Diabetes Mellitus Type 1

Part I
General Information
Diabetes mellitus type 1, normally known as Type 1 Diabetes, is a type
of diabetes that is caused by the lack of insulin resulting from the
destruction of insulin-producing cells. Since insulin regulates the amount
of glucose in the body, the destruction of the insulin-producing cells
subsequently leads to high level of glucose in blood and urine. As a
result, Type 1 Diabetes is normally associated with frequent urination,
increased thirst and hunger, and drastic weight loss in case of poor
lifestyle management. Type 1 Diabetes is less common as compared to Type 2
Diabetes and is normally referred to as juvenile diabetes because it mainly
affects children and adolescents (Diabetes UK 2011). In contrast, Type 2
Diabetes is observed when the insulin is being produced but the body does
not use it efficiently, leading to high glucose level. The body responds by
producing more and more insulin, eventually exhausting the insulin-
producing cells and making them fail, thus, provoking the onset of Type 2
Diabetes. This form of diabetes is the most common one, accounting for more
than 80% of all cases of diabetes in the UK. Its cause is mainly attributed
to obesity (WebMD 2012).

Living with Type 1 Diabetes
Type 1 Diabetes can be fatal if it is not managed properly. One of the
most common methods of managing the disease is through the administration
of insulin shots. It could be made through injections or inhalation. Having
Type 1 Diabetes does not necessarily lead to poor health and a diabetic can
still live his/her full life. The following list outlines how patients can
manage their lifestyles to reduce the risk of long-term health
complications.

Seeking to Learn More about the Disease
When it is first diagnosed, most people always have little insight
into the disease and try to have access to any information that can create
awareness. Consequently, the patients experience a steep learning curve as
they try to comprehend all the information obtained from various media.

Unfortunately, most people stop learning because they assume that just
after a few months they know enough (WebMD 2012). This is a mistake as
learning should be a continuous process. Deeper knowledge about the
condition increases the confidence in the ability to manage it. Besides,
through learning, a patient is able to get tips on the ways of managing the
side effects of Type 1 Diabetes from professionals and people who have
diabetes themselves (WebMD 2012). There are a number of materials that
offer simplified information on how the disease can be conducted and one
should read these materials occasionally.

Daily Management of Diabetes
There are four main pillars for managing Type 1 Diabetes Mellitus
(T1DM). They are insulin, food, exercise, and blood glucose level testing.

A well balanced diet is the first step to control the disease as it helps
coordinate the amounts of blood glucose, blood fats, and blood pressure.

Since T1DM is caused by a deficiency of insulin in the blood, its
introduction is vital towards reducing blood glucose level. The main
purpose for administration of insulin in the body is to lower blood glucose
and hence avoid long-term health complications which affect the nervous
system (e.g. poor cognition abilities, loss of conscience, etc), and the
cardiovascular system (e.g. heart attack and loss of sight). Insulin
administration is achieved through injection or inhalation of insulin which
is manufactured artificially. Continuous glucose monitoring can be used to
alert patients of severely high or low glucose levels. People who have the
disease for a long time will know when their blood glucose levels fluctuate
as this illness affects various physiological processes and patients learn
to associate them with low blood glucose (BG) levels, such as thirst or
fatigue (Silverstein et al. 2005, p199). However, blood testing is the
surest way of knowing BG levels and there are simple kits that can be used
to carry out a home blood sugar test (WebMD 2012).

A balanced diet also helps regulate body weight and hence reduce the
risk of heart attacks. It is important to find a balance between the
quantity of carbohydrates and fats in any diet (Silverstein et al. 2005,
p189). Patients should consume less fats, especially animal fats as this
could lead to heart illnesses. Monosaturated fats such as olive oil and
rapeseed oil are encouraged. Oily fish should be consumed at least twice a
week as it contains monosaturated fats as well. Other low-fat foods include
eggs, lean meat and pulses (such as lentils). Regular meals should contain
more carbohydrates and starch (Silverstein et al. 2005, p200). Such foods
include bread, pasta, chapattis, potatoes, noodles, low fat fruit yoghurt,
baked beans, rice, and cereals (Gillespie, Kulkarni & Daly 1998, p901).

Meals should be accompanied with adequate amounts of fresh fruits and
vegetables (WebMD 2012).

Exercises are very important in the management of T1DM since they
increase glucose absorption by the body tissues and hence reduce insulin
requirements. With adequate exercises, the amount of insulin administered
into the body can be lowered significantly. Besides, there are numerous
health-related benefits in regards to exercises, such as lowering blood
pressure, managing body weight, and helping in lipid metabolism. Children
with Type 1 Diabetes should exercise at least three to four times a week
for about 20-60 minutes. A physician should provide a piece of advice on
the best activities to exercise (Silverstein et al. 2005, p208). However,
such activities as running, walking, cycling, swimming, dancing or
gardening are recommended.

Avoid Stress
Stressful conditions cause the body to react as if it were under
attack by hormones and sugars that are released into the blood stream. Such
conditions can elevate BG levels within a short period of time and result
in serious health complications (WebMD 2012). Any signs of stress, such as
difficulty in concentrating and difficulty in falling asleep, should be
handled in a relaxed manner, like breathing deeply or exercising.

Seek Support
People with T1DM can benefit immensely from participating in diabetes
support groups and other diabetes events such as the Diabetes UK event.

Assistance can also be sought from family members and friends. One should
not be ashamed of telling others about their diabetic condition as there
are more than 2.5 million people living with the condition in the UK
(Diabetes UK 2011). Therefore, telling others about the disease not only
helps the person, but also encourages others to open up (BBC 2012).

PART II
National Service Framework Standards for Diabetes
In spite of the fact that diabetes is the fourth leading killer in
the UK, response to the disease has been slow and studies show that 50% of
older people with diabetes remain undiagnosed, and many of those diagnosed
have normally had the disease for many years prior to the diagnosis (Harris
et al. 1992, p817). In order to improve the national management of
diabetes, the National Service Framework (NSF) set up 12 standards with an
aim of preventing diabetes, to identify people with diabetes, and ensure
that diabetics get given high-quality, evidence-based care. These 12
standards are outlined below:
Standard 1: Prevention of Type 2 Diabetes Mellitus (T2DM)
The NSF will create, execute, and monitor policies to reduce the risk
of developing T2DM in the whole UK and reduce the inequalities in the risk
of developing T2DM. Under this standard, the NSF aims to increase awareness
of the causative factors of T2DM, such as obesity. The NSF will also inform
people about strategies that can be used to lower the risks of developing
the disease, such as education to promote healthy eating and exercise,
assisting people to lose and maintain weight (Nazarko 2003).

Standard 2: Identification of Persons with Diabetes
A number of people remain undiagnosed with T2DM for many years.

During those years, complications arising from the disease develop
significantly. This standard aims to identify persons suffering from the
disease at the initial stage (Nazarko 2003). The government undertakes
regular screenings with assistance from the National Screening Committee to
help identify these people and place them on diabetes management programs.

Standard 3: Empowering People with Diabetes
All children, adolescents, and adults with diabetes will receive a
service that promotes partnership in decision-making, supports them in
diabetes management, and assists them in adopting and maintaining a
lifestyle that does not put their lives at risk. Generally, people with
diabetes who are not necessarily professionals are given freedom to
exercise personal control over their lives in the day-to-day management of
the condition.

Standard 4: Clinical Care of Adults with Diabetes
All diabetic adults will be given high-quality care throughout their
lifetime. This care will include support to ensure that they exercise
adequate control of their BG levels, blood pressure, and other risk factors
in the management of diabetes. This standard aims to get experts work
together with diabetics in order to assist them in weight control, increase
activity levels, and firmly control the BG and cholesterol levels and
hypertension (Nazarko 2003).

Standard 5 & 6: Clinical Care of Children and Young People with Diabetes
All children and young people with diabetes will always be given high-
quality care and, together with their families and others partaking in
their routine care, will receive assistance to optimize the control of
their BG and their physical, psychological, intellectual, educational, and
social development. All children and adolescents with diabetes will have a
smooth transition of care from paediatric diabetes management to adult
diabetes services in any healthcare institution. The transition will be
arranged in consultation with each patient separately at an appropriate
age.

Standard 7: Management of Diabetic Emergencies
The NSF will develop, implement, and supervise common protocols for
speedy and effectual treatment of diabetic emergencies with the help of
expert care professionals. Such protocols include the management of serious
complications and procedures to alleviate the risk of recurrence.

Standard 8: Care of People with Diabetes during Admission to Hospital
All children, young people, and adults with diabetes who are for
whatever reason admitted to hospital will be given appropriate care
pertaining to their condition. Where possible, the patients will continue
to get involved in choices regarding the management of their diabetes
(Nazarko 2003).

Standard 9: Diabetes and Pregnancy
The NHS will develop, implement, and monitor strategies with the hope
of empowering and supporting women with diabetes to ensure the pregnancy is
not affected by the disease.

Standard 10, 11 and 12: Discovery and Management of Long-Term Complications
All children, young people, and adults with diabetes will be
monitored regularly to manage the long-term complications of the disease.

The National Health Service (NHS) will develop, implement, and monitor
approved protocols and systems of care to ensure that people who develop
long-term complications are given immediate, appropriate, and effective
monitoring and treatment to lower risks of disability and early death
(Nazarko 2003). All people with diabetes and those who require multi-agency
support will receive integrated support and care.

PART III
Near Future Issues for Children with Diabetes
During the teenage years and youth, the insulin requirements of
children and young people may change over time and this will change their
diabetes management plan. Over the years, their insulin requirements will
increase and this may lead to a shift in the daily meal plans. Moreover,
the way they administer insulin (using shots or an insulin pump) may change
too. Generally, as children grow up, they must continue controlling the BG
levels and carefully monitor their lifestyle in order to reduce the
likelihood of developing acute complications. Due to increased metabolic
processes and physical activity while growing up, children may have to
increase the monitoring of their BG levels. In addition, a change in the
meal plan will make up for increased physical activity.

Although there are specific types of meals recommended for people
with diabetes, this does not necessarily mean that the children will be
restricted to similar food for the rest of their lifetime. Instead, the
children can consume a variety of meals as long as these meals are high in
nutrition and low in fats and calories. Fruits, vegetables, and all kinds
of grains are highly recommended while animal products and sugary foods
will be minimized. The quantity of carbohydrates in any meal must be
controlled since that is the main determinant of BG levels. Sugary foods
such as sweets, fruit juices, and soft drinks should be consumed
moderately.

As years go by, lifestyle will be of high importance in managing BG
levels. Activities such as smoking and drinking can create complications
for people suffering from Type 1 diabetes. While smoking increases the
chances of getting diabetes, it also makes the management of diabetes
difficult for people who have the condition already. Smoking also creates
other complications such as heart disease, renal diseases, vascular
disease, increased blood pressure, and so on. Diabetics should consume
alcohol with extreme caution since alcohol substances contain calories and
carbohydrates that may complicate BG level management. Some alcohol
products can cause low blood sugars. Drug use can cause fluctuations in BG
levels apart from creating serious health complications since some drugs
can become harmful when they come into contact with various medications
used to manage diabetes.

Over the years, people with diabetes may require additional treatment
to supplement the insulin administration and a healthy lifestyle to manage
T1DM. This treatment can be in the form of tablets. However, they can only
be used upon advice of a healthcare professional (BBC 2012). Finding out
the best treatment options is vital for managing diabetes.

Reference List
BBC 2012, Health. Diet and diabetes. Available from:
. [4 January 2012].

Diabetes UK 2011, Children and diabetes. Available from:
. [4 January
2012].

Gillespie, SJ, Kulkarni, KD & Daly, AE 1998, ‘Using carbohydrate counting
in diabetes clinical practice’, Journal of the American Dietetic
Association, vol. 98, no. 8, pp. 897-905.

Harris, MI, Klein, R, Welborn, TA & Knuiman, MW 1992, ‘Onset of non-insulin
dependent diabetes occurs at least 4-7 years before clinical
diagnosis’, Diabetes Care, vol. 15, pp. 815-819.

Nazarko, L 2003, ‘Meeting the national service framework standards for
diabetes’, Nursing Times. Available from:
. [4 January 2012].

Silverstein, J, Klingensmith, G, Copeland, K, Plotnick, L, Kaufman, F,
Laffel, L, Deeb, L, Grey, M, Anderson, B, Holzmeister, LA & Clark, H
2005, ‘Care of children and adolescents with type 1 diabetes: a
statement of the American Diabetes Association’, Diabetes Care, vol.

28, no. 1, pp. 186-212.

WebMD 2012, ‘Type 1 Diabetes: Children Living With the Disease – Topic
Overview’, Diabetes Health Center. Available from:
. [4 January, 2012].