Type 1 diabetes mellitus: symptoms, diet and treatment

By Cristiano Antonino On Apr 11, 2023

Type 1 diabetes, also called juvenile diabetes due to its tendency to develop predominantly during the childhood and adolescent years, is an autoimmune disease

The immune system, identifying the cells of the pancreas that produce insulin (Beta cells) as foreign and harmful, is led to attack and then destroy them.

In the face of this, there is a progressive reduction culminating in the zeroing of insulin production, a hormone whose job is to regulate the blood glucose level.

Therefore, a situation of excess glucose in the blood occurs called hyperglycemia.

The lack or scarcity of insulin, therefore, does not allow the body to use the sugars introduced through the diet.

The unprocessed sugars are thus eliminated in the urine.

In such a circumstance, the body is forced to produce energy in other ways.

Mainly through the metabolism of fats, inducing the production of what are called ketone bodies.

The accumulation of the latter in the body, in the absence of timely intervention, can cause very dangerous effects up to coma.

The difference between type 1 and type 2 diabetes mellitus

Unlike type 1 diabetes, characterized by the absence of insulin secretion due to an autoimmune process, in type 2 diabetes there is no lack of insulin production.

Just as there is a lack of an immune response that prevents the pancreas from functioning. Instead, there is a reduced amount or what is called insulin resistance.

That is, an inadequate use of glucose by the cells.

Another difference between the two types of diabetes lies in the age of onset.

In fact, type 2 diabetes typically appears after the age of 40, even if the age of onset is progressively decreasing due to the ever-increasing diffusion of obesity even in the younger age group.

Type 1 diabetes mellitus accounts for about 10% of diabetes cases. It typically develops during the teenage years.

It can also appear in very young children (even infants) or young adults and is lifelong.

Type 1 diabetes can be divided into two main categories

Autoimmune diabetes mellitus

Until recently known as insulin-dependent diabetes.

It occurs in the vast majority of cases during childhood or adolescence (infantile diabetes), although cases among adults are not uncommon.

It is generated by the destruction of beta cells by antibodies.

The speed of destruction of these cells varies according to the individual concerned, in some it is high and in others very slow.

The rapidly progressing form occurs mainly, but not exclusively, in children.

The slowly progressive form typically occurs in adults and is sometimes called latent autoimmune diabetes in adults (LAD).

Idiopathic diabetes mellitus

It is a rather rare form of type 1, which occurs mainly in people of African or Asian ethnicity.

It is characterized by permanent insulin deficiency accompanied by ketoacidosis.

There is no evidence of autoimmunity.

For idiomatic type 1 diabetes mellitus, the underlying causes are not yet known.

Type 1 diabetes symptoms

The absence (or scarcity) of insulin does not allow the body to use glucose to produce the energy necessary for its functioning.

Consequently, glucose taken with food is not used but eliminated from the body through the process of urination.

This generates an increase in urinary volume, with a consequent increase in the sensation of thirst, and a sudden weight loss as nutrients are not retained.

Symptoms of type 1 diabetes, which tend to come on more quickly and more severely than type 2 diabetes, typically include:

exhaustion
polydipsia, i.e. increased thirst
polyuria, i.e. increased diuresis
paradoxical polyphagia (sudden weight loss unrelated to changes in diet)
malaise
abdominal pains

In severe cases, mental confusion and loss of consciousness can also occur.

The major complications deriving from diabetes can cause serious damage to the patient at a neurological, renal, ocular and cardio-cerebrovascular level.

Often the first manifestation of type 1 diabetes is diabetic ketoacidosis: an increase in the amount of ketone bodies in the blood.

In some cases there is an interruption of symptoms immediately after this first phase; it is a transient condition, known as a honeymoon, which can only last for a few months.

After this short period, the symptoms reappear and remain permanently, giving life to the pathology itself.

Type 1 diabetes diet

A healthy and balanced diet is essential in case of juvenile diabetes.

Together with the correct administration of insulin, nutrition contributes to the maintenance of an adequate metabolic balance, a priority objective for every diabetic subject.

The diet of the type 1 diabetic child does not essentially differ from that of a non-diabetic child.

Starting from similar nutritional needs, it will aim at harmonious growth and the achievement and maintenance of the ideal weight.

The same general principles valid for the diet of adults also apply to children.

Distribution and number of meals, distribution of calories among the various food principles and so on.

With the foresight that, since it is a growing organism, it is advisable to let the child eat his fill.

Even ice cream, with the necessary precautions, can be included in the diet of children affected by diabetes.

It is also advisable that a correct balance of all the elements of the diet is associated with regular physical exercise.

Given that an appropriate and balanced diet in the case of juvenile diabetes can only be prescribed by a specialist doctor, the diet should approximately follow a similar pattern:

carbohydrates should make up about 55% of total calories.
And accompanied by adequate quantities of vegetable fibers, water-soluble species such as those of legumes, fruit and vegetables.

Foods with complex carbohydrates such as pasta, rice, potatoes and bread are preferable

proteins must represent about 15% of calories, they can be of both animal origin (milk, meat, eggs, fish) and vegetables (legumes, rice, pasta)
fats must cover about 30% of total calories; vegetable ones are suggested
vitamins and mineral salts do not add calories and are essential for a well-balanced diet
fibers have a positive effect on lipid and glucose metabolism; legumes, green leafy vegetables, fruit, whole grains are particularly recommended

Sweet foods such as cakes or ice cream can be eaten, but as part of a meal rich in vegetables and fiber.

The “breaks from the rule” in the diabetic child

As for habits such as eating meals in a fast food restaurant, in the case of a child with type 1 diabetes it is certainly not recommended to go overboard in this sense, even more so than in normal conditions.

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However, if the diet followed is balanced, an occasional meal of this type will not be harmful.

However, it is recommended to take portions of vegetables and avoid ketchup and mustard, which contain a lot of sodium.

Furthermore, it is always important to read the product labels carefully, especially to make sure of their sugar content.

Great care is recommended in the case of “sugar-free” products, as they are often rich in fat and therefore high in calories.

Of great importance in the context of an adequate diet is the counting of carbohydrates.

The latter has the function of optimizing insulin therapy, evaluating the extent of the insulin dose before the meal, in relation to the meal itself.

This principle is evidently part of a food education aimed at the child and his family.

The diet is usually provided by a specialist (the dietician) as part of the therapeutic education project for diabetes management.

The distribution of meals

At the end of the course, the diabetic subject will be able to establish direct equivalences between the dishes he habitually eats and their appropriate insulin bolus.

Finally, the diet of a diabetic child should contemplate the following distribution of meals:

– 2 main

– 3 secondary, i.e. breakfast, mid-morning snack, snack

– 1 snack before bedtime for those who are used to it.

As briefly mentioned, a healthy and correct diet should be accompanied by regular physical activity.

Also with a view to preventing cardiovascular complications.

In adolescents, for example, sport represents an important moment of socialisation.

A diabetic boy probably feels more discomfort in places where aggregation occurs around food or drink than on a playing field.

However, sporting activity presents risks and this is why it cannot be exempt from a certain type of organization.

Workouts and meetings can be planned and incorporated into the planning of meals and insulin doses.

Furthermore, in sporting activities the boy must always have a reserve of simple sugars and a device for measuring blood sugar close at hand.

It is essential that coaches or other reference adult figures are informed about the risk of hypoglycemia crises and the measures to be taken with patients with type 1 diabetes.

Treatment of type 1 diabetes mellitus

Today, there is still no cure for type 1 diabetes mellitus.

The only viable therapy is lifelong exogenous administration of insulin.

Compliance with insulin therapy together with a balanced diet and physical exercise allow effective control of blood sugar.

Insulin is mainly administered by injections into the tissue under the skin from which it then spreads throughout the body.

The task of exogenous insulin (given by injection) is to simulate as closely as possible the action of endogenous insulin (i.e. insulin produced by the body).

This applies to both basal (constant throughout the day) and acute (following meals) insulinisation and therefore allows normal use of glucose by cells both in fasting conditions and after meals.

In recent years, progress in the scientific field has made insulin therapy much easier to follow, without too rigid constraints so as not to have to give up spontaneity in one’s daily life.

Previously, the life of diabetics was heavily penalized by the need to perform insulin injections at precise times and in relation to meals.

Iron and steel rules often difficult to respect in a precise way, above all if one considers that type 1 diabetes mellitus mainly affects children and adolescents.

Today patients with type 1 diabetes can finally eat when they want while maintaining excellent glycemic control.

All thanks to the quantitative evaluation of carbohydrates, the control of blood sugar levels and any adjustments in insulin dosages.

Of fundamental importance in the therapy of type 1 diabetes is the daily self-monitoring of blood sugar.

We refer to a series of operations to be carried out every day independently and comfortably at home to monitor the level of glucose in the blood.

Self-control is an essential practice for:

achieve adequate metabolic control
prevent or delay the onset of acute complications (ketoacidosis and hypoglycemia)
prevent or delay the onset of chronic complications.

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