How Type 1 Diabetes Works

Chances are, if you live in the United States, you know someone who has type 1 diabetes. When people hear the term diabetes, they often think of a disease that is caused by a poor lifestyle. However, there are two types of this disease. Type 1 Diabetes is a chronic condition that develops in children and young adults. Type 2 diabetes, however, usually affects obese adults, and is much more prevalent than type 1. Diabetes results in high blood glucose levels which in turn affect the whole body to give a variety of symptoms. However, those with type 1 diabetes are still able to live a normal life through active monitoring of the disease. Before the advent of insulin discovery in 1921, those diagnosed with type 1 diabetes would have a life expectancy of one year, usually dying in painful process. Thankfully insulin is currently available to help treat diagnosed type 1 diabetes, though the exact source of this disease is unknown. In this paper, the causes, implications, and treatment will be addressed to inform how type 1 diabetes works. First, one must understand how a normal person functions and what makes a person with type 1 diabetes different.

What Happens

Glucose is the simple sugar that humans utilize for energy that supports muscles and tissues. When glucose is consumed in the form of carbohydrates or produced in the liver, it enters the bloodstream (Freudenrich 2). In order to process the glucose in the bloodstream, a functioning pancreas produces insulin (note fig 1.). The insulin essentially makes the glucose available to cells, thus lowering the amount of amount of glucose in the bloodstream, and supplying energy to cells. Insulin is the “key” which unlocks the cell’s “door” to receive energy. Without insulin the cell does not get any energy and starves. The problem with a type 1 diabetic, however, is that their pancreas no longer produces insulin. Type 1 Diabetes is an autoimmune disease, meaning that the body’s immune system thinks that the islets, which contain the insulin-producing beta cells, are pathogenic and destroys them. This is like friendly fire in a war, where the body thinks your pancreas is the enemy and devastates your insulin producing cells. Exactly why this happens is unknown, but a genetic link has been shown (JDRF). On rare occasion environmental factors, such as ingesting a poison such as the rodenticide Vacor, kill the beta cells, yielding the same inability to produce insulin (Karam 971).

Fig. 1. This graphic shows the components of the pancreas and the location of the beta-cells that produce insulin(MacDonald).

In a normal person, the pancreas will secrete insulin to monitor the blood glucose levels, as insulin is needed throughout the day and in higher amounts when glucose (carbohydrates) is consumed. In a diabetic person, insulin is no longer available to monitor the blood-glucose levels, resulting in hyperglycemia—high blood glucose levels. Hyperglycemia causes the major symptoms of untreated diabetes, which include:

• ·         Frequent Urination
• ·         Thirst
• ·         Dehydration
• ·         Weight Loss
• ·         Irritability

As previously mentioned, diabetes is generally associated with overweight inactive people, a common characteristic in type 2 diabetes. In contrast, type 1 is characterized by weight loss and decrease in energy.  As insulin is no longer produced, energy cannot be absorbed and fat and muscles are depleted by the starving cells. Thus treatment of diabetes is crucial to return the body to proper function.

Treatment

Insulin therapy begins as soon as type 1 diabetes is diagnosed and continues for the rest of the patient’s life. Insulin is manufactured by several companies through biosynthesis, and plays the same role that insulin from the pancreas does. Simply put, injecting insulin works similarly to and acid-base titration in chemistry. If used in the right amount, insulin “neutralizes” the carbohydrates and high blood glucose levels. Conversely, if excess insulin is administered, the blood glucose levels will plummet to an undesirable low. Normally, insulin is administered through injection. There are two major ways insulin is injected: shots and pumps.

Shots: With shots there are two types of insulin that are used. One is fast-acting insulin which is taken before eating to account for carbohydrates that will be consumed. Taking insulin for consumed carbohydrates is known as “bolusing”. The other shot is a background insulin, known as a basal dosage, and is taken once a day to help control blood glucose levels when a person is not eating.

Fig.2. This graphic illustrates how insulin is administered
using an insulin pump(DiabetxCare)

Pumps: Modern insulin pumps can function much like a pancreas located outside the body. A three-day supply of insulin is placed in a reservoir within the pump, and the pump is connected to the body through an injection site (see fig. 2). The pump provides the basal dosage by continuously providing a small amount of insulin for the body (the basal dosage). For bolusing, a user can simply plug in the amount of carbohydrates he or she intends to consume, and the pump will use a predetermined bolus rate to administer the correct amount of insulin.

Another important part of successfully treating type 1 diabetes is monitoring blood-glucose levels. To check blood-glucose levels, one must prick their finger to draw a drop of blood, and place the blood on a test strip which is connected to a meter. The meter then displays the blood glucose level. A diabetic is continuously involved in a balancing act between hyperglycemia and hypoglycemia (low blood glucose levels). If too much insulin is administered, the blood glucose levels will decline. If levels fall too low, it can result in coma and even death. On the other hand, if the amount of insulin is administered for the food taken is inadequate, hypoglycemia will result, which is also negative for your health, potentially producing many of the symptoms that an undiagnosed diabetic experiences.

Conclusion

Currently there is no cure for diabetes. Although much research has been done for transplantation in diabetics, the body will usually reject the new pancreas or transplanted cells. Even if a new pancreas could be built or transplanted into a type 1 diabetic, there is no reason to suggest that the diabetic’s immune system would not attack the beta cells all over again. Research should be continually pursued in order to find a cure, as a cure would prolong and benefit many type 1 diabetics’ lives. If you know someone with diabetes, understand that they can still live a normal life, and give them support, as managing diabetes is no small task. Knowing how this chronic disease works is fundamental to understanding what type 1 diabetics need to live, and how to support them in their constant fight against diabetes.