Excessive thirst and reduced energy levels combined with sudden weight loss and passing urine excessively – if you notice these four symptoms in yourself or a child or adult you know, it’s time to think “GP visit”.

That’s because these are the four main symptoms of type 1 (T1) diabetes, a lifelong condition which occurs when one’s pancreas stops producing the hormone called insulin.

Blood glucose levels are then not being controlled and the above symptoms ensue. Leave it too long to seek medical help and the situation can be life-threatening.

Unlike type 2 diabetes, T1 isn’t preventable or lifestyle related. It also isn’t curable at present and can manifest itself at any age but why does diagnosis age differ from person to person with T1?

System attacks insulin-producing cells

“T1 diabetes is an auto-immune condition, meaning the immune system attacks the insulin producing cells in the pancreas and they stop making insulin,” says nurse Clair Naughton who is also regional development officer for Diabetes Ireland. “We don’t know fully yet what can trigger the auto-immune process that leads to it.

“It can develop at any age but the majority of cases are diagnosed in childhood or in young adults.”

Only one in 10 have genetic link

While there is a genetic element to the disease, only about one in 10 diagnosed Irish children have a history of T1 diabetes in a parent or sibling, she points out.

“A diagnosis is a bolt out of the blue, then, for most families.”

November is Diabetes awareness month with World Diabetes Day falling on 14 November.

Act quickly

“We want people to be aware of the main symptoms and act quickly by seeking medical attention,” Clair says.

Her reason for that is simple. “In 2020, four in every 10 children diagnosed with T1 diabetes were critically ill by the time they were admitted to hospital. What’s known as diabetic ketoacidosis (DKA) had occurred, which is a life-threatening complication of T1 diabetes. When a person is critically ill it is hugely traumatic for the whole family unit so the earlier it’s picked up the better.”

Symptoms can be missed

It can be difficult to recognise the symptoms in a young child, however, as they can’t verbalise how they feel and when wearing nappies the excess urine may go unnoticed.

“Sometimes, also, the symptoms may be construed as something else, or a parent may delay seeking medical attention in the hope that the symptoms will resolve and this leads to a delayed diagnosis,” Clair says. “If your child is vaguely unwell seek medical attention and ask for a simple finger prick blood test and urine test to rule out diabetes.”

See graphic of symptoms above.

What happens when diagnosed

When a person is diagnosed with T1 diabetes they are admitted to hospital. After they are medically stabilised a lot of learning starts in order for the individual or family to be able to self-manage the condition daily. Daily diabetes tasks include self-administering insulin injections, monitoring blood glucose levels and learning about how different foods affect the blood glucose level and learning about what to do when blood glucose levels go too high or too low.

“Each individual or a parent of a child will have to learn how to adjust daily insulin doses (to mimic what the pancreas should be doing) depending on what they eat, levels of physical activity and so on. It’s a very steep learning curve,” she says.

Grief at diagnosis

Some people say adjusting to their diagnosis is akin to a grieving process with a variety of feelings being experienced. “If it’s a child often the parents are relieved to get a diagnosis because their child has been so unwell,” Clair says.

“They are relieved that the condition is manageable and that they can live with it and that it is not something more serious. At that stage they ask, ‘What do we need to do?’ and are eager to learn. A few weeks down the line and they are at home and they realise that all this (measuring and testing) is all day, every day, for the rest of their lives.

“There is shock and ‘Why me?’ feelings but feeling like that is absolutely normal. It does take time to come to terms with the diagnosis as it does for diagnosis with any life-long illness. One should seek the support of family and friends and the diabetes team during this time.”

Despite needing to be managed continuously diabetes does not hold a person back from anything they want to do in life, she points out, once everything that a person does is planned for, around their diabetes.

Symptoms explained: insulin is key

When we eat, certain foods are broken down into a simple sugar called glucose that is needed for energy. Insulin is a hormone that acts like a key and opens up the cells in the body for glucose to move from the blood into the cells where it is converted into energy and heat. That is why one of the symptoms of undiagnosed diabetes is reduced energy.

Without insulin the glucose stays in the blood. The body can’t use it for energy and heat so the body starts breaking down fat stores for energy hence weight loss.

The increased urination is because there’s too much sugar in your blood, meaning that your body tries to get rid of the excess glucose by passing it out in the urine.

The excessive thirst symptom is because of one’s kidneys having to work extra hard to absorb and filter the extra sugar in the blood. Some of it is passed out of the body through urine and as that happens, it pulls fluids from your tissues making you feel dehydrated and excessively thirsty.

Lifelong education about the condition

Ongoing support and education from the person’s diabetes team is an essential part of diabetes management and continues throughout the person’s life, Clair adds.

“Everyone with T1 would attend a specialist diabetes clinic in a hospital setting a couple of times a year run by a multidisciplinary team. They would also have the option of telephoning the diabetes team for advice if something happened that they couldn’t manage their diabetes. “

Needs change over time

Needs change as time goes on too.

“Maybe a teenager takes up a new (sport-related) hobby or a student wants to go backpacking in Australia or a woman may want to plan a pregnancy. They will need advice about managing everything around that so the diabetes team provide that ongoing education and support throughout the life course.”

An essential part of diabetes management is, of course, having routine medical checks to ensure there are no long-term complications of diabetes occurring. These regular routine checks include blood tests, an annual eye test and a foot examination.

Good news: tech improvements

There isn’t a cure for T1 yet but there are now newer insulins available and technology is improving all the time, including insulin pumps, glucose sensors and continuous glucose monitors. This definitely reduces the burden of care in the management of diabetes, see Patrick’s story above. CL

How technology is helping: a part-time farmer’s story

Patrick Moran (60) is from Co Leitrim and was diagnosed with T1 diabetes at the age of 16 after experiencing excessive thirst and losing three stone over the course of a few months. He has seen the management of diabetes improve hugely in the 44 years since.

“After I was diagnosed, I was taught to inject myself twice a day with a glass syringe like one you’d use to inject cattle,” he says. “The syringe and needles had to be sterilised in methylated spirits each time. Doing urine samples and going by the colour of it was the only way of knowing if your blood sugars were high or low back then.

“In the 80s the disposable syringes came in and that was a big improvement. The blood-sugar testing meters came out then in the 90s or 00s and they were marvellous too because from then on you didn’t have to be testing urine. It was a finger-prick blood test instead and it told you how the blood sugar levels were.”

“The dial-up insulin pens have been a great invention as well – they came out 15 years ago. You keep them in the fridge and you dial up precisely what insulin is needed and you just change the disposable needle each time.

“Nine months ago I got a glucose sensor and I can now take a reading by holding my phone up to the sensor on my arm. The app tells me what insulin I need and it’ll bleep at you if you are running high or low. I take insulin four times a day now, three short-acting and one long-acting injection.

“For any new diabetic the changes are mighty. In the past you didn’t know where you were with your blood sugars. Now we have exact readings. It’s a huge improvement.”

Patrick is supported in managing his condition by Sligo General Hospital and Diabetes Ireland and says that farming helps to keep his blood sugars under control by keeping him active.

100 years since insulin discovered

The Diabetes community is also celebrating 100 years since insulin was discovered – a life-saving moment for millions of people living with type 1 diabetes.

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