Type 1 Diabetes: Pathology & Management

Etiology

Epidemiology

Type 1 Diabetes Overview

Type 1 diabetes is a metabolic disorder that is also known as juvenile diabetes or insulin-dependent diabetes. In type 1 diabetes the pancreas does not produce enough of the hormone insulin or stops making it altogether. Insulin is vital to the process of moving glucose from the bloodstream into the body's cells, where it is used for energy. It also is needed to help the liver to store excess glucose.

Without sufficient insulin, the body is unable to process and use sugar properly to produce the energy that the body needs. Medically, this is known as an inability to metabolize glucose, which results in an abnormally high level of glucose in the blood, called hyperglycemia.

Left untreated, Type 1 diabetes can rapidly progress into life-threatening conditions, including diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, and shock. Long-term complications of Type 1 diabetes are serious and affect every major body organ. They include kidney failure, diabetic retinopathy and blindness, peripheral neuropathy, kidney failure, serious skin infections, gangrene, cardiovascular disease, stroke, disability, and death.

About five to ten percent of all people with diabetes have Type 1 diabetes. The vast majority of people with diabetes in the U.S. have Type 2 diabetes.

Author's Sidebar: Because the majority of diabetics are Type 2, many people make the assumption that when they meet a diabetic, that the person is Type 2. Do not make that assumption! That is offensive to the person in question. Also, there is a stigma associated with Type 2s that some Type 1s do not like being associated with. Type 1s had no control over becoming diabetic, while most Type 2s could have avoided their diabetes by making better dietary and lifestyle choices. So, please, always ask the person whether he or she is Type 1 or Type 2.

It is not yet known what exactly causes Type 1 diabetes, but it is believed to be due to a variety of causes. These include an autoimmune response, in which the body's immune system destroys the insulin-producing cells (islet cells) of its own pancreas. Exposure to certain viruses and family history of the disease may also play a role in the development of the disease. Some other medical conditions, such as cystic fibrosis and alcoholism can damage the islet cells in the pancreas and result in type 1 diabetes.

Prompt diagnosis of Type 1 diabetes and effective ongoing life-long treatment to normalize blood sugar levels in the blood are key to minimizing serious complications.

Symptoms include excessive thirst, excessive urination, fatigue, extreme hunger, significant weight loss, frequent yeast infections and urinary tract infections, blurred vision, impotence, nausea, vomiting, and dehydration.

Type 1 diabetes can be diagnosed during a routine office visit with a simple blood test, called a fasting blood glucose test, which will detect hyperglycemia. High levels of glucose can also be quickly detected with a random blood glucose test or an urinalysis performed on urine. The newest form of testing for diabetes is the glycated hemoglobin (A1C) test, which measures the average overall blood sugar for the past several months.

Management of Type 1 diabetes includes regular monitoring of blood sugar levels, eating a well-balanced healthy diet, and regular aerobic/anaerobic exercise.

Type 1 diabetes is treated with insulin injections, which must generally be given two to four times a day to maintain stable blood glucose levels. Eating superior, well-balanced, wholefood meals can help reduce the amount of insulin needed by the body, but, unlike type 2 diabetes, a certain amount of insulin will always be required.

Please Note: One of the biggest mistakes that hurt Type 1s is the belief that they can eat whatever they want and compensate by injecting more insulin! This leads to unnecessary damage of the blood vessels and organs that could have been prevented or slowed down with a superior nutritional program.

Symptoms of Type 1 Diabetes
The symptoms of Type 1 diabetes are often subtle, but they can become severe. They include:

Type 1 Diabetes: Diagnostic Tests
The list of diagnostic tests for Type 1 diabetes includes:

• Physical examination
• Urine sugar test
• Blood glucose tests

• Fasting plasma glucose (FPG)
• Random plasma glucose

• Tests for ongoing monitoring of diabetes control:

• HbA1c blood test - an average blood sugar measure over about 3 months.
• Fructosamine blood test - an average blood sugar measure over about 2 weeks
  

• Oral glucose tolerance test (OGTT)
• C-peptide blood test
• Insulin level blood test
• Urine ketone tests
• Self-managed blood glucose testing

          o Fingerprick blood drop blood glucose tests
          o Urine glucose home testing
          o Urine ketone home testing

• Type 1 diabetes antibody tests

• Insulin antibody tests
• Glutamic Acid Decarboxylase (GAD) antibody tests
• Islet cell antibody (ICA) tests (or Islet cell cytoplasma antibody test)
• Tyrosine phosphatase IA-2 test
  

• Tests for conditions related to Type 1 diabetes

• TSH blood test - tests thyroid function
• Vitamin B12 blood test - test for pernicious anemia and other digestive problems
  

Glutamic Acid Decarboxylase (GAD) antibody test

This test detects the presence of antibodies to glutamic acid decarboxylase (GAD), which provides early evidence of autoimmune disease activity. Its measurement has been shown to be useful in assisting the physician in the prediction, diagnosis, and management of patients with type 1 diabetes.

Type 1 Diabetes and What Parents Need to Know

Type 1 Diabetes (insulin-dependent diabetes mellitus, IDDM) is associated with the inability of the pancreatic beta cells to produce insulin. This disease is classified as an autoimmune disease that attacks and kills the insulin-producing beta cells. The pancreas continues to form beta cells, but they are rapidly killed off by the malfunctioning immune system.

Type 1 diabetes used to be called childhood-onset diabetes, because it primarily afflicted children whose immune systems had not fully matured. But today adults in their 20s and 30s are now developing this disease.

Key Point 1: Because this disease primarily attacks children, it is imperative that the parents of the child become educated in understanding diabetes, nutrition, and drugs -- beyond the conventional information about Type 1.
 
Children should be applauded for taking on the responsibility to manage their blood glucose every day. Parents should also be applauded for doing an excellent job caring for their child.

But if you want to prepare your child for their college years and beyond, it is imperative that you understand how to take caregiving to the next level -- and, create the proper environment that will prepare your child for the later years. Unfortunately, most parents miss a major opportunity to prepare their child's future beyond the early and teen years.

We recommend that you get a copy of our Diabetes Caregiving Guide to better understand how to prepare your child for the immediate future and beyond. It is critical that the parents educate themselves and act as role models for their child. 

Fill out this form if you would like a free copy of "The Mistakes that Parents Make with Type 1 Children" document.

You may think that you are feeding healthy foods to your child, and you may think that you are doing everything for your child to protect his/her health. To help you to understand the knowledge that you are missing, we strongly recommend that you get Mr. McCulley's book Death to Diabetes today.

If you want to improve your child's quality of health for the future and lead him out of the darkness of ignorance, you must be his/her light. And, in order to be his light, you must acquire the proper knowledge -- the superior knowledge that goes beyond what "the experts" have told you about diabetes and nutrition. That superior knowledge is in Mr. McCulley's book, especially the chapters about nutrition and blood glucose testing.

Dehydration. The build up of sugar in the blood can cause an increase in urination (to try to clear the sugar from the body). When the kidneys lose the glucose through the urine, a large amount of water is also lost, causing dehydration.

Weight loss. The loss of sugar in the urine means a loss of calories which provide energy and therefore many people with high sugars lose weight. (Dehydration also contributes to weight loss.)

Diabetic ketoacidosis (DKA). Without insulin and because the cells are starved of energy, the body breaks down fat cells. Products of this fat breakdown include acidic chemicals called ketones that can be used for energy. Levels of these ketones begin to build up in the blood, causing an increased acidity.
 
The liver continues to release the sugar it stores to help out. Since the body cannot use these sugars without insulin, more sugars piles into the blood stream. The combination of high excess sugars, dehydration, and acid build up is known as "ketoacidosis" and can be life-threatening if not treated immediately.

Damage to the body. Over time, the high sugar levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke.

Who Gets Type 1 Diabetes?
Although the disease usually starts in people under the age of 20, Type 1 diabetes may occur at any age.

The disease is relatively uncommon, affecting 1 in 250 Americans. The condition is more common in whites than in blacks and occurs equally in men and women.

What Causes Type 1 Diabetes?
Doctors don't know all the factors that lead to Type 1 diabetes. It appears that the susceptibility to the condition can be inherited.

Doctors have identified that an environmental trigger plays a role in causing the disease. Type 1 diabetes appears to occur when something in the environment -- a toxin or a virus (but doctors aren't sure) -- triggers the immune system to mistakenly attack the pancreas and destroy the beta cells of the pancreas to the point where they can no longer produce sufficient insulin. Markers of this destruction -- called autoantibodies -- can be seen in most people with Type 1 diabetes. In fact, they are present in 85% to 90% of people with the condition when the blood glucose levels are high.

Because it's an autoimmune disease, Type 1 diabetes can occur along with other autoimmune diseases such as hyperthyroidism from Grave's disease or the patchy decrease in skin pigmentation that occurs with vitiligo.

What Are the Symptoms of Type 1 Diabetes?
The symptoms of Type 1 diabetes are often subtle, but they can become severe. They include:

Signs of an emergency with type 1 diabetes include:

How to Manage Type 1 Diabetes with Less Drugs    
Many people with Type 1 diabetes live long, healthy lives. The key to good health is keeping your blood glucose levels within your target range (80-100 mg/dl), which can be done with proper meal planning, exercise, and (minimum) insulin therapy. People with Type 1 diabetes must use insulin injections to control their blood sugar, but superior nutrition will help to reduce the amount of insulin that is needed.

You will also need to check your blood glucose levels regularly and make adjustments of insulin, food, and activities to maintain a normal blood glucose level.

It is unfortunate that people with Type 1 diabetes are told that they can eat anything they want as long as they increase the amount of insulin to compensate for their food intake. This is wrong! In the long run, it is better to eat healthier foods and reduce the body's need for large amounts of insulin.

Type 1s and even Type 2s are taught to carry some candy with them to combat low blood sugar episodes. This is okay for obvious emergencies but eating candy  or taking sugar tablets every day should not be the norm! Again, in the long run, it is better to eat more frequent, healthier, balanced meals and snacks instead of over-compensating with eating too much candy because of low blood sugar!

One of the keys of any effective diabetes management program should be blood glucose stabilization -- consistent blood glucose readings with minimum fluctuations between the highs and lows.

Key Point: Both Type 1s and Type 2s suffer unnecessarily, especially when a superior nutritional program can help to stabilize blood glucose levels, strengthen the immune system, and cleanse/detox the body, especially the pancreas (for Type 1s).

There must be an adequate intake of foods that don't require a lot of insulin and that provide antioxidants and other phytonutrients to keep the pancreas  and other organs healthy. Antioxidant-rich, low-insulin-response foods include most (organic) green and bright-colored vegetables and (some) fruits, i.e. broccoli, Brussel sprouts, string beans, spinach, kale,  Romaine lettuce, celery, cucumbers, cantaloupe, berries, peppers, (cooked) tomatoes, sweet potatoes, and (organic) carrots. Other key foods include sea kelp, shitake mushrooms, goji berries, aloe vera gel, cabbage, okra, and eggplant.

Unfortunately, both Type 1s and Type 2s who try to eat properly still suffer because they're eating too many "dead" foods and too many so-called healthy foods that are not healthy for diabetics. Once they reduce or eliminate these foods and replace them with superior plant-based foods, both groups are able to achieve more consistent blood glucose stabilization.

Most people are aware that the pancreas controls blood glucose with its secretion of insulin to help lower blood glucose levels. But most people are unaware of the other hormone -- glucagon, which helps to raise blood sugar.

In addition, most people forget that the pancreas performs another key function -- secrete digestive enzymes to help break down the food we eat. That's one of the reasons why a plant-based digestive enzyme supplement may be important for most diabetics.

It is imperative that a Type 1 diabetic avoid all the 5 "dead" foods, especially the dairy, wheat, gluten, grains, hydrogenated oils, fatty animal meat, and the refined processed foods made with sugar and flour. Type 1s should also avoid most soy products, except for the fermented ones,  i.e. kefir, tempeh.

Beans can be a healthy alternative to meats, and in addition to being a low-fat source of protein, beans also provide fiber and B vitamins. Healthy bean choices for the pancreas include kidney beans, black beans, navy beans, garbanzo beans and lentils.

There are other foods and herbs that help to cleanse and detox the pancreas so that it can be repaired and healed by the body. In fact, some clinical studies  [see references below] have shown that the pancreatic beta cells can be awakened from their dormancy to help produce insulin. Refer to Chapters 8, 9 and 15  and the Clinical References in the Appendix of the Death to Diabetes book for more details.

Note: No other diabetes book or program focuses on how to nourish  cleanse, and protect the pancreas! (which is especially critical to Type 1 diabetics).

Note: In addition to more frequent blood glucose testing, the following Super Meal planning attributes are more critical to a Type 1 vs. a Type 2: Meal timing, meal consistency, meal frequency, meal content, carb/protein/fat ratio, number of carbs, and type of carbs.

Consequences of Uncontrolled Type 1 Diabetes
Similar to Type 2 diabetes, when Type 1 diabetes isn't well controlled, a number of serious or life-threatening problems may develop, including:

Retinopathy. This eye problem occurs in 75% to 95% of adults who have had diabetes for more than 15 years. Diabetic retinopathy in Type 1 diabetes is extremely rare before puberty no matter how long they have had the disease. Medical conditions such as good control of glucose, management of high blood pressure, and regulation of blood fats like cholesterol and triglycerides are important to prevent retinopathy. Fortunately, the vision loss isn't significant in most people with the condition.

Kidney damage. About 35% to 45% of people with Type 1 diabetes develop kidney damage, a condition called nephropathy. The risk for kidney disease increases over time and becomes evident 15 to 25 years after the onset of the disease. This complication carries significant risk of serious illness -- such as kidney failure and heart disease.

Poor blood circulation. Damage to nerves and hardening of the arteries leads to decreased sensation and poor blood circulation in the feet. This can lead to increased risk of injury and decreased ability to heal open sores and wounds, which in turn significantly raises the risk of neuropathy and amputation. Damage to nerves may also lead to digestive problems such as nausea, vomiting, and diarrhea.

The good news is that these complications can be prevented by utilizing a superior nutritional program such as the Death to Diabetes Super Meal program, with some slight modifications, i.e. avoid pasteurized cow's milk/cheese and gluten-based products, eat more plant-based organically-grown foods.

Autoimmune Diseases and Glycobiology

Type 1 diabetes is a form of diabetes mellitus that results from autoimmune damage to the insulin-producing beta cells of the pancreas.

Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. In other words, the body actually attacks its own cells. The immune system mistakes some part of the body as a pathogen and attacks it. This may be due to a cellular communication problem.

At one time medical professional learned in biology classes that cellular communication in humans took place via proteins embedded in the surface of most cells of the body. New research in glycobiology has proven that this is not the case. Science now recognizes that cellular communication takes place via glycoproteins, which are the biological merging of specific plant carbohydrates and proteins embedded in cell surfaces. This new biological structure is now referred to as glyconutrients. 

Although it is recognized that a multiple of factors ensure good health and no nutrient stands alone in this process, there is strong belief that without proper cell-to-cell communication, there is no hope for good health because without communication there can be no function. Glycoproteins, proteoglycans and glycolipids are the most abundant glycoconjugates found in mammalian cells. They are found predominantly on the outer cell wall and in secreted fluids. Glycoconjugates have been shown to be important in cell-cell interactions due to the presence on the cell surface of various glycan binding receptors in addition to the glycoconjugates themselves.

However, more research in glycobiology needs to be performed and studied to determine the benefits to our health.

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Diabetes (Type 1):

1. Possible regeneration of the Islets of Langerhans in Streptozotocin-diabetic rats given Gymnema sylvestre leaf extract, J. Ethnopharmacology 30:265-279 (1990). Shanmugasundaram, E.R.B. et al (Dr Ambedkar Institute of Diabetes, Kilpauk Medical College Hospital, Madras, India).
2. Effect of nicotinamide therapy upon B-cell function in newly diagnosed type 1 (insulin-dependent) diabetics. Diabetologia 1989;32:160–2. Mendola G, Casamitjana R, Gomis R.
3. Relationship between cows’ milk consumption and incidence of IDDM in childhood. Diabetes Care 1991;14:1081–3. Dahl-Jorgensen K, Joner G, Hanssen KF.
4. Type I (insulin-dependent) diabetes mellitus and cow milk: casein variant consumption. Diabetologia 1999;42:292-6. Elliott RB, Harris DP, Hill JP, et al.
5. A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. Children antibodies cross-react with and damage the insulin-producing cells of the pancreas. N Engl J Med 1992;327:302-7. Karajalainen J, Martin JM, Knip M, et al.
6. Cow’s milk exposure and type I diabetes mellitus. Preliminary studies have found that early introduction of cows’ milk formula feeding increases the risk of developing type 1 diabetes. Diabetes Care 1994;17:13-9. Gerstein H.
7. Biotin status and plasma glucose in diabetics. Type 1 diabetics were given 16 mg of biotin per day for one week, their fasting glucose levels dropped by 50%. Ann NY Acad Sci 1985;447:389-92. Coggeshall JC, Heggers JP, Robson MC, Baker H.
8. A population based strategy to prevent insulin-dependent diabetes using nicotinamide. Healthy children at high risk for type 1 diabetes (such as the healthy siblings of children with type 1 diabetes) may be protected from the disease by supplementing with niacinamide, but only under doctor supervision. J Pediatr Endocrinol Metab 1996;9:501-9, Elliott RB, Picher CC, Fergusson DM, Stewart AW.
9. The Deutsche Nicotinamide Intervention Study. An attempt to prevent type 1 diabetes. Supplementing with niacinamide may not help prevent type 1 diabetes. Diabetes 1998;47:980-4. Lampeter EF, Klinghammer A, Scherbaum WA, et al.
10. Insulin Cells Persist in Long-standing Diabetes. Study showed that the majority (88 percent) with type 1 diabetes for up to 60 years still had detectable insulin-producing beta cells in their pancreas. According to Dr. P. C. Butler: Type 1 could, theoretically, be cured by stopping the beta cells from being destroyed. Therefore, type 1 diabetes may be reversible by targeted inhibition of beta cell destruction. Additional studies being funded by the Juvenile Diabetes Research Foundation. Reuters Health, June 2005; Diabetes Today; Dr. P. C. Butler, University of California, Los Angeles, CA.
11. China Study supports a plant-based diet that can prevent heart disease, diabetes, and some cancers. The China Study:The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health (2005).   Dr. T. Colin Campbell, Ph.D., Nutritional Biochemistry Cornell University.
12. Note: The China Study was the culmination of a 20-year partnership of Cornell University, Oxford University and the Chinese Academy of Preventive Medicine.

Gymnema sylvestre, Bitter melon:

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