Type 1 diabetes mellitus is a lifelong disease that develops when the pancreas can no longer produce insulin. Insulin lets sugar (glucose) enter your body's cells, where it is used for energy. Without insulin, sugar builds up in your blood. The level rises above what is safe for your body. Over time, high blood sugar levels can damage blood vessels and nerves throughout your body and increase your risk of eye, heart, blood vessel, nerve, and kidney disease.
Type 1 diabetes can develop at any age. But it usually develops in children and young adults. In the past, type 1 diabetes was called juvenile diabetes and insulin-dependent diabetes mellitus (IDDM).
Insulin is made by certain cells (beta cells) in the pancreas. Type 1 diabetes develops because the body's immune system destroys the beta cells and therefore the pancreas's ability to produce insulin.
Some people inherit the risk for type 1 diabetes. But even these people may not develop type 1 diabetes unless something else triggers it, such as being exposed to certain viral infections.
The main symptoms of high blood sugar from diabetes are:
These symptoms usually develop over a few days to weeks. Some people have these symptoms before they are diagnosed, but they do not realize the symptoms are caused by diabetes. They may believe the symptoms are caused by the flu or some other illness.
Severe diabetic ketoacidosis can cause difficulty breathing, brain swelling (cerebral edema), coma, or death. But by taking your insulin regularly and keeping your blood sugar levels in your target range, you can avoid DKA.
The main symptoms of low blood sugar from diabetes are:
Low blood sugar occurs when the sugar (glucose) level in your blood drops below what your body needs to function normally. Not eating enough food or skipping meals, taking too much medicine (insulin), exercising more than usual, or taking certain medicines that lower blood sugar can cause your blood sugar to drop rapidly.
If your blood sugar level drops very low (usually below 1.0 mmol/L), you may lose consciousness or have a seizure. Eating or drinking something that contains sugar usually can bring your blood sugar back up to a safe level. But if you have symptoms of severe low blood sugar, you need medical care immediately.
You need to test your blood sugar 3 or more times a day to make sure it falls within the target range you and your doctor set. You use a home glucose monitor to do these tests.
At first, you will keep in close touch with your doctor while finding the right dose of insulin that best keeps your blood sugar levels within your target range. When your blood sugar levels are staying within this range, you will see your doctor about every 3 to 6 months. During these checkups, your doctor will look at your treatment to see how well it is controlling your diabetes. If your treatment isn't working very well, your doctor may have you try different things. You will also start having a A1c test to find out what your average blood sugar level was during the 2 to 3 months before your visit. This test checks your long-term blood sugar control.
You will take insulin injections daily or use an insulin pump. Treatment for type 1 diabetes focuses on keeping your blood sugar levels within your target range. This is called tight control. It is the best way to reduce your risk of diabetes complications. But some people—such as those whose blood sugar drops too low with tight control—may need to set a different target range with their doctor.
A target range for blood sugar is 4.0 mmol/L to 7.0 mmol/L before eating or less than 10.0 mmol/L (8.0 mmol/L for some) 2 hours after eating. It also may be measured as an A1c of 7% or less. This is a test of your blood sugar control for the past 2 to 3 months.
You also need to eat a healthful diet that spreads carbohydrate throughout the day, check your blood sugar 3 or more times a day, and get regular exercise. Because you have diabetes, you are at higher-than-average risk of a heart attack and stroke. You may take medicine to keep your blood pressure and cholesterol in the normal ranges. You also may take ASA to lower your risk for having a heart attack.
Your treatment plan may change based on your blood sugar levels and other test results reviewed in your doctor's office.
If your child has type 1 diabetes, treatment involves the same actions but also allows for normal growth and development.
You may find that soon after you are diagnosed with type 1 diabetes, your blood sugar levels return to normal. You are in what is called the "honeymoon period." The remaining insulin-producing cells in your pancreas are working harder to supply enough insulin for your body. You may take little or no insulin. But this does not mean that the disease is gone. After the remaining insulin-producing cells are destroyed, the honeymoon period ends, and you will need to take insulin for the rest of your life.
You can live a long, healthy life if you keep your blood sugar levels within a target range. This requires the right combination of food, physical activity, and insulin every day. If your young child has diabetes, you assume the responsibility for balancing these things. As your child grows, he or she will take over more responsibility for his or her care.
Many people are afraid of giving themselves shots every day. With practice, it will become routine. Figuring out how to mix diet, insulin, and exercise in your daily life takes time. Don't get discouraged. Seek out help from your doctors if some part of diabetes care gives you trouble.
As you adjust to having diabetes, you will learn how to monitor your blood sugar level at home, give yourself insulin injections, recognize high and low blood sugar symptoms, count carbohydrate in your diet, and take precautions when you are sick. Diabetes care will become an important part of your life, but it doesn't have to take over your life.
Frequently Asked Questions
Learning about type 1 diabetes:
Living with type 1 diabetes:
Health Tools help you make wise health decisions or take action to improve your health.
|Actionsets are designed to help people take an active role in managing a health condition.|
|Diabetes in Children: Checking Blood Sugar in a Child|
|Diabetes in Children: Giving Insulin Shots to a Child|
|Diabetes in Children: Preventing High Blood Sugar|
|Diabetes in Children: Preventing Low Blood Sugar|
|Diabetes: Checking Your Blood Sugar|
|Diabetes: Counting Carbs if You Use Insulin|
|Diabetes: Dealing With Low Blood Sugar From Insulin|
|Diabetes: Giving Yourself an Insulin Shot|
|Diabetes: Preventing High Blood Sugar Emergencies|
|Healthy Eating: Using a Plate Format to Plan Meals|
Type 1 diabetes develops because the body's defense system (immune system) tells the body to destroy the beta cells in the pancreas that make insulin. It's not known what causes this immune response. Some people inherit the risk for type 1 diabetes. But even these people may not develop type 1 diabetes unless other factors, such as exposure to certain viral infections, are present.
Certain genes make a person more susceptible while other genes seem to protect the person from the disease. A complex interaction between a person's genes and some environmental factors, such as having enteroviral infections—especially Coxsackie B infections—may increase the risk of developing the disease, but it does not mean that the person will definitely develop the disease.
In the past, experts thought that vaccines caused diabetes. But studies have found no link between getting a vaccination and getting type 1 diabetes.1
Your (or your child's) symptoms of type 1 diabetes probably developed quickly, over a few days to weeks. These symptoms are caused by blood sugar levels rising above the normal range (hyperglycemia) and include:
All of these symptoms will get better or go away when your blood sugar levels are controlled.
If your blood sugar rose to very high levels at the time you were diagnosed with diabetes, you may have received treatment in a hospital for diabetic ketoacidosis, which is an emergency.
Now that you are taking insulin injections, watch for signs of either high or low blood sugar. High blood sugar (hyperglycemia) usually develops slowly over a few days or weeks. But it can also develop quickly (in just a few hours) if you eat a large meal or miss an insulin dose. On the other hand, low blood sugar (hypoglycemia) can develop within 10 to 15 minutes. Children, especially very young children, are at greater risk for harm caused by very low blood sugar levels.
Watch for the following symptoms of high or low blood sugar. You (or your child) may not have the same symptoms every time, and you may have symptoms that are not listed.
After you are diagnosed with type 1 diabetes, you may find that your blood sugar levels return to normal. You are in what is called the "honeymoon period." The remaining insulin-producing cells in your pancreas are working harder to supply enough insulin for your body. You may take little or no insulin. But this does not mean that the disease is gone. After the remaining insulin-producing cells are destroyed, the honeymoon period ends, and you will need to take insulin for the rest of your life.
Treatment for your diabetes includes following a diet that spreads carbohydrate throughout the day, getting regular physical activity, monitoring your blood sugar levels (using a home blood sugar meter), and taking insulin. By working closely with your doctor and following your prescribed treatment, you will feel better and have more control of your life. If your child has type 1 diabetes, treatment involves the same tasks but allows for normal growth and development.
Before diagnosis, your insulin level may have been low enough to cause severe high blood sugar, with symptoms such as confusion or even coma. This condition is called diabetic ketoacidosis and often requires treatment in a hospital. During your hospital stay, you are given insulin injections and fluids in a vein (intravenous or IV), and your condition is monitored closely. You are still at risk for this emergency in the future if you don't take enough insulin to keep your sugar levels and metabolism normal.
If you have persistent high blood sugar levels over a long period of time, diabetes can damage your:
If you keep your blood sugar level within your target range, you may prevent, or at least delay, these complications. Children seem protected from developing these complications during childhood. But when they become adolescents, their risk begins to increase. Keeping blood sugar levels as close to normal as possible at the beginning of the disease will help prevent these complications.2
Risk factors for developing type 1 diabetes include:
Call 911 or other emergency services right away if you are:
Call a doctor right away if:
Call a doctor if you:
Health professionals who can treat type 1 diabetes include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Routine tests for type 1 diabetes include an A1c or similar test (glycosylated hemoglobin or glycohemoglobin) that estimates your average blood sugar level over the previous 2 to 3 months. It helps monitor blood sugar control after treatment has started.
You need to see your doctor about every 3 to 6 months throughout your life for examinations and tests to watch your condition and adjust your treatment.
After you have had diabetes for 5 years, you will need annual tests to watch for signs of damage to your eyes (diabetic retinopathy), kidneys (diabetic nephropathy), heart, blood vessels, and nerves (diabetic neuropathy). If your child has diabetes, this testing should begin at puberty.
You may need a thyroid-stimulating hormone (TSH) test when type 1 diabetes is diagnosed and then every 1 to 2 years. This test checks for thyroid problems, which are common among people with diabetes.
You may have found out that you have type 1 diabetes when your insulin levels dropped very low and you were admitted to a hospital for diabetic ketoacidosis (DKA). The following tests were likely used to diagnose and monitor treatment of ketoacidosis. You may have these tests again if you develop DKA in the future.
The focus of your treatment for type 1 diabetes is to keep your blood sugar level within a target range. This is called tight control. It is the best way to reduce your risk of diabetes complications. But some people—such as those whose blood sugar drops too low with tight control—may need to set a different target range with their doctor.
In addition to blood sugar testing, a test called A1c is often used to measure your blood sugar control over the past 2 to 3 months. The target A1c value is 7% or less for most people with diabetes.
To keep your blood sugar in a target range, your daily treatment includes:
Chronic illnesses such as diabetes take a toll on your energy and emotions. It's normal to feel down sometimes. But if you feel seriously overwhelmed, tearful, and not yourself, you may be suffering from depression. Talk to your doctor if you feel depressed. Medicine, counselling, and other support can help you.
At first, you will keep in close touch with your doctor while you are trying to find the right dose of insulin that best keeps your blood sugar levels within your target range. After your blood sugar levels are staying within this range, you will see your doctor about every 3 to 6 months. During these checkups, your doctor will evaluate and adjust your treatment. You will also start having examinations and tests that check your blood sugar control and monitor your condition on a regular basis.
After you have had diabetes for 3 to 5 years, you will start having yearly examinations and tests to watch for signs of complications, particularly eye and kidney damage. If your child has diabetes, this testing should begin at puberty.
If your blood sugar level was very high at the time you were diagnosed with diabetes, you may have been treated for diabetic ketoacidosis. This life-threatening condition can happen to you again if you do not take enough insulin, have a severe infection or other illness, or become severely dehydrated. Treatment for diabetic ketoacidosis requires hospitalization and includes:
If your blood sugar levels return to the normal range soon after diagnosis, you are in what is called the "honeymoon period." This is a time when the remaining insulin-producing cells in your pancreas are working harder to supply enough insulin for your body. Treatment during this time may include:
Check whether the school will help you and your child manage diabetes. If possible, work with your child's teachers and school to make a plan to handle your child's special needs, including testing blood sugar and eating snacks when needed.
Let your child with diabetes take part in his or her daily care to the extent that is appropriate for your child's age and development. For example, your 4-year-old child cannot be responsible for testing his or her blood sugar but can get out the supplies and perform some of the simpler steps. By the time your child is an adolescent, he or she should be able to take responsibility for his or her diabetes care, with appropriate supervision. For more information, see the topic Type 1 Diabetes: Children Living With the Disease.
You (or your child) have just been diagnosed with a disease that requires daily attention and will last for the rest of your life. It is hard to accept and adjust to all the lifestyle changes that you need to make, such as eating the right amount of carbohydrate at each meal and snack, giving injections every day, and coping with blood sugar variations.
Anger, resentment, or denial are normal feelings in these circumstances and can be expected because you are experiencing the loss of what your life was like before you got type 1 diabetes. Give yourself time to deal with your feelings and grieve your loss. For more information, see the topic Grief and Grieving.
Wear medical identification at all times. If you have an accident or you are taken to a hospital, this identification lets people know that you have diabetes so that they can care for you appropriately. You can buy medical identification in bracelets, necklaces, or other forms of jewellery at your local pharmacy.
Blood sugar usually rises above a target range slowly, but it can lead to a life-threatening emergency unless it is treated promptly. Your blood sugar is likely to rise when you are sick. For more information, see guidelines for when you are sick.
A hyperosmolar state is life-threatening and can occur when your blood sugar level is very high and you get dehydrated. Diabetic ketoacidosis (DKA) is a life-threatening blood chemical (electrolyte) imbalance that develops in a person with diabetes when the cells do not get the sugar (glucose) they need for energy.
Low blood sugar or hypoglycemia occurs when the level of sugar (glucose) in your blood has dropped below what your body needs to function normally. When your blood sugar level drops below 4.0 mmol/L, you will likely have symptoms of low blood sugar which can develop quickly. Low blood sugar can be especially dangerous if you drive. Do not drive if your blood sugar level is low. Talk to your doctor about safe blood sugar levels for driving. Driving can be impaired even when your blood sugar is above 4.0 mmol/L. Take precautions when you are driving, and be prepared to stop and treat low blood sugar.
Having a routine (when you eat, exercise, take your insulin, and check your blood sugar at about the same time every day) can also help prevent high and low blood sugar emergencies. When you have a routine, your blood sugar levels may be more predictable. A routine will also help you to remember to check your blood sugar and give yourself your insulin injections.
You can prevent soreness and infection at your injection sites by:
Your daily routine now includes new tasks and safety measures because you have type 1 diabetes. You can help keep your blood sugar levels within a target range by following a routine. This means testing your blood sugar and eating at regular times. It also means consistently eating about the same amount of food every day. There is a lot to learn about this complex disease, but for now concentrate on these critical steps:
Carbohydrate is the one nutrient in your diet that most affects blood sugar levels. A registered dietitian can help you learn about what foods contain carbohydrate and how to manage it in your diet. If your child has diabetes, talk with the dietitian about how to adjust meals and snacks for your child's varying appetite.
You need to take injections every day because your pancreas no longer produces insulin. Eventually, your child can learn to give an insulin injection. Talk to your doctor and your child to find out when is a good time to start teaching your child to give an insulin injection.
Your doctor will want you to test your blood sugar level several times a day.
Try to do moderate or vigorous activity for 2½ hours a week spread over at least 3 days that are not in a row.4. One way to do this is to be active 30 minutes a day, at least 5 days a week. Some tips for exercising safely may help. Drink plenty of water before, during, and after you are active. This is very important when it's hot out and when you do intense exercise. It may also help to keep track of your exercise on an activity log (What is a PDF document?).
Encourage your child to do moderate to vigorous activity at least 1 hour every day.5, 6 It's okay for them to be active in smaller blocks of time that add up to 1 hour each day. Children with type 1 diabetes can participate in sports just like children who do not have diabetes. But children who use insulin are at risk of low blood sugar. Some tips on safe exercising for your child with type 1 diabetes can help prevent low blood sugar.
In addition to exercising, it is a good idea to limit the amount of alcohol you drink. The Canadian Diabetes Association recommends that people with diabetes limit alcohol to no more than 2 drinks a day. If you are a man, limit alcohol to no more than 14 drinks per week. If you are a woman, limit alcohol to no more than 9 drinks per week.4 One drink is 355 mL (12 fl oz) of beer, 150 mL (5 fl oz) of wine, or 45 mL (1.5 fl oz) liquor.
Tobacco has many bad health effects, especially for people with diabetes. Having type 1 diabetes can cause a lot of problems in your body. Smoking can make many of these problems worse, especially heart and blood vessel disease. Smoking raises your cholesterol and makes it harder for your body to heal. No matter how long you've smoked, your health will improve after you quit. For help quitting, see the topic Quitting Smoking.
Never skip a dose of insulin without the advice of your doctor. Be sure to know:
There are no surgical treatments for recently diagnosed type 1 diabetes.
Avoid products that promise a "cure" for diabetes. No such cure exists. If you have questions about a product for diabetes, check with your local Canadian Diabetes Association office, your doctor, or a diabetes educator.
You may hear of people with diabetes following meal plans other than carbohydrate counting, or using low glycemic-index foods to prevent high blood sugar levels (hyperglycemia) after meals. Talk with a registered dietitian before choosing an alternate meal-planning method for your or your child's diabetes diet.
Complementary therapies, such as acupuncture or biofeedback, may help relieve stress and muscle tension and improve your overall well-being and quality of life. Talk with your doctor if you are using any complementary or alternative therapies, including chiropractic therapy and osteopathy.
Talk with your doctor about any herbal or natural products that you are taking or that you want to take.
|Canadian Diabetes Association|
|1400-522 University Avenue|
|Toronto, ON M5G 2R5|
The Canadian Diabetes Association (CDA) is devoted to meeting the needs of people with diabetes in Canada. This organization provides general information about diabetes and its care. It organizes summer camps for young people with diabetes and conducts educational seminars to help people manage their diabetes. The CDA also sells a range of products, including cookbooks, in its stores.
|Dietitians of Canada|
|480 University Avenue|
|Toronto, ON M5G 1V2|
The Dietitians of Canada website provides a wide range of food and nutrition information, including fact sheets on frequently asked food and diet questions, quizzes and other tools to assess your diet habits, and meal planning guides.
|Health Canada: Diabetes|
This website provides basic information about diabetes, as well as resources for and information about national programs in Canada for monitoring, preventing, and treating diabetes.
|Juvenile Diabetes Research Foundation Canada|
|2550 Victoria Park Avenue|
|Toronto, ON M2J 5A9|
|Phone:||1-877-CURE-533 (1-877-287-3533) toll-free|
The mission of the Juvenile Diabetes Research Foundation Canada is to find a cure for diabetes and its complications through research. This organization publishes a wide variety of booklets on complications and treatments of diabetes. The organization's main focus is on research for the prevention and treatment of type 1 diabetes.
|National Aboriginal Diabetes Association (NADA)|
|B1-90 Garry Street|
|Winnipeg, MB R3C 4J4|
The mission of the National Aboriginal Diabetes Association (NADA) is to address diabetes among Aboriginal peoples as a priority health issue. It supports individuals, families, and communities to access resources for diabetes prevention, education, and research in culturally respectful ways; partners with organizations committed to the prevention and management of diabetes; and promotes community wellness as a strategy to prevent diabetes.
- Hviid A, et al. (2004). Childhood vaccination and type 1 diabetes. New England Journal of Medicine, 350(14): 1398–1404.
- Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group (2001). Beneficial effects of intensive therapy of diabetes during adolescence: Outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). Journal of Pediatrics, 139(6): 804–812.
- Masharani U, German MS (2011). Pancreatic hormones and diabetes mellitus. In DG Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 9th ed., pp. 573–655. New York: McGraw-Hill.
- Canadian Diabetes Association (2008). Clinical practice guidelines for the prevention and management of diabetes in Canada. Available online: http://www.diabetes.ca/for-professionals/resources/2008-cpg.
- Canadian Society for Exercise Physiology (2011). Canadian Physical Activity Guidelines For Children. Available online: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-child-ENG.pdf.
- Canadian Society for Exercise Physiology (2011). Canadian Physical Activity Guidelines For Youth. Available online: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-youth-ENG.pdf.
Other Works Consulted
- American Diabetes Association (2004). Dyslipidemia management in adults with diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S68–S71.
- American Diabetes Association (2006). Pancreas and islet transplantation in type 1 diabetes. Position statement. Diabetes Care, 29(4): 935.
- Anderson JW (2006). Diabetes mellitus: Medical nutrition therapy. In ME Shils et al., eds., Modern Nutrition in Health and Disease, 10th ed., pp. 1043–1066. Philadelphia: Lippincott Williams and Wilkins.
- Beaser RS (2010). Designing a conventional insulin treatment program. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 297–340. Boston: Joslin Diabetes Center.
- Campbell AP, Beaser RS (2010). Medical nutrition therapy. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 91–136. Boston: Joslin Diabetes Center.
- Centers for Disease Control and Prevention (2005). National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Atlanta: U.S. Department of Health and Human Services. Available online: http://www.diabetes.org/diabetes-statistics.jsp.
- Chalmers KH (2005). Medical nutrition therapy. In Joslin's Diabetes Mellitus, 14th ed., pp. 611–631. Philadelphia: Lippincott Williams and Wilkins.
- Cheng AYY, Zinman B (2005). Principles of insulin therapy. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 659–670. Philadelphia: Lippincott Williams and Wilkins.
- Hviid A, et al. (2004). Childhood vaccination and type 1 diabetes. New England Journal of Medicine, 350(14): 1398–1404.
- Weir GC (2005). Pancreas and islet transplantation. In Joslin's Diabetes Mellitus, 14th ed., pp. 765–776. Philadelphia: Lippincott Williams and Wilkins.
|Primary Medical Reviewer||Adam Husney, MD - Family Medicine|
|Primary Medical Reviewer||Andrew Swan, MD, CCFP, FCFP - Family Medicine|
|Specialist Medical Reviewer||Matthew I. Kim, MD - Endocrinology|
|Last Revised||November 13, 2012|
Last Revised: November 13, 2012
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