Today, when most people think about diabetes, they probably assume the condition in question is Type 2 diabetes. Type 2 diabetes is commonly associated with obesity, heart disease and kidney disease. Having Type 2 diabetes does not necessitate the use of insulin, but often elicits the use of other drugs that either promote insulin secretion or prevent excess glucose from entering the bloodstream through a variety of mechanisms.
Because only about 5 percent of the population of those living with diabetes has Type 1 diabetes, this condition is often glanced over or forgotten. But individuals within this subset often carry emotional, mental and nutritional concerns that are much different from those living with Type 2 diabetes.
What is Type 1 Diabetes?
Those who have Type 1 diabetes lack of insulin production. This means that glucose is not able to be removed from the bloodstream to be used within the cells of the body. Typically, diagnosis happens before the age of 20, but it can happen at any age depending on the severity of the disease. It appears that those diagnosed later in life are able to manage their diabetes easier than those who completely lose function early. Signs that someone may have Type 1 diabetes include frequent urination, excessive thirst or hunger, drowsiness, fruity-smelling breath and even seizures. The root cause of this disease is still unknown; however genetic and environmental factors are believed to play a role. Nutrition and lifestyle have nothing to do with the development of Type 1 diabetes.
What is It Like to Have Type 1 Diabetes?
People with Type 1 diabetes have to check their blood sugars often, manage meals and snacks with insulin, and overcome unexpected high- and low-blood sugar levels.
They also need to carry a glucometer, glucagon pen, insulin, needles and snacks with them at all times just for daily management. Another option is an insulin pump, which requires constant cleaning and maintenance. Failure to do all of this can result in potentially devastating complications, including kidney failure and death.
Needless to say, this is a lot of responsibility to put on very young children or teenagers.
The Emotional Toll of Type 1 Diabetes
For those with Type 1 diabetes, depression, self-doubt and body image issues can and do exist. Finding a place to inject insulin can be a reminder of body fat, which can lead to restrictive eating patterns, under-dosing of insulin or over-exercising. To some, taking insulin equals getting fat. Prolonged elevated blood sugars can even affect brain function, mood and coping skills.
This can prevent effective emotional and mental treatment and coping strategies. If an eating disorder does develop, it often goes untreated because the person may not have "typical" signs and symptoms. Improving blood sugars and treating the condition can actually improve emotional symptoms. This often involves eating regular meals and snacks, meal coaching, and education about carbohydrate counting. Understanding the person as a whole is the goal for every health care provider, as the diabetes alone is never the only concern.
How RDNs Can Help
The two cornerstones of care for someone with Type 1 diabetes are carbohydrate counting and appropriate insulin management. Routine appointments with an endocrinologist are essential to regulation of blood sugars and close monitoring of insulin levels. An endocrinologist or certified diabetic educator will determine carbohydrate-to-insulin ratios throughout the day, while the individual with Type 1 diabetes is responsible for carbohydrate counting all foods and drinks, adjusting basal rates of insulin during times of physical activity (when less insulin is needed and the risk of low blood sugars are elevated), and controlling high- and low-blood sugar levels. (Because low-blood sugar levels are common, most individuals carry juice boxes, glucose tablets or quickly absorbing snacks with them.)
When it comes down to it, living with Type 1 diabetes is significantly different than living with Type 2 diabetes. The emotional, mental and nutritional factors make living with this condition an everyday struggle. Of course, living with Type 1 diabetes also teaches discipline and self-reliance at an early age. With regular appointments by an endocrinologist and registered dietitian nutritionist, close monitoring of insulin, and adequate carbohydrate intake, the effects of Type 1 diabetes can be managed.