Thursday, November 13, 2008

Diabetes symptoms come on gradually

Many ask how I knew that Emma was sick and I can talk about the symptoms that she was experiencing, but its easy to look back and see what you were missing. Emma was taken to the Urgent Care with an ear infection on New Years Eve 2006. That was the first time she had had any sort of illness - she had been surprisingly healthy. Within 2 1/2 months, she was diagnosed with Type 1 diabetes. And looking back at the photos of her during that 2 1/2 months, I'm surprised we didn't suspect anything sooner about her illness.

Here's some information from the Children With Diabetes site that talks about the gradual development of Type 1 Diabetes:
Diabetes Develops Gradually

The process of developing diabetes is gradual. Studies performed by the Joslin Clinic1 have shown changes as much as nine years before the actual presentation of diabetes symptoms. The development of Type 1 diabetes can be broken down into five stages:
  • Genetic predisposition
  • Environmental trigger
  • Active autoimmunity
  • Progressive beta-cell destruction
  • Presentation of the symptoms of Type 1 diabetes

People with Type 1 diabetes have a genetic pre-disposition to the disease, but one or more environmental insults is required to trigger disease. This fact can be derived from studies of identical twins with Type 1 diabetes. When one twin has Type 1 diabetes, the other twin gets diabetes only half the time. If the cause of Type 1 diabetes were purely genetic, both identical twins would always have Type 1 diabetes.

One environmental trigger is thought to be the Coxsackie B virus. Researchers at UCLA found that a small segment of GAD is structurally similar to a segment of a Coxsackie B protein. GAD is found on the surface of insulin-producing beta cells. The implication is that the body's immune system, after warding off the Coxsackie B virus, continues to attack beta cells because of the similarity of GAD to the virus.2

The environmental trigger results in the production of autoantibodies. People with Type 1 diabetes have antibodies in their blood that indicate an "allergy to self," or an autoimmune condition. One autoantibody found in people with Type 1 diabetes is the islet cell antibody. This antibody is often present months or years before the diabetes presents. Other antibodies include the GAD (or 64-K) antibody and the ICA 512 antibody. The presence of these antibodies is a sign that the body is attacking its own beta cells.

Symptoms of Diabetes
Once over 90% of the beta cells are destroyed, the body is no longer able to regulate blood sugar levels and the patient develops some or all of the classic symptoms of diabetes:

  • excessive thirst
  • excessive urination
  • excessive hunger
  • weight loss
  • fatigue
  • blurred vision
  • high blood sugar level
  • sugar and ketones in the urine
  • Kussmaul breathing (rapid, deep, and labored breathing of people who have ketoacidosis or who are in a diabetic coma)

While the symptoms appear abruptly, the development of the disease actually occurs over a much longer period of time.

So, despite the fact that we saw the obvious symptoms for about 2 1/2 weeks, it was clear that Emma was developing this disease over a period of time. And I'm just glad that we identified it when we did or she could have been much worse before she was diagnosed.

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