TYPE I DIABETES

By William Lucas
(Biology 015, T: 9:30 1:45, Th: 9:30 10:45)
Diabetes is on the rise in the United States and it seems that most people
know someone who is afflicted with the disease. The American Diabetes
Association estimates that 25.8 million people or 8.3 percent of the United States
population has diabetes. There are 18.8 million people who are diagnosed already,
and an estimated seven million people walking around undiagnosed and unaware
that they have diabetes. (www.cdc.gov, p. 2) What many people may not know or
understand is that there are several types of diabetes, including type I diabetes,
type II diabetes, gestational diabetes, latent autoimmune diabetes of adults (LADA)
and maturity-onset diabetes of youth (MODY). LADA and MODY diabetes are fairly
rare. (Mayo Clinic, pp. 10-12). The most common form of diabetes is type II
diabetes, which used to be called adult onset diabetes and accounts for almost 95
percent of diabetic patients. Five percent of diabetics have type I diabetes,
previously known as juvenile diabetes.(www.cdc.gov, p.2) This report will focus on
type I diabetes, which is an autoimmune disease, and is usually diagnosed in people
under the age of 40, with most diagnoses coming in the childhood or teen years.
Type I diabetes is the most common childhood chronic disorder diagnosed in
the United States, which, according to the American Diabetes Association, affects
one in every 500-600 children. Type I diabetes is an autoimmune disease and is
defined as a chronic condition in which the body is unable to produce insulin and
properly break down sugar (glucose) in the blood, requiring the administration of
insulin by external means. (McCarthy, p. V). Normally, the immune system
protects a person by targeting and destroying viruses and bacteria that enter the
body, in addition to killing diseased cells such as tumors and other dangers to a
healthy persons immune system. (www.niaid.nih, p.2). Healthy cells and tissues
are left alone in a normal immune system response. An autoimmune disease,
however, is when a persons own immune system attacks his or her own cells
because the immune system sees those cells as dangerous and foreign rather than
good cells in the body. In type I diabetes, for example, the immune system attacks
the insulin producing beta cells in the pancreas, and thus a person with type I
diabetes is unable to produce the insulin needed to control blood sugars. The
National Institutes of Health says Type I diabetes is organ-specific and is caused by

immune cells erroneously recognizing insulin-producing pancreatic B cells as

foreign. (www.niaid.nih, p. 1)
As stated in the previous paragraph, type I diabetics are no longer able to
produce insulin and thus must inject insulin in order to control blood sugars and
survive on a daily basis. Insulin is a hormone made by beta cells located in a part of
the pancreas called the islets. (Chase, p.65) The pancreas is an organ in the
endocrine system in the body and is responsible for manufacturing several
hormones. The immune system in a person with type I diabetes has destroyed the
beta cells in the pancreas which produce insulin. Insulin is a necessary hormone
for controlling blood sugars in human beings. Sugar (glucose) is the energy source
needed by our body to function. All organs and systems within the body need sugar
to burn as fuel, including the heart, lungs, liver, pancreas and muscles to name just
a few. Insulin acts as a key to unlocking the cells and thus allowing the sugar to
enter the cells so it can be used by the body. (Chase, p. 10). While a person
without type I diabetes produces his or her own insulin, a person with type I
diabetes must inject the insulin either by a shot or an insulin pump.
Insulin, whether produced in a non-diabetics pancreas or injected, is vital to
keeping blood sugars within a target range and this is crucial for all human beings.
Blood sugars that are too high or too low can cause severe complications, coma and
even death. Blood sugars are tested using a small drop of blood from a finger poke
and a blood glucose meter which measures the amount of sugar in the blood
stream. A person without diabetes will usually have a blood sugar reading in the
range of 80-120. The pancreas of a non-diabetic automatically adjusts the amount
of insulin produced depending on how much is needed to keep the body in the
target range. The goal for a person with type I diabetes is to also keep blood sugars
as close to the target range as possible in order to avoid serious complications.
Blood sugars that are too high for an extended period of time means that there is
not enough insulin in the blood to allow the sugar into the cells. Extreme high blood
sugars, over 300, for a period of time can lead to an emergency situation called
diabetic ketoacidosis (DKA) and can lead to a diabetic coma and death.
Diabetic ketoacidosis is very dangerous and occurs when there is not enough
insulin in the body. The cells in the body think they are starving because they are
empty of sugar. Instead the sugar is free floating in the bloodstream. The cells
signal the brain which signals the liver to release more glycogen (stored glucose) in
William Lucas, Bio 015

order to erroneously raise blood sugar. Thus, blood sugars rise even higher.
Ketones are produced in the liver as a by-product of high blood sugar. According to
Dr. Ragnar Hanas, In Type I Diabetes, In normal circumstances, ketones are used as
fuel by your muscles, heart, kidney and brain. If you have diabetes, ketones are
produced in excess when there is a lack of insulin in your bodytoo many ketones
make your blood acidic, causing ketoacidosis. (Hanas, p.29) Ketoacidosis can
cause the organs in the body to shut down and lead to death. High blood sugars
over long periods of time, even those in the 200s consistently, may not cause
severe DKA, but can lead to complications in later years such as blindness,
amputations, stroke and heart disease, among other serious illnesses. Insulin
brings blood sugars down; that is why is it essential to have insulin in a body, either
made by the pancreas or injected if one does not produce it naturally.
Blood sugars that are too are high dangerous, but DKA can take hours to
come on and the serious side-affects of long-term high blood sugars may take years
to emerge. Low blood sugars, below 70, are an immediate emergency for a type I
diabetic. The body needs sugar to burn as fuel in order to survive. When there is
not enough sugar, and blood sugars are dropping into the 50s, 40s or lower, the
body starts to shut down. A diabetic with a low blood sugar can become
unconscious and die in a short period of time unless emergency action is taken. If a
type I diabetic is already experiencing low blood sugars, but has not passed out, the
person needs an immediate source of fast acting sugar, such as glucose tablets,
regular soda (not diet), candies that are not chocolate such as skittles and
starbursts, juice or glucose drink. Once a diabetic becomes unconscious, a lifesaving glucagon shot needs to be administered and an ambulance called. Glucagon
is the shot (which comes in a red case) that includes a glucagon tablet and water to
mix, and is then injected into a diabetic. Glucagon is another hormone naturally
produced in the pancreas. When blood sugars in the body start to drop, the
pancreas releases glucagon which in-turn tells the liver to release stores of glycogen
(stored sugar) in order to raise blood sugars. In a person with type I diabetes, the
body is no longer able to produce sufficient amounts of glucagon, especially if too
much insulin has been injected or too much fuel has been burned by the body. For
that reason, glucagon must be injected into a type I diabetic to save that persons
life and raise the blood sugar. (Hanas, pp. 33 -34)

William Lucas, Bio 015

In order to keep blood sugars in a target range, type I diabetics must be

vigilant about carbohydrate intake and insulin coverage. All foods, except meat,
cheese, eggs, water and drinks specifically made carbohydrate free have some
carbohydrates. Carbohydrates are converted to glucose (sugar) in the body and
used as fuel by the cells to keep body functions running well. Many people know
that foods such as candy, cake, cookies, potatoes, rice and cereal are high
carbohydrate foods. Some people do not realized that foods such as apples, corn,
milk, carrots and other fruits and vegetables also have carbohydrates. Usually the
amount of carbohydrates in healthy foods such as fruits and vegetables are lower
than breads, pastas and unhealthy foods, such as cake. All carbohydrates are
converted to glucose in the body, though, whether those carbohydrates came from
an apple or a cookie. It is important to choose the right carbohydrates to be
healthy. A type I diabetic must choose carbohydrates to eat, count the amount of
carbohydrates in the chosen foods and then accurately give the right dose of insulin
to cover the carbohydrates and keep the blood sugar in range. It may sound
simple, but it is actually very difficult. Fat, such in the cheese in pizza, will slow
down the absorption of the carbohydrates because the stomach empties slowly.
Thus a diabetic must adjust for this knowing that some of the carbohydrates from
the crust normally absorb quickly, but that the cheese will slow that absorption rate
down and thus blood sugars are likely to rise again several hours after eating the
pizza. Drinks, such as juice, or even a high carbohydrate food such as a potato
without butter will cause a rapid rise in blood sugar because they pass quickly
through the stomach. Insulin must be given prior to eating or drinking these types
of foods so it will already be working when the sugars from those carbohydrates
enter a persons blood stream.
Living with type I diabetes is not easy. A type I diabetic must test his or her
blood sugar with a blood glucose meter a minimum of four times a day, and more if
exercising, feeling unwell or for other reasons. Exercise is very good for all people
and especially for those with diabetes because it helps a persons body use insulin
more efficiently. Diabetes is hard to live with, but there are many advances in the
area of technology and medications, as well as ideas for how to cure this disease.
Type I diabetics can now wear insulin pumps 24 hours a day to deliver a constant
flow of insulin, in addition to the insulin they need to administer to cover the
carbohydrates they ingest. Continuous glucose monitors can also be worn on the
stomach which measure glucose readings in the subcutaneous fluid and can then
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graph wirelessly to the pump. These are helpful, but not completely accurate yet.
Advances in medicine make a cure in the near future more likely. Experiments are
already taking place in how to reintroduce the beta cells that produce insulin. The
main stumbling block for researchers and scientists in this hopeful area is how to
keep the immune system from targeting and killing these new cells as it did with the
original beta cells. In addition, doctors and researchers can test siblings and
relatives of type I diabetics to see if they already have antibodies in their blood
which make it more likely that they will develop type I diabetes. Experiments are
ongoing with medications to halt the progression of the destruction of the beta cells
in those people that already show the destructive antibodies in their blood stream.
Some researchers believe this may eventually lead to some sort of vaccine in the
future for those who are at risk, but do not already have type I diabetes. The future
is hopeful on many fronts for people with diabetes and those who may be
diagnosed. Many people contribute support, both financially and emotionally to
causes focused on diabetes, and scientists and doctors are working hard to find a
cure and make living with diabetes easier

Bibliography
Center for Disease Control and Prevention. Fast Facts on Diabetes - 2011 National
Diabetes Fact Sheet. 24 October 2013. 28 April 2014
<http://www.cdc.gov/diabetes/pubs/factsheets11/fastfacts.htm>.
H. Peter Chase, M.D. Understanding Diabetes A Handbook for People Who Are Living
with Diabetes. Denver: Children's Diabetes Foundation, 2006.
Hanas, Dr. Ragnar. Type I Diabetes in Children, Adolescents and Young Adults.
London: Class Publishing, 2007.
McCarthy, Moira. The Everything Parent's Guide to Children with Juvenile Diabetes.
Avon, Massachusetts: Adams Media, 2007.
The Mayo Clinic. The Essential Diabetes Guide. Time Home Entertainment, Inc.: New
York, 2013.
U.S. Department of Health and Human Services: National Institutes of Health.
Disorders of the Immune System. 23 January 2014. 28 April 2014
<http://www.niaid.nih.gov/topics/immunesystems/pages/default.aspx>.
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William Lucas, Bio 015