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Living with Type 1 Diabetes
Dr. William Russell, Vanderbilt’s Director of the Division of Pediatric Endocrinology and Diabetes, joins Stacey Bonner, Family Services Coordinator, to speak on Type 1 Diabetes.
View Vanderbilt Children’s Diabetes Program for resources and services
Learn about Type 1 Diabetes TrialNet at Vanderbilt
Stacey Bonner: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Stacey Bonner with the Child and Family Center. The most common type of diabetes in children is type 1 diabetes. Dr. William Russell, director of the Division of Pediatric Endocrinology and Diabetes, has joined me to discuss what type 1 diabetes is and how to manage type 1 diabetes. Welcome Dr. Russell.
Dr. William Russell: Thank you very much. Happy to join you.
Stacey Bonner: Dr. Russell, what is type 1 diabetes?
Dr. William Russell: Well, type 1 diabetes is a disease of abnormally high blood glucose levels or blood sugar levels, and its origin though is in the immune system. Type 1 diabetes occurs when a patient’s own immune system begins to attack the cells in the pancreas. They are called beta cells that make insulin, and so with increasing levels of destruction of the beta cells by the immune system, the ability of the patient to make insulin begins to go down and eventually blood glucose levels become abnormally high. It is very different from type 2 diabetes which we also see in children although too much lesser extent. Type 2 diabetes is a disease of high blood sugars, but they result from usually a resistance of the body to the insulin that the patient is making. The insulin signal just does not work very well in the cells, and the blood sugar level is high. The major difference in the treatment is that in type 1 diabetes, there is only one treatment, and that is to replace the insulin that the patient is not making with shots or insulin pumps. In type 2 diabetes, you can often get pretty good control of blood glucose with pills, with other things which you can take by mouth that are not insulin but actually either cause the pancreas to produce even more insulin or sensitize the body cells to the insulin that the patient is making.
Stacey Bonner: Who is usually diagnosed with type 1 diabetes?
Dr. William Russell: Well, as you can surmise from its old name of juvenile diabetes, type 1 diabetes is diagnosed predominantly in young people. The peak age group is roughly 10 to 15 years of age. That is the peak incidence, but we see it as young as 9 months of age, and we see it in people well into their 40s and even 50s. The way we confirm the diagnosis of type 1 diabetes or distinguish it from type 2 is that in type 1 diabetes because of this immune system problem, you can detect antibodies in the blood that are quite characteristic of this autoimmune attack on the pancreas, so even adults who develop diabetes if they are screened with antibodies, we can segregate out those few who actually have autoimmune diabetes or type 1 diabetes. One thing that is important to know–there is a lot of concern about the increasing incidence of type 2 diabetes in children. As children become more inactive and obese, we see a lot more type 2 diabetes in children, and it is highly variable around the country as to what proportions of type 2 and type 1 people see.
Stacey Bonner: What are some of the symptoms of type 1 diabetes?
Dr. William Russell: So, when the blood glucose becomes elevated, normally it stays around 100 mg/dL but around 100 is normal, and after you eat, it might go up to something less than 140 or so. When the blood glucose becomes much over 200, you start to notice a variety of things, the body tries to get rid of the extra glucose through the kidneys, and you will start to see increased urination, and in order to excrete or get rid of the glucose in the blood, it pulls water out with it, so the patient becomes dehydrated, so they start to urinate more frequently. They start to drink more often and eventually their appetite may be unaffected or even increased a little bit, but with the passage of time what happens is that they begin to lose weight, so they are often eating more, they are definitely drinking and urinating more, but they start to lose weight, they start to feel sickly, they feel tired and run down, and as this progresses and really what is happening is that there is more and more destruction of the beta cells, and so, there is less and less insulin to do the job. Eventually, they get quite sick. They start to vomit, and there is a condition that can be fatal what is called diabetic ketoacidosis where the patient becomes extremely dehydrated. They start developing high levels of acid in their blood or acetone is one of the features, so these are called ketones, and the blood glucose becomes very high. It can lead to death because in children in particular can often cause brain swelling. So, it is a condition we really do not want to allow kids to progress to. We would like to be able to determine who is at risk to develop type 1 diabetes much earlier and intervene far before anything like that happens.
Stacey Bonner: Thank you Dr. Russell. Thanks for listening. Please feel free to leave us any comments on this Wellcast by clicking the “Add New Comment” link at the bottom of this page. If you have a story or suggestion, please email us at firstname.lastname@example.org or you can use the “Contact Us” link on our website at healthandwellness.vanderbilt.edu.
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