The Complexity of a Type 1 Diabetes Diagnosis

A type 1 diabetes (T1D) diagnosis can happen suddenly and unexpectedly. Many times, the disease is identified through symptoms that can appear as a cold or flu. While it represents a big life change, people with T1D can live long, full, happy lives.

How is type 1 diabetes (T1D) diagnosed?

T1D often initially presents itself as the flu or malaise, but physicians must be quick to spot the telltale signs of a possible T1D diagnosis and order additional tests.

Fasting blood-glucose test

Doctors will often recommend a fasting blood-glucose test when they suspect T1D may be present. This is a small sample blood test typically conducted in the morning after fasting overnight. The fasting helps give doctors a clear look at how the body manages blood-sugar levels without the impact of food intake.

Oral glucose tolerance test

The oral glucose test takes the fasting test one step further. After fasting and having an initial blood test, people drink a sugary drink and then have their blood sugar tested over the course of approximately two hours. This shows the benchmark sugar without outside influences and later measures how the body responds to carbohydrate (sugar) intake.

Random blood-glucose test

The quickest option for testing for T1D is a random glucose test. This test simply measures a patient’s current blood sugar regardless of when and what he or she ate most recently. On occasion, this will be the first test, and then doctors will elevate to tests noted above as needed.

Glycated hemoglobin (HbA1c) test

The most comprehensive test is the hemoglobin A1c test. This blood test shows the average blood-sugar level for the past two or three months.

The honeymoon phase

The onset of symptomatic diabetes doesn’t always happen all at once. During what is known as the “honeymoon phase,” people with T1D can experience a period in which they are asymptomatic. The honeymoon phase typically lasts a few months to a year post-diagnosis as, with the help of some injected insulin, a patient’s existing beta cells continue to function normally and produce enough insulin for blood-glucose management. Eventually, the majority of the insulin-producing beta cells in the pancreas cease functioning and the diabetes symptoms return.

The honeymoon phase and treatment

No matter how good A1C or blood-sugar tests are during the honeymoon phase, the disease is still present and killing beta cells. During this phase, physicians will help maintain blood-glucose management with low-dose insulin treatments. Eventually, the remaining healthy cells will die off and insulin dosages will need to be increased.

What it means for people with T1D

T1D is fairly predictable with regard to endocrine system function during the honeymoon phase, but every case varies just a bit. Paying close attention to the body’s responsiveness to insulin therapy paired with regular blood-sugar testing is paramount to successful management.

Less common T1D tests

Because each case can be as unique as the individual, some doctors may employ the following tests to find markers of T1D to ensure the optimal treatment plan:

• C-Peptide
  While most tests check for antibodies, this test measures how much C-peptide is in a person’s blood. Peptide levels typically mirror insulin levels in the body. Low levels of C-peptide and insulin can point to T1D.
• Insulin Autoantibodies (IAA)
  This tests looks for the antibodies targeting insulin.
• Insulinoma-Associated-2 Autoantibodies (IA-2A)
  This test looks for antibodies mounted against a specific enzyme in beta cells. Both the IA-2A and GADA tests are common T1D antibody tests.
• Zinc Transporter 8 (ZnT8Ab)
  This test looks at antibodies targeting an enzyme that is specific to beta cells.
• Islet Cell Cytoplasmic Autoantibodies (ICA)
  Islet cells are clusters of cells in the pancreas that produce hormones, including insulin. This test identifies a type of islet cell antibodies present in up to 80 percent of people with T1D.
• Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)
  This test looks for antibodies built against a specific enzyme in the insulin-producing pancreatic beta cells.

How age affects a T1D diagnosis

There are some side effects in the overall health of a person with T1D that present themselves in time. Diabetic eye disease and kidney, nerve, or circulation damage can appear in people who have had T1D for 15 years or more. With proper maintenance and routine checkups, these effects can often be limited or avoided altogether.

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Type 1 diabetes diagnosis

Diagnosing type 1 diabetes is based on symptoms and blood tests.

Type 1 versus type 2 diabetes

It is usually easy to tell what type of diabetes someone has when diagnosing type 1 or type 2 diabetes. However, in some cases it may not be clear if a person has either type 1 or type 2 diabetes so more tests are required.

What are the symptoms of type 1 diabetes?

Most people with type 1 diabetes have symptoms of high blood glucose levels (hyperglycaemia). These symptoms can include:

• excessive thirst
• feeling tired
• frequent urination
• unintentional weight loss
• blurred vision
• increased hunger
• frequent yeast infections or urinary tract infections
• slow healing wounds

How quickly do the symptoms of type 1 diabetes develop?

What blood tests are used to diagnose type 1 diabetes?

When diagnosing type 1 diabetes, a number of tests are used including fasting plasma glucose, random blood glucose, oral glucose tolerance test, and Hb A1c. When testing for diabetes, the first step is to confirm that a person has diabetes and the next step is to differentiate type 1 diabetes mellitus from any other form of diabetes.

Fasting plasma glucose

This test requires a person to fast for over eight hours followed by a blood test. A fasting plasma glucose of greater than 7 mmol/L or 126 mg/dL on more than one occasion can indicate diabetes.

Random blood glucose

A random blood glucose test is taken at any point… it’s random! A reading of 11.0mmol/L or 200mg/dL or more can indicate classic symptoms of hyperglycaemia (high blood glucose levels).

Oral glucose tolerance test

An oral glucose tolerance test (OGTT) involves consuming a sugary glucose syrup followed by a blood test one hour later and another two hours later. A plasma glucose reading of 11.0mmol/L or 200mg/dL or more at the two-hour blood test can indicate diabetes. Most children and adolescents display symptoms of type 1 diabetes, with blood glucose levels well over 11. 0mmol/L (200mg/dL), so an OGTT isn’t necessary to diagnose type 1 diabetes.

Haemoglobin A1c (Hb A1c) test

The Hb A1c test looks at the amount of glucose that has bound to a particular type of haemoglobin, the oxygen carrying molecule in our blood. A persons Hb A1c can be a good indicated of average blood glucose control, as it shows the average blood glucose levels over a 2-3 month period. A reading of 6.5% or more can indicate diabetes. However, measured Hb A1c may not be truly reflective of blood glucose control in some people. To learn more about conditions that can contribute to a falsely elevated or lowered Hb A1c reading, visit the Hb A1c test to diagnose diabetes article to learn more.

Type 1 diabetes and diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is a condition that occurs due to a build-up of poisonous chemicals, called ketones, in the bloodstream. DKA occurs in approximately 30% of children who present with type 1 diabetes (Diabetic Ketoacidosis in Infants, Children, and Adolescents). This causes the blood to become acidic, and the combination of acids and dehydration can lead to comas and potentially death.

DKA is a medical emergency and requires immediate medical treatment. Ketones can often be smelt on the breath and has a distinctive ‘nail polish’ smell. Low levels ketones are often normally present in prolonged starvation with or without diabetes.

In a person who has type 1 diabetes, the body isn’t able to use glucose for energy. Instead, stored fat in the body is used as a source of energy. It’s the breakdown of these fatty acids that results in the build-up of ketones, which can also appear in your urine.

Some symptoms of DKA include:

• Moderate to heavy ketones in the urine
• Rapid breathing
• Flushed cheeks
• Abdominal pain
• Sweet acetone (like nail polish remover) smell on the breath
• Vomiting
• Dehydration

What to do if you think you might have type 1 diabetes?

The first thing if you suspect you may have diabetes is to visit your doctor and request a blood test. Your doctor may perform a finger prick test or a more accurate laboratory blood test. There are a number of ways to diagnose diabetes. Once diagnosed it is very important to get educated!! Once you know what is happening and what to do, you can get back to feeling good again.

What should I do next?

If you experience any symptoms of type 1 diabetes or you have risk factors for developing type 1 diabetes, it is important to get tested for as soon as possible. Some people are at higher risk and need regular testing.

By diagnosing and treating the type 1 diabetes early, it means you can decrease the risk of developing or delay any further health complications of type 1 diabetes, for example nerve damage, blindness, and heart disease. It is important to know that diagnosing type 1 diabetes should not rely solely on using a Hb A1c test.

Once you learn what your type 1 diagnosis is, or if you already have type 1 diabetes, the next most important step is to become educated. You can join the 12-week Type 1 Diabetes Program to help you learn how best to manage the condition. For example, you can learn how best to monitor blood glucose levels in type 1 diabetes. The program is personalised and tailored, giving you more of the content that you want. The program also helps you to stay motivated and teaches you what changes you need to make. The first week is free and full of helpful and crucial information.

Follow the links below to learn more about type 1 diabetes.

Diabetes mellitus – types, symptoms, causes, diagnosis, tests, treatment, prevention

How to recognize diabetes? This question worries many who suspect that something is wrong with their health. Typical manifestations of the disease are a constant feeling of thirst and frequent urge to urinate, irritation and itching of the skin, weakness, including muscle, daytime sleepiness, rapid weight loss against the background of increased appetite.

Types and symptoms of diabetes mellitus

In type 1 diabetes, there is a lack of insulin. This hormone is produced in special areas of the pancreas – in the islets of Langerhans. It is produced by beta cells. If a disease occurs, the cells die, are destroyed, so the hormone does not enter the bloodstream. Type 1 diabetes is immune-mediated or occurs spontaneously for no apparent reason (idiopathic).

The onset of type 1 diabetes (onset) can be acute and life-threatening. A recent infection can provoke it, most often the disease begins in autumn or winter.

At the same time, typical clinical symptoms of the disease appear, which are necessarily fixed by the doctor: dry skin, a decrease in its elasticity, blush on the cheeks, shortness of breath, noisy breathing. As a rule, in 15-20% of people at the onset of the disease, the smell of acetone is felt when exhaling.

At the time of treatment, the doctor necessarily prescribes a comprehensive laboratory examination. It includes an analysis to determine the level of glucose. A concentration above normal is hyperglycemia. A number of other tests can confirm the diagnosis of type 1 diabetes. In this case, lifelong insulin therapy is prescribed.

Diabetes mellitus of the second (II) type refers to socially significant diseases, the prevention of which is given a lot of attention. Violation of the production of insulin secretion against the background of a decrease in sensitivity to it occurs for a number of reasons. Often these are metabolic disorders due to hereditary factors. It is important to understand that the second most common cause of the disease is obesity.

In type 2 diabetes, glucose insensitivity develops, it can be of varying degrees and is also accompanied by impaired insulin production of varying degrees.

With the development of type II diabetes, general fatigue, apathy, an increase in the amount of urine, thirst, leg cramps (mainly at night) are often observed. Most often, the disease can “manifest” after 40 years against the background of concomitant diseases (arterial hypertension, obesity).

Causes of diabetes mellitus

1. Hereditary predisposition, metabolic disorders caused by obesity, a sedentary lifestyle (lack of exercise), which to a certain extent is also associated with obesity.

2. Diseases of the pancreas.

3. Infectious diseases that provoke viruses, such as rubella, smallpox, influenza.

The chronic course of diabetes, as a rule, is accompanied by severe complications and dysfunction of some organs and systems. So, with retinopathy, visual impairment is possible, up to cataracts and blindness. Nephropathies lead to kidney damage, angiopathy – fraught with ulcers of the lower extremities (“diabetic foot”). Often this leads to tissue necrosis, gangrene and leg amputation. The urogenital system, heart and blood vessels, teeth (periodontal disease) “suffer” from an increased level of glucose in the blood. That is why, if diabetes is suspected, it is important to diagnose the disease in a timely manner, if it is necessary to start treatment, and follow preventive measures.

Laboratory diagnosis of diabetes mellitus

To diagnose diabetes, the doctor must prescribe laboratory tests of hormones, a biochemical study of blood and urine. So, to diagnose diabetes, you need to donate blood for glucose, glycosylated hemoglobin and fructosamine. To differentiate the first type from the second, a glucose tolerance test is used. It includes glucose, insulin, C-peptide. Blood sampling is carried out strictly on an empty stomach (at least 8 hours after the last meal), it is repeated after 2 hours, when the patient is allowed to drink water with glucose dissolved in it (75 g).

To diagnose glucose insensitivity, insulin resistance is assessed, also calculating the HOMA-IR index. It is calculated on the basis of data on the content of glucose and insulin. During an illness, it is recommended to take tests to control its course and make adjustments to the therapeutic course.

blood glucose. The main indicator of blood sugar levels. If a person does not have diabetes and there are no prerequisites for its development, the concentration almost does not fall below the established norm and rarely increase.

Insulin is a hormone that regulates blood glucose levels and the metabolism of carbohydrates and fats. If it is not secreted enough, glucose rises. An increase indicates a possible DM II. A blood test for this hormone is prescribed to resolve the issue of prescribing insulin preparations, as well as in a complex of studies of metabolic disorders. Proinsulin is a molecule made up of insulin; characterizes the functionality of pancreatic beta cells.

C-peptide is a fragment of proinsulin that circulates in the blood and allows you to evaluate the work of pancreatic cells.

Glycosylated hemoglobin (glycated, HBA1c) is the combination of hemoglobin with glucose. The presence of this compound in the blood indicates an increase in sugar levels over the period of the previous 2-3 months, since the life of an erythrocyte is 90 days. Therefore, it can be a laboratory marker of hyperglycemia long before the onset of other clinical symptoms of DM. The analysis is recommended by the World Health Organization, including as a key parameter in monitoring the course of diabetes.

Fructosamine. The fructosamine readings also reflect the change in glucose levels over the previous two to three months.

Treatment and prevention of diabetes mellitus

The main thing to understand is that life with diabetes is possible. But its quality directly depends on compliance with the complex of therapeutic and preventive measures prescribed by the doctor.

It is important to control your glucose levels. Therefore, be sure to purchase a glucometer with test strips for it. You need to eat in a balanced way. You can not allow an overabundance of some nutrients and a deficiency of others, for example, monitor the amount of carbohydrate foods in the diet and do not exceed the recommended norm.

Physical activity has a significant impact on maintaining the quality of life of a person suffering from diabetes. Many people mistakenly believe that exercise helps control blood sugar. This is not entirely true – you should not train too hard and intensely. It is also important to exclude extreme sports (alpine skiing, diving, surfing).

Remember, self-prescription of drugs and the use of unverified folk methods are not only ineffective, but also life-threatening.

Diagnosis of diabetes mellitus: cost of tests

Diagnosis, treatment and prevention of diabetes always begins with laboratory tests. At the moment, this is the most informative way. The list of necessary studies in the table. The cost of analyzes varies for Moscow and regions.

Be healthy!

References

1. Dedov I.I, Melnichenko G.A. Endocrinology. National leadership. M.: Geotar-Media, 2013.
2. Dedov I.I., Shestakova M.V. Clinical guidelines “Algorithms for specialized medical care for patients with diabetes mellitus.” 7th issue. M.: Ministry of Health of the Russian Federation Russian Association of Endocrinologists FGBU Endocrinological Research Center, 2015.
3. Kholodova E.A. Clinical endocrinology. Guide for doctors. M.: Medical Information Agency, 2011.

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