Understanding & Diagnosing Type 1 Diabetes

 Dr.  Ajay Gupta, MD Chief Pathologist IFA , Gurugram

 Type 1 diabetes is an autoimmune disorder (disease in which our body destroys our own cells) leading to high blood glucose levels. This type of diabetes is usually diagnosed in children and young adults, and less than 5% of people with diabetes have this form of the disease. In this disease, the body produces little or no insulin-a hormone released by pancreas in our body.

Insulin is responsible for getting glucose from blood into our cells so that blood glucose levels are maintained within a specific range. What actually happens in type 1 diabetes is: there occurs destruction of the beta cells of pancreas which produce and release insulin, ultimately leading to the hormone’s decreased levels or even absence of it. Hence when insulin levels are very low, glucose from the blood would not be transported to our cells, as a result blood glucose levels rise abnormally leading to diabetes. This type of diabetes requires regular insulin injections to maintain blood glucose levels hence monitoring blood glucose levels is very important.

Common symptoms of type 1 Diabetes-

  • Increased Urine frequency; bed wetting in children
  • Increased thirst
  • Increased appetite
  • Unwanted weight loss
  • Lethargy
  • Blurred vision in some children

Type 1 diabetes can also occur in adults; in such cases the symptoms are not generally clear.

ADA (American diabetes Association) recommends the following reference range of blood sugar tests for diagnosis of both type 1 and type 2 diabetes.

  • FPG ≥126 mg/dL
  • 2-h Post Glucose meal blood sugar ≥200 mg/dL
  • Hb A1C ≥6.5%

Type 1 diabetes usually starts in childhood hence early diagnosis is of utmost importance. It is estimated that India is housing approximately 1 lakh people with type 1 diabetes.

We at SRL had one such case of a 5 year old girl who had visited a paediatrician with complaints of pain in stomach with vomiting. She didn’t have loose motions or fever but had been losing weight over past month or so. She was investigated in detail and finally when her blood sugar was checked, it was 300 mg/dl with urine sugar being 3+, all her routine and special investigations were done at SRL and she was finally diagnosed with Type 1 Diabetes.

Role of Special tests in Type 1 diabetes-

Glucose and A1C levels rise well before the clinical onset of diabetes, making diagnosis feasible well before the onset of complications of diabetes. It is important to check these markers in children if there is a family history of autoimmunity (e.g. Type 1 Diabetes, Rheumatoid Arthritis, SLE etc). Although a diagnosis of diabetes can be made on the basis of blood sugar tests, Type 1 diabetes is defined by the presence of one or more of these autoimmune markers.

  • GAD 65 ( Glutamic acid decarboxylase ) antibody – This test helps not only to diagnose but also helps to assess the risk of developing & predicting the onset of the development of type 1
  • Insulin Autoantibody – This test helps to detect insulin antibodies in pts who are prediabetic; also helps to detect autoantibodies in patients on treatment with human insulin
  • ICA (Islet Cell Antibody) – These antibodies are present in the serum of pts the prediabetic phase and also predict development of type 1 diabetes.
  • C –peptide – This test helps to monitor treatment by insulin and also to distinguish between type 1 and type 2 diabetes.

 

 

 

 

                                                                                                                                                                                                                                          

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