Kulwicki 1

Joshua D. Kulwicki

Jackson collage

Bio 254

December 4, 2014

Type 1 Diabetes

The disorder I have chosen to research is Type-1 Diabetes or Diabetes

Mellitus (T1DM). Type 1 diabetes, once known as juvenile diabetes or insulin-

dependent diabetes, is an autoimmune disease in which a persons pancreas

stops producing sufficient amounts of insulin, a hormone needed to allow

sugar (glucose) to enter cells to produce energy. It occurs when the bodys

immune system attacks and destroys the insulin-producing cells in the

pancreas, called beta cells. This disease has nothing to do with lifestyle

choices or health; it is something you are born with. It causes are still

somewhat unknown but it is theorized that genetics and some environmental

factors may play a role. Type 1 diabetes accounts for approximately 10-20%

of all types diabetes. Diabetes is the 7th leading cause of death in the U.S.

and affects 25.8 million people (8.3% of the U.S. population). Approximately

18.8 million people are diagnosed and 7 million are undiagnosed cases. It is

one of the most common childhood diseases and has been increasing 3 to 4

% per year in youths and even more in children under 5 years old.

The pancreas is the organ that secretes insulin to lower blood sugar. It

is both an exocrine and endocrine organ. The exocrine portion is a digestive

organ that secretes digestive juices and enzymes into a duct that runs down
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the middle of the pancreas and empties into the duodenum of the small

intestine at the head of the pancreas. The pancreas is also an endocrine

organ, producing insulin, glucagon, and somatostatin that flow directly into

the bloodstream, eventually reaching almost every cell in the body. The

endocrine portion of the pancreas is where we want to focus and more

specifically the cells that secrete the hormones that normally regulate blood

sugar levels in the body. The endocrine function consists primarily of the

secretion of the two major hormones, insulin and glucagon. Both insulin and

glucagon are important in the regulation of carbohydrate, protein and lipid

metabolism. B cells or Beta cells produce insulin, an anabolic hormone that

increases the storage of glucose, fatty acids, and amino acids in cells and

tissues, lowering the level of glucose circulating in the blood. Insulin

secretion is stimulated by high blood glucose levels and other factors

including several amino acids, intestinal hormones, acetylcholine, and

parasympathetic N.S. (rest and digest) functions, storing glucose when the

body has too much in circulation exceeding the bodys resting energy

requirements. Inhibitory factors include somatostatin, norepinephrine a

sympathetic N.S. stimulation (fight or flight), calling for an increase in blood

glucose levels. A cells or Alpha cells produce glucagon, a catabolic hormone

that mobilizes glucose, fatty acids, and amino acids from stores into the

blood, increasing the level of glucose in the blood for the use of energy

powering cell functions all throughout the body. Insulin binds with specific

membrane receptors forming an insulin-receptor complex which is taken into

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the cell by endocytosis. Insulin receptors are found in almost all cells of the

body. Some glucose moves into the cell even in the absence of insulin but

most of the time not in an efficient amount. With insulin, however, the rate of

glucose entry is much increased due facilitated diffusion as mediated by

transporters. A major effect of insulin is to promote the entrance of glucose

and amino acids in cells of muscle, adipose tissue and connective tissue for

storage and then later use. These hormones are the two key instruments in

conducting and sustaining safe and efficient levels of glucose in the body.

The exact cause of T1DM is not known for sure but is theorized that

exposure to certain environmental factors, such as viruses, may trigger the

disease and genetics play a major roll. T1DM is something that you are born

with and is classified as an autoimmune disease, meaning that the bodys

immune system attacks its self. Autoimmune diseases can be genetically

passed on to offspring, for this reason T1DM is linked to being caused by

genetics. This is why it was once called Juvenal diabetes. In T1DM the bodys

immune system cells recognize the insulin producing beta cells of the

pancreas as foreign antigens and as a result destroy them. This leaves the

body with few to nun beta cells resulting in insufficient amounts of insulin

being released. Insulin is the key that allows cells to take in glucose. Because

of the lack of insulin being secreted cells all throughout the body are unable

to take up glucose leaving high levels of glucose in the blood stream. If T1DM

is not regulated properly with insulin, diet, and exercise it can affect major

organs in your body, including heart, blood vessels, nerves, eyes and
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kidneys. Such as heart conditions including coronary artery disease with

chest pain, heart attack, stroke, narrowing of the arteries and high blood

pressure. Excess sugar from lack of insulin can injure the walls of the

capillaries that feed your nerves, especially in the legs, leaving the affected

with a sense of numbness or no feeling at all. Nerve damage to the

gastrointestinal tract can lead to nausea, diarrhea, vomiting and erectile

dysfunction in males. It can also damage the blood vessels of the retina,

potentially leading to blindness and increases the risk of other serious vision

conditions, such as cataracts and glaucoma. It can damage the kidneys

filtration system and if sever enough can lead to renal failure. Keeping blood

sugar levels as close to normal as possible most of the time, can greatly

lower the risk of many complications.

T1DM is typically diagnosed at an early age because the signs and

symptoms are very apparent and the result of no treatment can be life

threating. The most common signs and symptoms of T1DM as a result of

hyperglycemia or high blood sugar are being very thirsty, feeling hungry,

feeling tired all the time, having blurry eyesight, feeling numbness or tingling

in your feet, losing weight without trying, and urinating more often. Another

major condition, ketoacidosis, can occur and is sometimes one of the first

signs in someone undiagnosed. It happens when the body cannot use

glucose as a fuel source because there is no insulin or not enough insulin, so

fat is used for fuel instead. As the fat is broken down, acids called ketones

build up in the blood and urine, in high levels, ketones are poisonous. The
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symptoms of this are, decreased alertness deep and rapid breathing, dry skin

and mouth, flushed face, frequent urination or thirst that lasts for a day or

more, fruity-smelling breath, headache, muscle stiffness or aches, nausea

and vomiting, and stomach pain. To diagnose a doctor will request an A1C

test (Glycated hemoglobin test). This test shows your average blood glucose

level for the past two to three months. It measures the percentage of blood

glucose attached to hemoglobin. The higher the blood glucose levels are,

more glucose will be attached to hemoglobin. An A1C level of 6.5 percent or

higher on two separate tests indicates that a person has diabetes. The doctor

can also diagnose diabetes with a random blood glucose test and a fasting

blood glucose test. To determine if it is T1DM the doctor will test for specific

antibodies that attack the pancreases beta cells and if they are present the

person is positive for T1DM.

There is no cure for T1DM; the only treatment is to inject insulin into the

blood stream to allow cells to take up glucose. It is more about managing

diabetes rather than fixing it. Taking insulin along with carbohydrate

counting, frequent blood sugar monitoring, eating healthy foods, exercising

regularly and maintaining a healthy weight are good ways to manage T1DM

and reduces the risks of complications; if properly managed a relatively

normal and healthy life can be achieved. The overall goal is to balance what

you eat with how much insulin to use to keep blood glucose levels as close to

normal as possible. The goal is to shoot for blood sugar levels before meals

between 70 and 130 mg/dL and your after meal numbers no higher than 180
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mg/dL two hours after eating. Generally there are two types of insulin that

can be used the more common rapid acting insulin that is taken before or

after eating and long lasting insulin that you can take once or twice a day

and is supposed to keep blood sugar levels close to normal all day.

Depending on life style and health one or the other or a monitored

combination of the two can be used. There is also an artificial pancreas that

is not yet available that is supposed to monitor blood sugar levels and

automatically dispense the appropriate amounts of insulin.

As previously mention there is no cure for T1DM, so the recovery

prognosis would be somewhat nonexistent. Someone who manages their

condition with insulin and a healthy diet and exercise can be expected to

have fewer complications and a relatively normal life. Someone who does not

manage their condition with insulin would be at great risk for all of the

discussed complications and would probably lead to death. Poor diet and

obesity can lead to serious complications and conditions.

In conclusion T1DM is an autoimmune disease that attacks the

pancreases insulin producing beta cells and prevents the body from

efficiently using sugar. The causes could be genetic and or environmental but

still unknown. There is no way to prevent this disease because it is

something a person is born with, however if properly managed and balanced

with insulin, diet, and an active lifestyle a person can live a fairly normal life

and avoid the serious conditions.

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Works Cited

http://apps.nccd.cdc.gov/DDTSTRS/default.aspx

National Center for Chronic Disease Prevention and Health Promotion

Division of Diabetes Translation

4770 Buford Hwy, NE

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http://jonbarron.org/article/endocrine-system-pancreas-diabetes#.VH-

ZUHAo5jo

Date: 07/12/2010 Written by: Jon Barron 1999-2014 The Baseline of Health Foundation

http://www.mayoclinic.org/diseases-conditions/type-1-

diabetes/basics/definition/con-20019573

http://www.diabetes.org/diabetes-basics/type-1/

http://healthfinder.gov/FindServices/SearchContext.aspx?topic=2661

http://www.nlm.nih.gov/medlineplus/ency/article/000305.htm