal and encouraging your child to just get involved and do normal things with, obviously, some allowances. Yes, they have to have their injections and monitor their glucose, but when that’s all managed quite correctly they can do normal things with their friends. They can go out and play. They can eat foods, hopefully not too much sugar, and if they occasionally overdo it don’t lose a lot of sleep about it, you can adjust their dosage.

So, the more normal you can make every other aspect of life, the more it becomes for your child ‘yes, I have this, I have to live with it, life goes on.’

To that extent you can get involved with support groups, and generally through specialists clinics they will have those, or diabetes associations in different states will also have groups where you can talk with people and meet with people in a similar boat. But the more you can continue all other aspects of life as normal, that’s the best thing you can do to help and support your child.

So, hopefully, that has demystified some of the aspects of Type 1 Diabetes. It’s an area where there is a lot of research and in another 5, 10, 20 years time how things are gone about may be different, things like insulin pumps may be far more readily available than they are today. There’s a lot of work going into looking to find cures. For today, though, it does get back to the basics that we have spoken about.

For more information about Diabetes, including its types and how to manage the disease, see Diabetes.