Type 1 diabetes in adults

What happens in the body

Insulin is the pancreatic hormone that lets cells use glucose as an energy source and lowers its level in the blood. In type 1 diabetes, the immune system destroys the pancreatic beta cells that make it, so insulin production falls greatly or stops completely. Glucose accumulates in the blood (hyperglycemia) and passes into the urine, drawing water with it; hence the thirst and frequent urination. Without insulin, the body burns fat and produces ketones, acids that, when they build up, cause diabetic ketoacidosis, a life-threatening complication.

What the first signs are

• Unusual thirst and more frequent urination, also at night.
• Unexplained weight loss.
• Fatigue, weakness and blurred vision.
• Repeated infections or slow-healing wounds.

When these signs appear together, seek assessment the same day. Do not delay the check by trying only to change your diet.

Is it the same as type 2 diabetes

No. In type 1 diabetes there is a lack of insulin. In type 2 diabetes, insulin resistance and a progressive decline in its production predominate. Age and weight do not alone determine the type of diabetes. In some adults the autoimmune process develops more slowly (latent autoimmune diabetes of adults) and may at first be mistaken for type 2 diabetes; clues are normal weight, onset with weight loss and rapid loss of response to oral medicines.

How the diagnosis is made

The doctor assesses symptoms and glycemia. As the situation requires, HbA1c, ketones and other tests are used. Specific antibodies (anti-GAD, anti-IA2, anti-ZnT8) and C-peptide (a marker of the body’s own insulin production) help when the type of diabetes is unclear. If ketoacidosis is suspected, assessment is done in the emergency department and is not delayed for planned tests.

How it is treated and followed

Insulin is an essential part of treatment. The regimen is tailored individually, usually with basal insulin and fast-acting insulin before meals, or with a pump, and comes with education on glucose monitoring, carbohydrate counting, physical activity and hypoglycemia (glycemia below 4 mmol/L, that is below 70 mg/dl). Measurements with a glucose meter or continuous sensor are used as the doctor plans. Keep a written plan for acute illness and for ketone checks. Do not stop insulin because you are not eating; contact the medical team for the relevant instructions.

Follow-up includes checking the eyes, kidneys, feet and cardiovascular risk factors (diabetes and the heart); blood pressure is targeted below 130/80 mmHg (blood pressure 13 over 8) and checks are done every 6 months to a year, or sooner when the doctor considers it reasonable. See also nutrition and home care.

Care at Tirana Polyclinic: we offer endocrinology consultation, interpretation of tests and guidance on monitoring and follow-up. Acute complications require hospital care.