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What is Diabetes?

Published:
14-May-2005

By H. Peter Chase M.D.

Type 1 (Insulin Dependent) Diabetes

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Type 1 (insulin - dependent diabetes mellitus [IDDM] or "juvenile" or "childhood") diabetes is the usual type found in children and young adults. It is caused when the pancreas doesn't make enough insulin. Insulin allows sugar to pass into the cells so that it can be "burned" for our energy. Sugar comes from two places. "Internal" sugar comes from our body's own production in the liver or from the release of stored sugar from the liver and muscle. This sugar is released into the bloodstream. "External" sugar comes from the food we eat and is absorbed from the stomach (intestine) into our bloodstream. When people do not have diabetes, the pancreas makes insulin. People need insulin to help the "internal" and "external" sugars pass into the body's cells, where sugar is "burned" for energy. The cells are like a furnace, which burns fuel to make energy. Our bodies constantly need energy for all of our body functions, such as allowing our heart to beat and our lungs to breathe. When people have type 1 diabetes, the pancreas does not make enough insulin. The body's sugar can't pass into the body's cells to be burned. Instead, the blood sugar rises to a high level and overflows through the kidneys into the urine. When sugar enters the urine, water must go out with the sugar. The results are the usual SYMPTOMS of diabetes.

  • Frequent passing of urine
  • Frequent drinking of liquids : to make up for water lost in the urine
  • Frequent eating of food : because the body is hungry for the energy it isn't getting. This hunger is not always present in children. In addition, sometimes the appetite may even decrease. Ketones (see the article "Diabetic Ketoacidosis" on our "Health Concerns" page) can cause an upset stomach and vomiting.
  • Weight loss : when the body can't get sugar into the cells, it burns its own fat and protein for energy. This causes weight loss.
  • Changes in behavior : If the person is getting up frequently at night to pass urine, sound sleep will not occur. This can result in behavioral changes.

Insulin also shuts off the body's internal production of sugar. This "internal" sugar mostly comes from the liver and muscles. When the insulin level is too low, too much "internal" sugar is made. Thus, when there is not enough insulin, the blood sugar can be high for two reasons:

  • Too much "internal" sugar is being made
  • The sugar (from internal production or from external food) not being able to pass into the cells

Functions of insulin

  • To allow sugar (from external food or internal production) to pass into cells where it can be used for energy
  • To shut off excess internal sugar production in liver and muscle

Honeymoon (Grace) period

According to what is known, patients with type 1 diabetes will need insulin injections for the rest of their lives. Often there is a "honeymoon" or "grace" period that may occur a short time after the onset of diabetes. It commonly starts within two to eight weeks, although not all people have this honeymoon period. During the honeymoon, sugar production is turned off in the liver and a fair bit of insulin is still being made in the islet cells of the pancreas. This is a time when people often think they don't have diabetes. They may be attracted to "miracle cures". The honeymoon period may last a few weeks to a few years. During this time, the body may not need much extra insulin. After this period, the body will again need more insulin, although small amounts of insulin may still be made by some.

The Most important rule for new patients with diabetes to remember is: I must take my insulin every day from now on. If I forget my insulin, my diabetes will get out of control. There is absolutely no way I will ever not need insulin every day from now on. Even if I get sick, I still need insulin. I may need more or less insulin, but I must have it every day. IMPORTANT: The only known difference about people who develop type 1 diabetes is that their bodies don't make enough insulin. THE PERSON AND EVERY OTHER PART OF THE BODY ARE OTHERWISE COMPLETELY NORMAL.

By H. Peter Chase M.D.
Barbara Davis Center for Childhood Diabetes