The first signs - what parents see
- Ребёнок начинает много пить, просит воду ночью.
- Учащается мочеиспускание, возвращается ночное недержание у ребёнка, который давно перестал мочиться в постель.
- Худеет, несмотря на хороший или даже повышенный аппетит.
- Становится вялым, раздражительным, снижается успеваемость.
- Появляется запах ацетона изо рта, боль в животе, рвота — это уже кетоацидоз, требующий немедленной госпитализации.
Симптомы развиваются за недели, а не за месяцы. Если ребёнок стал много пить и часто мочиться — измерьте сахар крови в тот же день. Это простая проверка, которая спасает от реанимации.
How is it different from type 2 diabetes?
- Age: Most often children, teenagers and young adults, although possible at any age
- Speed: develops in weeks, not years
- Weight: usually normal or reduced, weight loss is typical
- Mechanism: destruction of beta cells, absolute lack of insulin
- Treatment: insulin is required from the moment of diagnosis
- Tests: low C-peptide, positive antibodies to beta cells
There is also LADA, a slow-onset autoimmune diabetes in adults, which is initially mistaken for type 2. If the tablets are ineffective, C-peptide and antibodies are tested in a thin adult patient.
Insulin therapy
- Basis-bolus regimen: long-acting insulin 1-2 times a day plus short-term insulin before each meal
- Insulin pump - continuous delivery with precise adjustments
- The dose of short-acting insulin is calculated based on the amount of carbohydrates in food (bread units) and current sugar
- The injection sites must be alternated, otherwise lipodystrophy develops and insulin is absorbed unpredictably
- Self-monitoring: glucometer several times a day or continuous glucose monitoring systems
- HbA1c - every 3 months
После начала лечения нередко наступает «медовый месяц» — период, когда потребность в инсулине резко снижается. Это не выздоровление, а временное восстановление остаточных клеток. Полностью отменять инсулин в это время нельзя.
Two emergencies
- Hypoglycemia (sugar below 3.9): trembling, sweating, hunger, palpitations, irritability, confusion. You need to immediately take 15-20 g of fast carbohydrates - juice, sugar, glucose tablets - and measure them after 15 minutes. If you lose consciousness, do not pour anything into your mouth, call an ambulance
- Ketoacidosis (high sugar with ketones): thirst, nausea, vomiting, abdominal pain, smell of acetone, noisy breathing, drowsiness. This is a life-threatening condition that requires emergency treatment.
With any illness with fever, the need for insulin increases, not decreases. You cannot stop insulin if you refuse to eat - this is the most common cause of ketoacidosis in children.
Living with type 1 diabetes
- Diabetes school education is a must for the patient and family
- Sports are allowed and useful, but require dose adjustment and supply of fast carbohydrates
- At school and at work they should know about diabetes and be able to help with hypoglycemia
- Always have fast carbohydrates and a supply of insulin with you
- Annually: ophthalmologist examination, kidney check, foot examination, thyroid control
- Pregnancy planning - in advance, achieving goals before conception