American Diabetes Association Complete Guide to Diabetes. American Diabetes Association

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СКАЧАТЬ researchers have found a few triggers that may point to why the body starts attacking itself.

      Celiac Disease

      One in 20 people with type 1 diabetes has celiac disease.

      Genes and Family History

      Scientists have long suspected that family history and genes play a role in type 1 diabetes. For example, if your parent or sibling has diabetes, you are more likely to develop the disease than someone without a family history.

      The way in which genes interact to cause diabetes is an extremely complex process that scientists are only just beginning to unravel. Some of the most promising discoveries have been made with a group of genes called HLA that are involved in the body’s immune response. Scientists can test a person’s DNA for specific mutations in HLA genes that would indicate that that person might get type 1 diabetes.

      Race and Ethnicity

      In addition to family history, race and ethnicity appear to play a role in who develops type 1 diabetes. White people are much more likely to develop type 1 diabetes than other racial groups. For example, 1 in 100,000 people in Shanghai, China, has type 1 diabetes, but more than 35 in 100,000 people in Finland have type 1 diabetes. Most likely, certain racial groups pass down genes that either trigger or protect against type 1 diabetes.

      Viruses

      Many scientists suspect that viruses may cause type 1 diabetes. Some people who develop diabetes have often had a recent viral infection. Also, cases of diabetes have frequently occurred after viral epidemics. Viruses—such as those that cause mumps, German measles, and a virus related to the one that causes polio—may play some role in causing type 1 diabetes. Nonetheless, there is no virus known that specifically triggers type 1 diabetes.

      Chemicals and Drugs

      Several chemicals, in rare cases, have been shown to trigger diabetes. Pyriminil, a poison used to kill rats, can trigger type 1 diabetes. Two prescription drugs, pentamidine (used to treat pneumonia) and L-asparaginase (an anticancer drug) can also cause type 1 diabetes.

Prevention

      There is no way to prevent type 1 diabetes. However, scientists are deeply interested in finding ways to delay or reduce the severity of type 1 diabetes.

      People without outward symptoms of type 1 diabetes often produce autoantibodies that can be detected in the blood. The autoantibodies may be present several years before diabetes is diagnosed. Currently, scientists can screen people who may be at high risk because they have a family member with type 1 diabetes or because they carry mutations in certain HLA genes.

      For example, if you have a parent or sibling with type 1 diabetes, you are 10% more likely to get diabetes. However, if you also carry certain HLA genes or autoantibodies in your blood, you are even more likely to get type 1 diabetes.

      Several studies currently underway are testing whether treating these people early may improve their lives. One study is treating people with insulin in a pill form, and other studies are examining whether certain diets could affect the development of type 1 diabetes. Still other studies are aimed at vaccines to slow the progression of diabetes after diagnosis.

      In summary, it is unlikely that either genetics or environment alone causes diabetes. Instead, it is probably a complicated interplay between the genes you were born with and the world in which you live.

Management and Treatments

      How you manage your diabetes depends on your personal goals and needs. No two people with diabetes are exactly alike. Therefore, everyone with diabetes needs an individualized diabetes care plan.

      Common Goals for People with Diabetes

      • Prevent short-term problems, such as a glucose level that is too low or too high.

      • Prevent or delay long-term health problems, such as heart disease and damage to the nerves, kidneys, and eyes.

      • Maintain a healthy lifestyle and keep doing enjoyable activities, such as exercising, working, and socializing.

      Work with your health care providers to come up with a plan for managing your diabetes and meeting your goals. You’ll find more about this topic in chapter 9. For now, though, let’s talk about some of the treatments for managing type 1 diabetes.

      • People with type 1 diabetes must take insulin. Therefore insulin injections play a big role in your diabetes care plan. How much insulin you need to take depends on your blood glucose level or what you predict the level will be after a meal.

      • Naturally, certain food choices also play an important role in your diabetes management plan, because they can add glucose to your blood.

      • Usually, exercise can lower your blood glucose level and, in turn, decrease your dose of insulin. So, you’ll need to account for exercise and physical activity in your diabetes management.

      Insulin

      Most people with type 1 diabetes take insulin by injecting it with a needle and syringe or an insulin pen. The goal is to mimic normal insulin release as closely as possible.

      People without diabetes have a low level of insulin available in the blood most of the time. This is a background, or basal, level of insulin. After meals, a bolus (extra dose) of insulin is released, just enough to clear the glucose in the blood after eating.

      To imitate this sequence, you can develop a regular schedule of insulin injections using different forms of insulin. Read on in chapter 13 for a lot more about insulin and insulin plans. Other people use insulin pumps to dispense insulin at a steady background, or basal, rate and to provide extra insulin to cover meals. More about insulin pumps can be found in chapter 13.

      Although today’s insulin pumps are worn externally, researchers are developing and testing pumps that are placed inside the body. Ideally, the pump would sense the amount of glucose in the blood and deliver the right amount of insulin, as needed. These pumps are called closed-loop systems.

      Your type of insulin therapy should relate directly to your health and your lifestyle choices. Your chosen therapy may aim to keep your blood glucose levels from shooting too high after meals or falling too low between meals. Or your therapy may aim to keep after-meal blood glucose levels as close as possible to those of someone without diabetes.

      The food you eat and the exercise you get go hand in hand with your insulin therapy. Of course, healthy eating and regular exercise are a part of everyone’s healthy living plan. But for you, knowing how these two daily features move your blood glucose level up and down is essential.

      To know how much insulin you’ll need to have, it helps to know:

      • Your current blood glucose level (you know this by blood glucose testing).

      • What you plan to eat (so you can estimate how much your blood glucose will increase).

      • What physical activities you plan to do.

      There СКАЧАТЬ