Type 1 diabetes mellitus is very unique from the other forms of diabetes mellitus. The causes of type 1 diabetes, classically include an autoimmune destruction of the cells that make insulin, as a result of not making enough insulin, blood sugar is elevated. That's the first sign of diabetes mellitus.
Most people with type 1 diabetes mellitus have no indicator that they're at risk of the condition. There's no family history of diabetes mellitus. It's really mostly a shock, and as a result, many people with type 1 diabetes mellitus rally around each other. There're a lot of groups on social media and also support groups, because it's so unique.
A Day in the Life of a Person with Type 1 Diabetes Mellitus
What is it like when you have type 1 diabetes mellitus? You wake up in the morning and you look at your blood glucose even before you go to the bathroom, the first thing you might do is even dose a little insulin if your blood sugar is high. You have your insulin technology, and you have your glucose monitoring technology, these are separate.
On the insulin side, you'll have your insulin pens if you're injecting insulin separately, or you might have an insulin pump that will allow you to adjust your insulin levels continuously, if you want, throughout the day.
On the glucose monitoring side, we have a finger stick glucose monitor that requires a drop of blood to measure your blood sugar. This is considered the gold standard for knowing what your blood sugar is right now.
But we also have what's called a continuous glucose monitor abbreviated as CGMs. The CGMs, as they're called, are designed to tell you what your blood sugar has been in the last five minutes, it's very close to the perfect now. That's why the FDA in the US and other bodies around the world have allowed now for the CGM monitor to take over the finger stick.
The guidance is now that instead of checking your finger prick up to 10 times a day, which is very difficult. You can rely mostly on your CGM, but when you are not clear on whether the CGM is accurate or say you don't feel the same way as the number shows you're advised to check your finger prick just to guarantee that you have the right result.
Maybe you get hungry and you need a snack, again you'll look at your blood sugar, and you might actually have already done that, because you dose insulin, and you want to see how that worked for you. You'll take a quick glance at your continuous glucose monitor and say, Oh, things are good.
You're then having your meal with your family, and somebody brings a dessert that you didn't expect. So you have to decide, am I going to eat that dessert because I already dosed my insulin, or is it something I'm going to dose insulin for because I really want that dessert? And hopefully you decide if the dessert is really special to eat it because you do have the ability to dose insulin for that food.
When you have type 1 diabetes, you'll be advised that you need a diabetes care team. Your diabetes care team might include a nutritionist or a dietitian, might include an endocrinologist, it might include a nurse practitioner or a certified nurse educator or certified diabetes care educator, these are individuals who are trained specifically to teach you about diabetes.
Other people on your team might include an exercise physiologist, and don't forget our therapists or psychiatrists and psychologists. They're very important to help you adjust to this new diagnosis. Men and women can experience type 1 diabetes differently at different times in their lives.
For men, one of the risks of high blood sugar over many years is erectile dysfunction. For women, perhaps the most impactful part of a woman's life when she has type 1 diabetes is pregnancy.
Women in pregnancy with type 1 diabetes mellitus
Normally, women without diabetes have lower blood glucoses than in usual, non pregnant life, the most important thing that you need if you're preparing for pregnancy is time. You need time to learn what are the strategies that you can adopt to achieve very tight control.
That's really mostly important for the first moments of pregnancy. In the first few weeks of pregnancy, that's when glucose control is most important. During the pregnancy, you'll be guided by a diabetes care team that includes your endocrinologist and your obstetrician.
Menstruation period and type 1 diabetes mellitus
Some women with type 1 diabetes also experience differences in their insulin requirements during their menstrual cycle. This is not true for all women, but it's common, the most important thing for you to do is to collect information around your cycle and communicate what you have found.
Routine things to check when you have type 1 diabetes mellitus
There are a few things that you want to make sure you stay on top of, when you are diagnosed with type 1 diabetes mellitus
1. An annual eye exam, those little vessels in the back of your eye, the retinal vessels are susceptible to the high blood sugar, but you won't know. You won't feel that it's completely asymptomatic. You need to have a test to make sure that your blood cholesterol is in target range for diabetes. This is important because all people with diabetes are at increased risk of heart disease.
2. An annual foot exam, or even more often than that, is very important. I always recommend my patients to just look at their feet every day, especially if you think your sensation is changing. That could be an early sign of what's called diabetic neuropathy.
3. You also need a renal function test and urine test every year to make sure your kidney function is normal. If there is a change in your kidney function or in the amount of protein in your urine, your provider might advise a different strategy, either for your blood sugar control or for your blood pressure control.
There are some times when we recommend a special blood pressure medicine to protect the kidney even when the blood pressure is normal. This happens when we see early signs of kidney disease in people with diabetes, just to protect you from any problems in the future.
4. We now know that people with type one diabetes are at more risk of developing bone disease like osteoporosis, and we also do promote maintaining normal vitamin D levels and calcium intake.
5. I think it's important to talk about alcohol as it relates to type 1 diabetes, mainly because it's another thing that changes your blood sugar in the moment, and you have to adjust, hypoglycemia or low blood sugar due to alcohol is a common problem, and the best way to avoid it is to not drink alcohol.
6. If you are to drink alcohol, the choice, especially in the evening, before sleep, is to eat food with the alcohol. So as you can see, a new diagnosis of type one diabetes is a challenge, and it requires learning a new set of skills, amassing a whole new set of knowledge and insulin therapy has come a long way to make it more patient centered and more patient oriented, so that you can control your diabetes. It does not need to control you.
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