The Diabetes Center of Excellence at Shands at UF

Type 1 Diabetes

Signs and Symptoms of Type 1 Diabetes

Type 1 diabetes often appears suddenly. Signs and symptoms include:

nausea and vomiting
feeling edgy and having mood changes
weakness and tiredness
extreme weight loss
extreme thirst
extreme hunger
requent urination and/or bed wetting in children
high levels of sugar in the urine
high levels of sugar in the blood

Treatment of Type 1 Diabetes

Once type 1 diabetes has been diagnosed, it is vital to follow the physician's treatment plan. The goal of the treatment plan is to keep the blood sugar level as close to normal as possible. It may include:

food to raise blood sugar
meal plans to regulate production of blood sugar
exercise to lower blood sugar
frequent blood testing using a portable meter to monitor blood sugar levels
urine testing for ketone levels

People with insulin-dependent diabetes (type 1) no longer make insulin and so, must give themselves insulin every day. It can be injected, which involves use of a needle and syringe, or it can be given by an insulin pump or pen.

The amount of insulin needed depends on height, weight, age, food intake and activity level. Insulin doses must be balanced with meal times and activities and dosage levels can be affected by illness, stress or unexpected events.

Insulin cannot be taken as a pill. Because it is a protein, it would be broken down during ingestion just like the protein in food. It must be injected into the fat under the skin for insulin to get into the blood.

Currently, there are over 30 types of insulin made by four companies in the United States. Allergic reactions to insulin are rare.

Complications of Type 1 Diabetes

There are three key complications of type 1 diabetes:

Hypoglycemia (Low blood sugar) - this is sometimes called an insulin reaction and happens when blood sugar drops too low
Hyperglycemia (high blood sugar) - this occurs when blood sugar is too high and is often a sign that diabetes is not well controlled
Ketoacidosis - or diabetic coma, a very serious condition requiring immediate medical intervention

Signs and Symptoms of Type 2 Diabetes

Almost half of all Americans who have diabetes may not know it. Because type 2 occurs most prevalently in those over the age of 40, the signs and symptoms may be confused with the general signs of aging and may be mild and sometime almost unnoticeable. They include:

increased thirst
increased need to urinate
feeling edgy, tired and sick to the stomach
increased appetite but loss of weight
repeated or hard to heal infections of the skin, gums, vagina or
bladder
blurred vision
tingling or loss of feeling in the hands or feet
dry, itchy skin
cuts and bruises that are slow to heal

Treatment for Type 2 Diabetes

Treatment of diabetes is an ongoing process of management and education. Its success depends on the patient's health care team, family members and motivation of patient to monitor his/her blood sugar levels. Through regular physical activity, meal planning and routine health care some people often are able to control their diabetes. Elements of treatment can include:

weight control
proper diet
exercise
proper hygiene
insulin replacement therapy directed and monitored by the treatment team

When diet and exercise are not enough to adequately control blood sugars, then insulin must be added to the treatment equation. This can be delivered as insulin shots or oral medications.

Only people with type 2 diabetes can take oral medications - they are ineffective for people with type 1 diabetes because in type 1 diabetes the pancreas has lost all ability to make insulin. People with type 2 diabetes still make some insulin, but not enough and their bodies do not "metabolize" glucose adequately.

Oral Medications

Sulfonylurea Drugs - boost the pancreas's production of insulin and make the body cells more receptive to glucose
Biguanides - may make cells more receptive and may also decrease glucose production in the liver
Acarbose - works by delaying the absorption of glucose in the intestine

Physicians often combine diabetes oral medications with insulin shots in people with hard-to-control type 2 diabetes. These oral medications do not replace other aspects of a treatment plan, especially weight control, exercise and an appropriate diet. And, they don't work for everyone. Sometimes insulin is still needed during illness, pregnancy, or surgery.

Complications of Type 2 Diabetes

Without good control of blood sugar, untreated or inappropriately treated diabetes can cause long-term complications which may involve the kidneys, heart, legs, feet, eyes, nerves and blood flow. Diabetic patients have a high rate of kidney and heart failure, gangrene and amputation, blindness and stroke. For these reasons, it is imperative to monitor one's blood sugar and closely follow a treatment plan. Recent studies indicate that people who keep their blood sugars as close to target as possible can reduce developing some of these complications by 50 % or more.