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What is diabetes

  • What is type 1 diabetes?

    Type 1 diabetes is a condition that occurs when the body loses its ability to produce a hormone called insulin. This life-long autoimmune condition affects over 120,000 people in Australia alone and is predominately diagnosed in childhood.Insulin is normally produced by the pancreas and allows glucose (sugar) to move from the blood to tissues such as muscle where it is required for energy.

    A children's guide to type 1 diabetes

    An adult's guide to type 1 diabetes

    What are the symptomsof type 1 diabetes?

    Type 1 diabetes may cause some of the following symptoms. If you think you or someone you know has these symptoms, seek medical help immediately, and drink sugar-free fluids to prevent dehydration.

    • Extreme thirst
    • Constant hunger
    • Sudden weight loss
    • Frequent Urination
    • Blurred Vision
    • Nausea
    • Vomiting
    • Lethargy
    • Infections

    When there is not enough insulin the blood glucose levels build up and eventually "spill over" into the urine. This results in excessive urine production and thirst. Thus, prior to treatment, affected children and adolescents have usually had the symptoms of thirst and increased urination for some time (usually 2-3 weeks). If this situation is allowed to progress unchecked, fat stores begin to break down, weight loss occurs and the blood becomes increasingly acidic. Eventually affected people become dehydrated, start vomiting and lose consciousness. This is called diabetic ketoacidosis (DKA).

    The treatment of type 1 diabetes involves replacement of insulin. Insulin can be replaced in the body either via insulin injections (twice daily insulin or four injections per day) or with insulin pump therapy. Checking blood glucose levels provides information on how much glucose is currently in the bloodstream and is a crucial part of managing diabetes. It is the only way to know if the body is getting the correct amount of insulin that it needs. Managing diabetes involves balancing insulin, food, and exercise.

    When people are first diagnosed with type 1 diabetes, they will be medically stabilised and start on insulin injections. They will usually be required to stay in hospital for a short period of time to commence diabetes education which can then be finished as an outpatient after discharge. These education sessions will be with a diabetes nurse educator (approx. three-four sessions), dietitian (approx. two sessions), and social worker (approx. one session).

    The goal of diabetes education is to provide the needed support to young people and their families to feel comfortable and confident with diabetes management in their day to day life.

    A young person with diabetes will have an appointment with an endocrinologist (diabetes doctor), diabetes educator and dietitian a few weeks after their diagnosis. Following this appointment, diabetes care involves an outpatient appointment every 3-4 months with the endocrinologist.

    Diabetes nurse educators, diabetes dietitians and social workers are available to be contacted in between the young person’s doctor appointment for support with diabetes management.

    What is insulin and why is it so important?

    Insulin is the hormone needed to move the glucose from the bloodstream into the cells. Insulin is the “key” which opens the door of the cell, allowing glucose to flow inside. Without insulin most of the organs cannot take up glucose.

    When there is not enough insulin in the body the glucose stays in the bloodstream. The blood glucose level rises very high because it cannot move into the cells. The body tries to clear the glucose from the bloodstream by offloading glucose in the urine.

    "When glucose cannot be used for energy the body uses fat instead. If fat is used for energy, some harmful substances called ketones begin to build up in the blood. The ketones that build up will make the person with diabetes very sick"

    - Diabetes in Children and Adolescents, 3rd ed, 2010

    When a person is diagnosed with type 1 diabetes, insulin needs to be replaced by an injection of manufactured insulin.

    Insulin is essential for survival. There is never a time when the body should be without insulin and there is no alternative treatment to insulin.

    Following the diagnosis of type 1 diabetes

    When people are first diagnosed with type 1 diabetes, they will be medically stabilised and start on insulin injections. They will usually be required to stay in hospital for a short period of time and commence diabetes education which can then be finished as an outpatient following discharge home. These education sessions will be with a diabetes nurse educator (approx. three-four sessions) and dietitian (approx. two sessions). We have a diabetes social worker as part of our team as well.

    The goal of diabetes education is to provide the needed support to young people and their families to feel comfortable and confident with diabetes management in their day to day life.

    A young person with diabetes will have an appointment with an endocrinologist (diabetes doctor), diabetes educator and dietitian a few weeks after their diagnosis. Following this appointment, diabetes care involves an outpatient appointment every 3-4 months with the endocrinologist.

    Diabetes nurse educators, diabetes dietitians and social workers are available to be contacted in between the young person’s doctor appointment for support with diabetes management.

    Long term management and HbA1c targets

    People who have been diagnosed with type 1 diabetes at the RCH will have a fingerprick blood test done in clinic every 3-4 months to test their HbA1c level. This test is the best measure for long-term blood glucose control. It can tell us about how much glucose has been circulating in the blood stream on overall over the last three months which tells us about the relative risk of complications associated with chronically (long term) elevated blood glucose levels. The risk of diabetes complications developing can be minimised by having good long term diabetes control. The target HbA1c for all children and adolescents with type 1 diabetes is less than 7% or less than 53 mmol/mol.