Insulin injection may be one of the toughest challenges for diabetics/ShutterStock
We often refer to diabetes as a uniform disease, but it is important to understand that there is a very significant difference between its subtypes. Unlike type 2 diabetes, which stems from many causes and is also linked to the obesity epidemic, type 1 diabetes is an autoimmune disease in which the immune system attacks the beta cells in the pancreas, which are responsible for secreting insulin - a hormone whose important function is to get the sugar we eat into the cells. Once these cells are destroyed, there is essentially no ability to secrete insulin – and that's type 1 diabetes.
The symptoms of the disease are first and foremost very high blood sugar values and this has many consequences: frequent urination, heavy drinking, weight loss, and general unwell because sugar - an important energy factor - does not reach the cells.
Another challenge for type 1 diabetics is the need to strictly maintain a proper and balanced diet/ShutterStock
"If the disease is not diagnosed in time, and there are many such cases, in the end, the situation can be very serious and may lead to the need for an urgent visit to the hospital with a condition called acidosis," explains Dr. Kinneret Mazor Aharonovitch, a specialist in pediatric endocrinology and diabetes at Edmond and Lily Safra Children's Hospital, Sheba Medical Center Tel Shomer. "It's a life-threatening condition that, if not diagnosed in time, can become an emergency, and once diagnosed, the patient often needs to be admitted to intensive care. We want there to be as much awareness as possible, so that as few children as possible end up in hospitals with acidosis."
According to Dr. Mazor Aharonovitch, when it comes to children, type 1 diabetes is the second most common disease after asthma (about 300 new patients are diagnosed each year in Israelis). Its diagnosis is made many times in childhood - from the age of 9 months to 18 years (which is why it was previously called 'juvenile diabetes'). It is important to emphasize that type 1 diabetes may also appear in old age. "When a child has diabetes, chances are he has type 1 diabetes," explains Dr. Mazor Aharonovitch. "When you have a diagnosis of diabetes, you have to get insulin. This is not a drug that can be given in pill form orally, but must be injected."
24/7 illness without vacations Insulin injection may be one of the toughest challenges for diabetics
, but just as difficult is to check and monitor glucose levels every day, all day. "It's important to remember that diabetes is present 24 hours a day, seven days a week, 365 days a year. It is not possible to take even a single day off from it. You can't say, 'Today I won't inject insulin because I don't have the energy.' If a type 1 diabetic does not inject, he may end up in the hospital," explains Dr. Mazor Aharonovitch, adding: "We send a message to parents and children that although it is possible to live a full and full life with type 1 diabetes, we must know all day long what to eat and how much insulin to inject."
One of the other problems in dealing with type 1 diabetes is the balance of blood sugar values. "A lot of times we have challenges with diabetes imbalances. This happens mainly if too much insulin is given. In such a situation, there is a decrease in sugar values - the so-called 'hypoglycemia' - which creates a bad feeling. In more severe cases, this can cause unconsciousness or seizures," explains Dr. Mazor Aharonovitch. According to her, the fear of hypoglycemia prevents many diabetics from being well balanced. "There is fear, especially among those who have experienced a severe hypoglycaemia, even if they have not lost consciousness but felt unwell and therefore inject too little insulin."
Another challenge for type 1 diabetics is the need to strictly maintain a proper and balanced diet and the importance of exercising regularly. "Leading such a lifestyle reduces the ability to maintain spontaneity and requires a lot of advance planning," explains Dr. Mazor Aharonovitch.
"It is also important to remember that diabetic children do not enlist in the army, but can volunteer. They are also entitled to test relief because it is sometimes necessary during the exam to inject insulin, check glucose or treat hypoglycemia. In addition, young children need an aide in kindergarten or school in the lower grades," says Dr. Mazor Aharonovitch.
"We want a solution to eventually be found that doesn't require the patient to connect to the devices" / ShutterStock
Medicine is constantly looking for solutions
Despite the advancement of technology, there is a constant need to maintain blood sugar control, and this is part of the reason why this is a debilitating disease. "In cases where diabetes is unbalanced, there may be long-term complications that include damage to the eyes, heart, nerves, kidneys and even mortality at an earlier age compared to those whose diabetes is balanced," explains Dr. Mazor Aharonovitch. "So you have to invest a lot in balancing it." She says one of the main problems teens and children face is that they feel good at a young age, and don't understand the future effects and consequences. "Great efforts are being made all over the world to find ways to prevent type 1 diabetes and stop complications. But we are still a long way off," explains Dr. Mazor Aharonovitch.
Treatment for type 1 diabetics includes prick finger glucose tests, which are conducted several times a day. "Basically, an insulin injection is given at every meal – that's about 4-5 injections a day. But fortunately, there are other solutions today, and in Israel the health basket allows additional options for children, such as: Insulin pump:
"Today many diabetics are treated with an insulin pump," explains Dr. Mazor Aharonovitch, "This is actually a small device inside which is insulin that comes through a tube through a butterfly that needs to be replaced every few days. The pump recommends how much insulin to give, and unlike the regular injections here, you don't feel the injection, except for replacing the butterfly, which requires stabbing."
Continuous glucose meter: "The meter is on the body and measures glucose continuously every few minutes," says Dr. Mazor Aharonovitch. "The patient is constantly receiving information about his sugar and also what the trend of sugar is in the body. This sensor is replaced once a week to two weeks (also requires stabbing when inserting the sensor)."
Smart pumps (loop): "A device containing a sensor that transmits data to the pump. Based on an algorithm generated from the sensor's data, the pump is instructed how much insulin to give," explains Dr. Mazor Aharonovitch. "The pumps do a lot of the work, which takes a lot of the patient's load off, but it still doesn't obviate the need to give insulin on food."
Is it possible to prevent or delay the disease?
"We want a solution to be found in the end that won't require the patient to connect to the devices because this is a big disadvantage," explains Dr. Mazor Aharonovitch. "Although it doesn't require stabbing several times a day, these are still electrical devices that they have to carry on their bodies. The device can break down, and some children develop allergies to it. Sometimes these devices also make mistakes. Patients want their diabetes taken away completely."
She says there is now a lot of research trying to eliminate diabetes or replace pancreatic cells with others, and for other cells to do the role of the pancreas. "Unfortunately, it may take years before we see results, but efforts are currently being made to find solutions in order to delay the onset of diabetes over time," says Dr. Mazor Aharonovitch.
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