What is type 1 diabetes?
Type 1 diabetes mellitus is a lifelong disease that develops when the pancreas can no longer produce insulin. Insulin lets sugar (glucose) enter your body's cells, where it is used for energy. Without insulin, sugar builds up in your blood. The level rises above what is safe for your body. Over time, high blood sugar levels can damage blood vessels and nerves throughout your body and increase your risk of eye, heart, blood vessel, nerve, and kidney disease.

Type 1 diabetes can develop at any age; however, it usually develops in children and young adults. In the past, type 1 diabetes was called juvenile diabetes and insulin-dependent diabetes mellitus (IDDM).

What causes type 1 diabetes?
Insulin is made by certain cells (beta cells) in the pancreas. Type 1 diabetes develops because the body destroys the beta cells and therefore the pancreas's ability to produce insulin.

Some people inherit the risk for type 1 diabetes. However, even these people may not develop type 1 diabetes unless other factors, such as exposure to certain viral infections, are present.

What are the symptoms of high and low blood sugar?
The main symptoms of high blood sugar from diabetes are:
Increased thirst.
Increased urination.
Weight loss.
Fatigue.
Increased appetite.
These symptoms usually develop over a few days to weeks. Some people have these symptoms before they are diagnosed, but they do not realize the symptoms are caused by diabetes. They may believe the symptoms are caused by the flu or some other illness.

Sometimes blood sugar rises very high. If this happens, a life-threatening situation called diabetic ketoacidosis (DKA) can develop. DKA is an emergency. Symptoms include:

Flushed, hot, dry skin.
A strong, fruity breath odor (similar to nail polish remover or acetone).
Restlessness, drowsiness, or difficulty waking up. Young children may lack interest in their normal activities.
Rapid, deep breathing.
Loss of appetite, abdominal pain, and vomiting.
Confusion.
Severe diabetic ketoacidosis can cause difficulty breathing, brain swelling (cerebral edema), coma, or death. However, your blood sugar level usually rises slowly over hours or days. You can treat the high level before DKA develops.

You also need to watch for low blood sugar. Low blood sugar occurs when the sugar (glucose) level in your blood drops below what your body needs to function normally. Not eating enough food or skipping meals, taking too much medication (insulin), exercising more than usual, or taking certain medications that lower blood sugar can cause your blood sugar to drop rapidly. Symptoms include:

Sweating (almost always present).
Nervousness, shakiness, and weakness.
Dizziness and headache.
Confusion and irritability.
Slurred speech.
Personality changes, such as anger or crying.
If your blood sugar level drops very low (usually below 20 mg/dL), you may lose consciousness or have a seizure. Eating or drinking something that contains sugar usually can bring your blood sugar back up to a safe level. However, if you have symptoms of severe low blood sugar, you need medical care immediately.

What tests do I need for diabetes?
You need to test your blood sugar 3 or more times a day to make sure it falls within the target range you and your health professional set. You use a home glucose monitor to do these tests.

You need to see your health professional about every 3 to 4 months for exams and tests to monitor your condition and adjust your treatment. About every 3 months-or whenever your health professional recommends-you will have a hemoglobin A1c test to estimate your average blood sugar level over the previous 2 to 3 months.

You also need to have regular tests to check your blood pressure and cholesterol levels; high levels increase your risk of diabetes complications.

How is it treated?
You will take insulin injections daily or use an insulin pump. Treatment for type 1 diabetes focuses on keeping your blood sugar levels as close to normal as possible. This is called tight control. It is the best way to reduce your risk of diabetes complications. However, some people-such as those whose blood sugar drops too low with tight control-may need to set a different target range with their health professional.

A normal to near-normal blood sugar level is 90 mg/dL to 130 mg/dL before eating or less than 180 mg/dL 1 to 2 hours after eating. It also may be measured as a hemoglobin A1c of 6% or less (normal) to 7% (near normal). This is a test of your blood sugar control for the past 2 to 3 months. If you do not have problems with low blood sugar, you may be able to tightly control your blood sugar to an A1c of 6% or less.

You also need to eat a healthful diet that spreads carbohydrate throughout the day, check your blood sugar 3 or more times a day, and get regular exercise. Because you have diabetes, you are at higher-than-average risk of a heart attack and stroke. You may take medication to keep your blood pressure and cholesterol in the normal ranges. If you are 30 or older, you also may take aspirin.

Your treatment plan may change based on your blood sugar levels and other test results reviewed in your doctor's office.

If your child has type 1 diabetes, treatment involves the same actions but also allows for normal growth and development.

You may find that soon after you are diagnosed with type 1 diabetes, your blood sugar levels return to normal. You are in what is called the honeymoon period. The remaining insulin-producing cells in your pancreas are working harder to supply enough insulin for your body. You may take little or no insulin; however, this does not mean that the disease is gone. After the remaining insulin-producing cells are destroyed, the honeymoon period ends, and you will need to take insulin for the rest of your life.

How will diabetes affect my life?
You can live a long, healthy life if you keep your blood sugar levels as close to normal as possible. This requires the right combination of food, physical activity, and insulin every day. If your young child has diabetes, you assume the responsibility for balancing these factors. As your child grows, he or she will take over more responsibility for his or her care.

Many people are afraid of giving themselves shots every day. With practice, it will become routine. Figuring out how to mix diet, insulin, and exercise in your daily life takes time. Don't get discouraged. Seek out help from your health professionals if some part of diabetes care gives you trouble.

As you adjust to having diabetes, you will learn how to monitor your blood sugar level at home, give yourself insulin injections, recognize high and low blood sugar symptoms, count carbohydrate in your diet, and take precautions when you are sick. Diabetes care will become an important part of your life, but it doesn't have to take over your life.