Type 1 diabetes:

With type 1 diabetes you have too much sugar (glucose) in your blood. The amount of glucose in your blood increases when you eat or drink carbohydrates. For example, sweets such as jam, lemonade, fruit juice, cookies, and pastries, or milk, bread, potatoes, pasta, and rice. But exercise, emotions, and other factors also influence the amount of glucose in your blood.

Your body needs the glucose for fuel. To absorb the fuel from the blood, most cells have the hormone insulin necessary. Normally the pancreas produces just enough insulin. In your case, however, the pancreas does not or hardly do this. As a result, your body cells do not extract enough glucose from the blood.

Type 1 diabetes usually starts in childhood. With this form you must administer insulin. This can be done by injecting it or using an insulin pump. The treatment and checks are done from the hospital.

There is another form of diabetes: type 2. This form usually develops in adulthood and is related to being overweight.

Type 1 and type 2 diabetes both involve insulin and blood sugar. Yet they are two different diseases with different causes.

What do I notice with type 1 diabetes?

• Type 1 diabetes often causes clear symptoms within a few weeks of onset, such as:
• a lot of thirst and a dry mouth, which means you probably drink several liters a day
• Pee a lot
• to fall off
• fatigue
• blurred vision

Due to the treatment withinsulinreduce these symptoms. However, you may still experience complaints. This may involve sudden (acute) complaints due to abnormal blood sugar and problems that only arise after years.

Sudden complaints due to abnormal blood sugar:

The best-known sudden complaints are:

• Hypoglycemia: too little sugar in the blood.
• Ketoacidosis: acidification of the blood. This can happen when the body’s cells start burning fat because they have too little sugar as fuel.
• Hyperosmolar hyperglycemic syndrome: too much sugar in the blood with severe dehydration, which can lead to loss of consciousness and coma.

Problems that can arise over the years:

Diabetes can damage your blood vessels. After a few years, all kinds of complaints can arise, such as:

• eye disorders: for example poorer vision
• nerve disorders: for example pain and tingling in the hands and feet
• foot disorders: for example poorly healing wounds on the toes
• kidney disorders
• heart and vascular disease

The better your blood sugar, the less chance of complaints and later problems. Your doctor or diabetes nurse will discuss this with you.

How does type 1 diabetes develop?

Why do you have too much sugar in the blood? That has to do with the lack ofinsulin. This hormone ensures that the body cells remove sugar (glucose) from the blood. Normally the pancreas produces insulin.

Your body does not produce insulin:

Type 1 diabetes occurs because your immune system destroys certain cells in the pancreas. It concerns the cells that produce insulin. It is not clear why the immune system does this. The consequence is clear: your body cannot produce enough insulin or none at all. Without insulin, the cells in your body do not receive a signal to take sugar from the blood. As a result, too much sugar remains in your blood. We then speak of diabetes.

Influence of heredity:

Heredity plays a small role in type 1 diabetes. Of 100 children who have a parent with type 1 diabetes, about 3 children also develop it themselves. Would you like to know more about heredity in diabetes? Then visit the website of the Diabetes Fund .

Difference between type 1 and type 2 diabetes?

Type 1 diabetes has a completely different cause than type 2. Your form of diabetes is caused by an error in the immune system. This is not due to an unhealthy lifestyle. Being overweight and not exercising enough increases the risk of type 2 diabetes, but not your type of diabetes. The influence of heredity is also less significant for you than for people with type 2.

Healthy lifestyle for type 1 diabetes:

Your diabetes is not the result of an unhealthy lifestyle. However, a healthy lifestyle is very important for you. It helps to reduce, postpone or prevent health problems. A healthy lifestyle means:

• do not smoke
• healthy food
• move a lot
• lose weight if you are overweight

Smoking increases the risk of heart and blood vessel diseases. It is extra important for people with diabetes not to smoke. Do you smoke and find it difficult to quit? Then your GP or diabetes nurse can guide you.

A healthy weight is important for everyone, even if you have type 1 diabetes. Therefore, try to prevent or reduce obesity.

Exercise is very important for diabetes mellitus. Sufficient exercise helps to lower your blood sugar, keep your weight healthy and your blood pressure normal.

Therefore, ensure sufficient exercise. Keep in mind that exercise lowers your blood sugar and therefore affects the doseinsulinor the amount of carbohydrates you need.

Treatment for type 1 diabetes:

You go to the hospital for the treatment of type 1 diabetes. You will receive guidance from a diabetes team that consists of an internist/endocrinologist, a diabetes nurse, a dietician and, if necessary, a medical psychologist.

Insulin:

Your body hasinsulinnecessary. Without insulin, too much sugar remains in the blood. Because your body does not produce (almost) any insulin itself, you must administer insulin. It is important that your blood sugars return to as normal as possible: not too high and not too low. To do this, you must administer insulin (with a syringe or pump ) and measure your blood sugar.

After type 1 diabetes has been diagnosed, you will immediately learn to measure your blood sugar yourself and to inject insulin. During the first period you will have a lot of (telephone) contact with the diabetes nurse and the dietician. You will also learn how diet and exercise affect blood sugar.

Injecting insulin lowers your blood sugar. This will make you feel better. The weight you lost before the diagnosis will be regained.

By keeping blood sugar as normal as possible, you reduce the risk of problems with your heart and vessels, eyes, kidneys, nerves, feet and toes.

Cholesterol lowering agents:

You may also be given medicines to lower your cholesterol (statins). These medications are recommended if:

• you have a heart or blood vessel disease, or
• you are 40 years or older and have an increased risk of cardiovascular disease, or
• you are younger than 40 years old and have multiple risk factors for cardiovascular disease or if your LDL cholesterol level is higher than 2.5mmol/l.

See also: Increased risk of cardiovascular disease .

Women under the age of 40 are usually not given cholesterol-lowering drugs, especially if they are or want to become pregnant.

Metformin:

There are also pills that help keep blood sugar normal. It is a well-known medicinemetformin. Metformin causes the liver to produce less glucose and makes the body cells more sensitive to insulin. People with type 2 diabetes in particular take this medicine. Very occasionally it is also good for type 1 diabetes. Namely if, in addition to type 1 diabetes, you also have characteristics of the metabolic syndrome: obesity, unfavorable cholesterol levels and high blood pressure.

Flu shot:

You can get the flu shot every year. Diabetes increases the risk of health problems with the flu. For example, you have a greater risk of pneumonia. Flu also causes blood sugar disruption.

How can I arrange my own treatment for type 1 diabetes?

You check your blood sugar yourself (self-monitoring):

• You measure your blood sugar in a drop of blood or with a sensor.
• You put the values ​​in a booklet or in an app on your mobile phone.

The internet and apps are useful for self-checks (e-health):

• You can send data securely digitally to your specialist or diabetes nurse. For example, the blood glucose day curve (a graph of your blood sugars during the day).
• Your doctor or diabetes nurse can give you advice about diabetes by emailinsulin-dosage.
• There are digital ‘diaries’ in which you can keep track of how much medicine you are taking.
• The outpatient clinic can send you a reminder text message on the day before a check-up appointment.

Your diabetes nurse will teach you how to monitor and treat your diabetes yourself (self-regulation or self-management).

• You adjust the dose and/or type of insulin yourself if necessary.
• You anticipate and recognize sudden changes in blood sugar (much too high or much too low) and know what to do.

For self-management you need to know:

• what effect food, exercise and stress have on your blood sugar
• how long the different insulins work
• how many carbohydrates (sugars) you consume with your food and drinks
• how to correct a blood sugar level that is too low or high

The calculation of the correct insulin dosage must be done carefully. There are online tools that allow you to easily calculate how many carbohydrates a meal contains. There are also apps to calculate insulin dosage adjustments.

More information about apps can be found on the website of the Dutch Diabetes Association . You can also ask your specialist or diabetes nurse about suitable and safe apps.

Controls for type 1 diabetes:

Quarterly checks:

Every three months the diabetes nurse or specialist checks how you feel and what your blood sugar is. You discuss whether you can usually keep your blood sugar within your target range.

General target values ​​are:

• fasting: higher than 4.5 and lower than 8 mmol/l
• 2 hours after eating: lower than 10

You may have agreed on different target values ​​with your doctor. If your blood sugar usually remains within your personal target range, your diabetes is ‘well controlled’.

The HbA1c can also be measured. For this purpose, your doctor or nurse will send some blood to a laboratory. The HbA1c provides information about the average glucose value over the past 3 months.

The checks are not just about your blood sugar. Attention is also paid to your state of mind and whether everything works out with the diabetes in your life. The doctor or nurse checks your blood pressure, cholesterol levels, the functioning of your kidneys (creatinine levels in the blood and protein in the urine), your weight, your blood pressure, your gums and any foot problems. Finally, the injection sites are checked for problems, such as thickenings or infections.

Annual checks:

Once a year you come to the hospital for an extensive check-up. Extra attention is then paid to complaints that often occur with diabetes, such as cardiovascular problems and foot problems. Eye checks are usually done every two years. Sometimes the internist or ophthalmologist recommends having this done more often, for example every year. This is related to your risk of eye problems due to diabetes.

What happens if I have type 1 diabetes?

Type 1 diabetes is a chronic disease and therefore does not go away. You have to spend your whole lifeinsulinkeep using. The treatment is done from the hospital.

Diabetes has a major impact on your daily life. You will need to check your blood sugar a few times a day. You must always take your diabetes into account. All kinds of activities can affect your blood sugar. Therefore, you should always think about your diet, your activities and, if necessary, adjust your insulin dosage. For example, if you exercise, go out, want to sleep in or drink alcohol.

A healthy lifestyle is important for diabetes, in addition to insulin and any other medications. A healthy lifestyle helps to prevent or reduce damage to your heart and blood vessels.