Explained: Managing type 1 diabetes

Last week, the Indian Council of Medical Research (IMCR) issued guidelines for the diagnosis, treatment and management of type 1 diabetes. This is the first time the International Board of Forensic Medicine has issued guidelines for type 1 diabetes, which is rare for type 2 – only 2% of all hospital diabetes cases in the country are type 1 – but it is diagnosed more frequently. In the last years.

“Today, more and more children are being diagnosed with type 1 diabetes in our country. This may be because the actual prevalence of the disorder is on the rise in India. It may also reflect better awareness and thus improved prognosis of type 1 diabetes. Finally, children can be Live more because of early diagnosis and better treatment.

India is considered the diabetes capital of the world, and the pandemic has disproportionately affected those living with the disease. However, type 1 or childhood diabetes is not talked about, even though it can become fatal without proper insulin treatment.

So, what is type 1 diabetes?

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Type 1 diabetes is a condition in which the pancreas completely stops producing insulin, the hormone responsible for controlling the level of glucose in the blood by increasing or decreasing the uptake by the liver, fat and other body cells. This is in contrast to type 2 diabetes — which accounts for more than 90% of all diabetes cases in the country — where the body’s production of insulin decreases or cells become insulin resistant.

Type 1 diabetes is diagnosed mostly in children and adolescents. Although the prevalence is lower, it is much more severe than type 2. Unlike type 2 diabetes where the body produces some insulin which can be managed with different pills, if a person with type 1 diabetes stops taking insulin, they die in within weeks. “The body doesn’t produce any insulin,” said Dr. V. Mohan, president of the Dr. Mohan Specialist Diabetes Center and one of the authors of the guidelines.

Before insulin was discovered 101 years ago, these children would die within months after diagnosis. Now, with better insulin and various innovations, they are living longer. My oldest patient with type 1 diabetes is now 90 years old; He was diagnosed when he was sixteen years old.

Children with this condition usually go to the hospital with severe symptoms of frequent urination and extreme thirst, and nearly a third of them have diabetic ketoacidosis (a serious condition in which the body is high in ketones, a molecule produced when the body is not otherwise able to absorb glucose for energy and begin to break down fat instead).

How rare is that?

There are more than 10 children and adolescents with type 1 diabetes in the world, with India accounting for the highest numbers. Out of the 2.5 thousand people living with type 1 diabetes in India, 90,000 to 1 lakh are under 14 years of age. For context, the total number of people living with diabetes in India was Rs 7.7 crore in 2019, according to the Diabetes Atlas of the International Diabetes Federation.

The guidelines, which distinguish type 1 diabetes from other, less common forms, also talk about how the increased incidence of type 2 diabetes due to obesity in young people can lead to confusion. Among individuals who develop diabetes under the age of 25, 25.3% have type II.

Who is at risk of developing type 1 diabetes?

The exact cause of type 1 diabetes is unknown, but it is believed to be an autoimmune condition in which the body’s immune system destroys islet cells in the pancreas that produce insulin.

Genetic factors play a role in determining whether a person will develop type 1 diabetes. The risk of developing the disease in a child is 3% when the mother has it, 5% when the father has it, and 8% when his brother has it.

The presence of certain genes is closely related to the disease. For example, the prevalence of genes called DR3-DQ2 and DR4-DQ8 is 30-40% in patients with type 1 diabetes compared to 2.4% in the general population, according to the guidelines.

What are the guidelines?

Of 173 pages, it was developed by leading diabetes doctors including Dr. Nikhil Tandon, Head of Department of Endocrinology at All India Institute of Medical Sciences (AIIMS), New Delhi. There were many guidelines from international agencies. However, this is the first truly Indian guideline that looks at everything from diagnosis, treatment and management of type 1 diabetes. It gives detailed guidance on managing the disease in different circumstances such as when one is pregnant or when one is traveling, said Dr. V Mohan.

The instructions provide details about diet, exercise, insulin monitoring, and prevention and treatment of complications such as retinopathy, kidney disease, and nerve disease. The doctor said the guidelines will hopefully serve as a ready reference book for all practicing physicians to improve the care of children diagnosed and living with the condition.

Similar evidence already exists for type 2 diabetes.

How has type 1 diabetes treatment evolved over the years?

Dr. Mohan said the discovery of insulin helped children with this condition survive, “but they still have to continue to prick themselves to deliver insulin throughout their lives, and researchers are now looking for a treatment and there are some encouraging results from stem cell therapy to the increase in islet cells.” .

“Every child in the world should have access to insulin, it is an essential medicine. In India, half of the people can afford it, and the other half can get it for free in most government hospitals. It costs around 5,000 rupees a month.”

Dr. Mohan said continuous glucose monitors and an artificial pancreas are starting to appear, although these are preliminary reports and it may take a few years for them to become available as a treatment. “Continuous glucose monitors can help monitor blood glucose levels 24 hours a day with the help of the sensor. The artificial pancreas goes further and, along with monitoring the levels, can deliver insulin automatically when needed.”
The guidelines state that “cost considerations remain an issue in India. Thanks to better management, diabetic ketoacidosis is becoming less common, although in rural areas and in peripheral centres, it remains a significant problem.”

The guidelines also recognize modern glucose meters. Monitoring of urine glucose (not blood glucose) was the standard before glucose meters. And at first, even glucose meters were expensive, painful, expensive and inaccurate. Today, we have blood glucose monitors that are very accurate and less painful. However, the cost of the strips remains a challenge,” the guidelines state.

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