Managing type 1 diabetes

Dr S K Wagnoo 

Often called a lifestyle disease, the awareness about type 2 diabetes is rising due to its increasing numbers in India. However, we also need to focus on a far more limiting disease called the type 1 diabetes, also known as juvenile diabetes. 

Affecting over 97,000 children nationwide, type 1 diabetes is fast becoming a growing concern in the country. The incurable autoimmune disease, by which the immune system destroys the insulin-producing cells in the pancreas, leaves children painfully dependent on insulin injections for survival. Although the exact causes of the disease are unknown, type 1 diabetes can be managed in a less painful way with many modern medical advancements like insulin pump therapy and reduce dependency on regular injections.

The incidence of type 1 diabetes is increasing at a faster rate as compared to earlier. While it is difficult to pin point the factors, as type 1 diabetes is an immunological dysfunction, but certain genes increase a person's risk of developing the disease, as does the family history. 

If there is a family member with type 1 diabetes, the risk of developing it is one in 20, 15 times greater than the general population. The genetic coding that puts a person at a higher risk for type 1 diabetes is largely related to the body's immune response. Some viruses have also been implicated as triggering agents for type 1 diabetes. 

Dealing with the problem

Since the disease is without any cure at present, the focus is on managing the problem. Injecting insulin is an essential part of the disease management. However, administering self injections at least two to four times a day, with increased chances of hypoglycaemia and hyperglycaemia, limits a patient’s hopes to live freely. A relatively recent method, insulin pump therapy is gaining much popularity because of the convenience it provides to the patient in the management of the disease. 

Through this therapy a user can do almost everything like any normal person — from pursuing sports to travel. There are other time-tested devices like glucometers which continuously help in managing type 1 diabetes. Equipped with continuous glucose monitoring system, the latest pump therapies help keep track of fluctuating glucose levels and raise alarm whenever the body requires insulin. The insulin can then be delivered at the press of a button. 

The use of this therapy can give certain degree of independence to pursue various activities, hobbies and careers in certain strenous activities such as tennis, badminton, dancing, and so on. The therapy benefits children because usually their meals are erratic and hence they are at higher risk of developing hypoglycemia. This therapy can also benefit others with less regular work hours. 

Creating conversations

Myths and social stigma related to the disease play a significant role in hindering the management of disease as it can affect the psyche of the patient. 

Busting myths and creating awareness on better ways of management of diabetes is crucial to live a normal life with type 1 diabetes. Taking insulin at public places, making schools understand about the needs of a diabetic child, a patient’s future regarding career and marriages — there are many problems and stigmas which a type 1 diabetic has to fight against other than the disease. 

One of the common myths is that type 1 diabetics cannot conceive. Many patients, especially from rural areas, may also fall victim to some alternative medicine system. 

There is a dire need to burst these myths and raise awareness in providing proper medical guidance and support about appropriate diet; using insulin and monitoring of glucose levels; psychosocial support; liaison with school authorities; ensuring proper growth and development as the child grows; sharing burden of care between parents and elders; and educating and making people aware about the disease and its management are some of the measures people need to take in combating the disease

With advancement in medical sciences, changing the mindset, sensitising the masses, and spreading awareness play a crucial role in making the lives of thousands of patients a lot better. 

— The writer is an endocrinologist,  Indraprastha Apollo Hospital, New Delhi

Dispelling myths

It is important that the following myths are dispelled so to help type 1 diabetes patients  manage the disease: 

• Having type 1 diabetes means saying good bye to an active lifestyle: The administration of multiple injections daily was a limiting factor earliers, but modern therapies help type 1 diabetic children and adult alike in leading active lifestyles.
• Type 1 diabetes can only happen to children: Despite being common in children, it can develop in young adults or even the elderly. 
• Type 1 diabetes is caused by high sugar intake: Type 1 diabetes results from the immune system turning against the body by killing the insulin-generating cells that regulate the metabolism of glucose and other chemicals, which are critical nutrients for the body. 
• People with active and healthy lifestyle will never have type 1 diabetes: Lack of physical activity level and being overweight are not causative factors for the onset of type 1 diabetes, although having healthy and active lifestyle is always good whether or not one has diabetes. 
• Sugar-free products can be taken by type 1 diabetics: One must ensure these sugar-free products do not have high carbohydrates content which is broken down by the body into sugar.
• People with type 1 diabetes shouldn’t have children: This is a serious issue. Related myths include that future pregnancy of type 1 diabetic woman means the child will get the disease. Also, it is believed that the mother plays a larger role in the child getting type 1 diabetes. All these are misconceptions. For expecting mothers suffering from the disease, it is important that glucose levels are kept in the normal range.