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AALRASHEED DIABETIC CLINIC Your complete guide & Free consultation
Type 1 Diabetes Mellitus

Heredity | Viruses | Immune Responses | Honeymoon Period
Inslulin   | Opening the Cells | Locking the Cells | Starving in the Midst of Plenty | Regulation of Blood Sugar Levels | Injected Insulin |
Self Monitoring Blood Sugar Levels

Although diabetes mellitus has been known since ancient times, it is only recently that we have begun to understand what causes it. We hope that eventually this understanding can help us develop methods both to prevent and reverse the disease. More is now known than ever before, but much is still to be learned.
Type I diabetes is a lifelong disease that prevents the body from properly regulating the metabolism (breakdown, processing, and storage) of its fuels. The body’s fuels include carbohydrates, proteins, and fats. However, carbohydrates are the body’s preferred energy source. Once digested, carbohydrates are converted into glucose (sugar) and provide the major fuel in the body.
The body can be viewed as a complex machine that performs many jobs. Through the carefully controlled release of insulin, which is a hormone made in the pancreas, the body is able to control how and when fats, proteins, and carbohydrates are broken down, stored, and released. Insulin is released continuously by the pancreas in amounts that change according to the needs of the body.
However, people with Type I diabetes have little or no insulin. As a result, they cannot automatically perform this job. Without insulin, the body rapidly builds up levels of ketones (breakdown products of the digestion of fats) in the blood that lead to rapid breathing, coma, and then death. Until 1922, when insulin was first used to treat diabetes, this happened to most people with Type I diabetes shortly after they were first diagnosed. Today this can be prevented by treatment with insulin injections.

People can inherit genes that make them more likely to develop Type I diabetes. Several years ago, scientists discovered that children with diabetes had certain proteins on the surface of their cells. These proteins, called HLA antigens, help the body to recognize and destroy invading bacteria and viruses. They also help to prevent the growth of cancers. We inherit a total of 10 different HLA antigens, help the body to recognize and destroy invading bacteria and viruses. They also help to prevent the growth of cancers. We inherit a total of 10 different HLA antigens. Some seem to increase a person’s risk of developing diabetes, while others seem to decrease the risk.
Just having the dangerous HLA antigens, however, does not mean that someone will definitely develop diabetes. In identical twins who have all the same genes, if one twin already has Type I diabetes, the risk of the second twin’s developing it is only about 50%.

Genes alone are not enough to explain why people develop diabetes; there must be some non-inherited factor. Viruses may play a major role in triggering the onset of diabetes in people who are likely to develop it based on their HLA antigens. Several viruses are linked to the development of diabetes. The virus that causes German measles is one, but other viruses seem to be involved, and not everyone with the right HLA antigens who develops German measles comes down with diabetes.

Immune Responses
The immune system is the body’s way of protecting itself from viruses, bacteria, and the development of groups of cancer cells. There are two major parts to the immune system. One part consists of specialized cells that are designed to recognize and destroy "foreign" substances. The second part consists of special proteins-antibodies-that are also designed to destroy foreign substances. Usually the foreign substance will be attached by both antibodies and cells, often in that order.
In diabetes, soon after diagnosis, it is possible to find both antibodies and cells that are designed to attack the insulin-producing cells of the pancreas. Which of these two parts of the immune system is more important in finally destroying the insulin producing cells is still uncertain. Some patients go for many years with these antibodies in their blood before becoming diabetic. Many people with these antibodies in their blood never develop diabetes.
The hope of research today is to find specific drugs that will attack those parts of the immune system that are destroying the insulin-producing cells without interfering with the rest of the immune system. As miraculous as this would seem to be, it may be possible in the future.

Honeymoon Period
One confusing feature at the onset of Type I diabetes is that a number of people with diabetes have a "honeymoon period" after their diagnosis. The honeymoon period is a period of time that can occasionally last up to a year, during which the newly diagnosed needs either no insulin or very little insulin to control blood sugar. Many people become fooled into thinking during this period that either they are not really diabetic or that their diabetes will be very easy to take care of and will not require any work on their part. When this period finally ends, many people have more trouble accepting their diabetes than they had in the beginning.

One Type I diabetes develops; it is always treated with insulin. To better understand the treatment, you need to know more about insulin, what it is and how it works. Insulin is a hormone, a chemical made by the beta cells of the pancreas. Insulin’s main function in the body is to make sure that the cells have enough fuels, or energy, to carry out their daily activities. Insulin does this in two ways: First, it allows the foods that have been digested by the stomach to move from the blood stream into the cells of the body. Second, it controls the release of these foods back into the blood stream. In other words, insulin works very much like a key. When you eat, insulin "opens" the cells and allows the digested foods (carbohydrates, proteins, and fats) to move inside. Between meals or whenever a person is not eating, insulin locks these same cells and prevents the release of these foods back into the bloodstream.

Opening the Cells
Insulin is normally released into the bloodstream 24 hours a day, regardless of whether the person is awake or asleep, eating or fasting. The largest amount is released when a person eats. This insulin "opens" the cells. If the insulin is not present at the time the food is eaten, the body will have difficulty moving the food out of the bloodstream and into the cell. That person will have trouble keeping the sugar level in the bloodstream from rising above that is normal (150 mg/dL) after a meal. Despite the person’s having just eaten, the cells will remain without food.
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Locking the Cells
A smaller amount of insulin is secreted at all other times. The body needs a steady supply of insulin, even if no food has been eaten for several hours or days. This insulin is needed to "lock" the cells. If insulin is not present, the body will have trouble preventing the release of the fuels (sugar, proteins, and fats) back into the bloodstream. That person’s blood sugar will increase even without eating.

Starving in the Midst of Plenty

In the person with Type I diabetes, the absence of insulin means that the cells will be unlikely to get or keep enough fuels to supply their energy needs. Even though that person continues to eat and may, in fact, be eating more than usual, without insulin the cells cannot use the food. The cells literally begin to starve in the midst of plenty. The person stays hungry even after eating because the foods digested by the stomach remain in the blood stream and do not get into the cells. As the level of sugar in the bloodstream increases, the body begins to pull water from the tissues into the bloodstream. The helps to dilute the sugar-filled blood but leads to an increased thirst and drying of the skin. Meanwhile, the kidneys begin to sense that the sugar level is too high. They start to push the excess sugar along with water into the urine. This causes the person to urinate often and in large amounts.
In an effort to obtain its needed supply of energy, the body begins to burn fats for energy and sets in motion a chain of events that, if left unchecked, will lead to coma and death. This is called diabetic ketoacidosis (DKA).

Regulation of Blood Sugar Levels

It might help to think of insulin’s two regulating functions in terms of a more common fuel regulating system a thermostat. The body, like a thermostat, can lower or raise the level of fuels, especially sugar. Like a thermostat, it has an automatic sensor that monitors both the level of fuels in the bloodstream and the level of hormones that control these fuels. The body has several hormones that respond to this sensor to make sure that the fuel level goes neither too high nor too low. These hormones balance each other to ensure that the blood sugar remains in the normal range. In the person without diabetes, insulin controls the body’s ability to lower the level. The counter regulatory hormones (e.g., adrenaline, cortisol, growth hormone, and glucagons) control the body’s ability to raise that level.
Regulation and counter regulation are so finely linked that the blood sugar is always maintained within normal levels.

Increased Blood Sugar
Increased Counter regulatory Hormones = Increased Insulin 
RESULT Blood Sugar kept normal

Decreased Blood Sugar
Increased Insulin levels = Increased Counter regulatory Hormones
RESULT Blood Sugar kept normal

Injected Insulin

In people with Type I diabetes, the insulin half of this system is missing. Even when insulin is replaced by injection, the body’s normal regulation of fuels is dramatically changed. Injected insulin is not as good as the insulin you were born with. It is not responsive to the blood sugar level. Injected insulin lowers the level of sugar in the blood even if the blood sugar is already too low. It does not work as quickly. Normal insulin levels increase 2-3 minutes after a meal is started and are at their strongest within 5-10 minutes. This allows the blood sugar level after a meal to remain basically unchanged despite the amount or type of food eaten. On the other hand, an injection of the fastest acting insulin is not available to the bloodstream for 30 minutes and then is not at its strongest for 2 hours. This means that the person with diabetes must select both the kind of foods and the time to eat those foods to match the activity of the injected insulin rather than the other way around.
The person with Type I diabetes has trouble not only controlling the level of fuels (blood sugar) but also preventing the counter regulatory hormones from over secreting, which increases the blood sugar and can lead to an increased need for insulin.
Insulin use in Type I diabetes must therefore be carefully planned so that it replaces as closely as possible the body’s "normal patterns" of insulin secretion. The insulin prescription should provide the patient with insulin 24 hours a day and with extra insulin at the time of meals. To achieve this distribution, the insulin schedule must include either a mixture of insulin types and at least two injections a day or a continuous administration of insulin through a mechanical device (an insulin pump).

Self Monitoring Blood Sugar Levels
Unfortunately, medicine has not yet discovered an insulin formula that will respond to the body’s senses. Since injected insulin does not automatically adjust itself to the current blood sugar level, the Type I diabetic needs to learn ways to check if changes are necessary. Insulin requirements can differ widely from day to day. A change in what or when you eat or a change in the level of your activity often changes the amount of fuels available to the bloodstream. This in turn can change the does of insulin needed to mimic the body’s normal response. At present, people with diabetes need to provide this sensor by monitoring their blood sugar levels with a meter.
Until our understanding of the causes of diabetes are advanced enough to allow us to reversed this disease, it is up to you, the diabetic patient, to take the primary responsibility for your own care.

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