Type 1 diabetes, early recognition, telltale signs

Sep 23 2010

Though they may present in a similar fashion, type 1 diabetes mellitus is vastly different from type 2, and Ralph Schmeltz, MD, incoming president of the Pennsylvania Medical Society, says it’s important to recognize and diagnose it early.

Formerly called juvenile diabetes because it appears more often in children and adolescents, it strikes both children and adults suddenly, progresses quickly, and lasts a lifetime. It is neither preventable nor reversible using current therapies, though active research continues.

When the pancreas stops producing insulin due to a process which destroys insulin-making cells, that’s type 1, says Dr. Schmeltz. People with type 1 diabetes must take multiple injections of insulin daily or receive a continuous infusion of insulin through a pump. Over the long-term, if type 1 diabetes (as well as type 2) is not adequately treated, high blood sugar levels can damage the blood vessels, heart, kidneys, eyes, nerves, and other tissues or organs resulting in severe and often life-threatening complications.

Dr. Schmeltz, a Pittsburgh area endocrinologist, emphasizes the importance of early recognition and diagnosis of type 1 diabetes, adding that “If type 1 goes undetected at the onset, or is inadequately treated, it may result in a potentially deadly complication called diabetic ketoacidosis or DKA.”

DKA occurs when the body, due to lack of insulin, breaks down fat for energy instead of sugar.  When this happens, the body produces acids, called ketones.  High levels of ketones are very dangerous and can lead to coma or even death, especially in young children. 

Dr. Schmeltz urges patients to be alert to the telltale signs of both types of diabetes:

• Frequent urination
• Excessive thirst
• Lower than normal energy
• Tiredness and weight loss
• Increased appetite
• Sudden vision changes

In addition, these symptoms are particular to type 1:

• Fruity odor on the breath
• Heavy or labored breathing
• Stupor or unconsciousness 

Children with type 1 diabetes may also be restless, apathetic, and have trouble functioning at school. If you notice these signs, talk to a doctor immediately.

Dr. Schmeltz notes that while there’s often an underlying genetic predisposition to type 1 diabetes, “there is not uncommonly, an inciting ‘event’ that sets it off. Mumps is one illness that can inflame the pancreas and act as the trigger. Even a severe ‘cold’ or other stress can set it off. Once insulin production stops, the symptoms appear.”

“I would urge patients to do three things. Number one – know the signs and symptoms, particularly the frequent urination and excessive thirst. Number two – get help and if it’s not diabetes, great. But if it is, treatment can begin immediately. And number three – it’s manageable. With appropriate guidance, diet and medication, a child with type 1 diabetes can do just about any age appropriate activity.

“I have a patient, a young man, who was diagnosed with type 1 about four years ago as a high school freshman. He has done well in school, developing into a 6’4”, 230 pound tight end without an ounce of fat on him. He just received a full ride to college for football. It didn’t hold him back.”

“The take away message: If your child is diagnosed with type 1 diabetes, don’t feel guilty and don’t overprotect. It’s manageable.”

Resources:

American Diabetes Association: http://www.diabetes.org/

Juvenile Diabetes Research Foundation: http://www.jdrf.org/

The patient-doctor relationship has been the priority of the Pennsylvania Medical Society since its founding in 1848. Today, the physician members continue to focus on better health for all Pennsylvanians. To learn more about the Pennsylvania Medical Society, visit the web site at www.pamedsoc.org or its patient website at www.myfamilywellness.org. The Institute for Good Medicine at PAMED can be found www.goodmedicine.org.