US Pharm. 2018;43(10):23-24.

Formerly Called Juvenile Diabetes

Diabetes is a chronic condition in which the body is unable to properly regulate blood glucose, or blood sugar. There are two types of diabetes; type 2 is more common. It develops slowly over time, and management involves lifestyle changes and medications. Type 1, which is less common, affects approximately 10% of people with diabetes. It is sometimes referred to as insulin-dependent diabetes and was formerly known as juvenile diabetes because of the frequency of diagnosis in childhood. About 1.25 million Americans have type 1 diabetes, and an estimated 40,000 people will be newly diagnosed each year in the United States.

Insulin Is the Key Player

Our bodies are designed to break down the sugars and carbohydrates we consume into a simple sugar called glucose that provides fuel for the cells. The hormone insulin is an important player in this process because it acts as a key to the door of the cell, allowing glucose to enter. In type 1 diabetes, the body is unable to regulate glucose because the insulin-producing beta cells in the pancreas are destroyed by the body’s immune system. As a result, glucose isn’t transported into the cells and instead accumulates in the bloodstream, causing the symptoms of diabetes.

While no one knows for sure what triggers the immune-system malfunction in this group of people, exposure to some viruses and genetic patterns seem to correlate with the onset of type 1 diabetes. A child’s risk of developing type 1 diabetes is one in seven, or about 14%, if one parent also developed type 1 diabetes before age 50 years, with a further increase in risk to 50% if both parents have type 1 diabetes.

Symptom Onset Is Sudden

Type 1 diabetes can occur at any age, but it is the most common chronic disease of childhood. The symptoms of type 1 diabetes can develop quickly, sometimes within weeks. The classic symptoms in children who develop type 1 diabetes are polydipsia (excessive fluid intake from extreme thirst), polyphagia (excessive hunger, ingestion), and polyuria (excessive urination, volume), along with overt hyperglycemia (high blood sugar levels).

A primary objective of diagnosis is to determine whether the patient has type 1 diabetes or type 2 diabetes, because the initial treatment pathways differ significantly. Blood tests to measure blood glucose level, such as the glycated hemoglobin (A1C) test, identify the presence of higher-than-normal blood sugar and signify diabetes. Further tests to identify antibodies, as well as ketone levels in the blood, better indicate the presence of type 1 diabetes.

Management Is a Full-Time Effort

Treatment of type 1 diabetes includes a combination of medication and lifestyle modifications aimed at keeping blood glucose levels within a recommended range and avoiding complications of the disease. A 24/7 effort is required to maintain a healthy blood glucose range. Patients monitor their blood sugar levels via finger pricks, track their intake of carbohydrates and physical activity, and self-administer insulin multiple times per day. A long-acting insulin analogue is used to provide a stable insulin dose, and short-acting insulin is injected after meals to manage spikes in blood glucose from carbohydrate ingestion. Improvements have been made in the delivery of insulin for type 1 diabetic patients through the introduction of automatic insulin delivery via a catheter placed under the skin of the stomach (commonly), a system known as an insulin pump.

The introduction of automated blood glucose–monitoring devices is a further enhancement in type 1 diabetes care. With both automatic blood monitoring and automated insulin delivery via a pump, it is possible to create a closed-loop system that can provide overall management with less effort (and error) by the patient. In September 2016, the FDA approved an artificial-pancreas device, Medtronic’s MiniMed 670G System, which continuously monitors blood sugar and adjusts insulin doses automatically.

Your local pharmacist is here to help. If you, a friend, or family member has questions about medications used to manage type 1 diabetes, ask a trusted pharmacist or another healthcare provider.

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