The course of type 1 diabetes - how does it manifest itself?

Type 1 diabetes (insulin-dependent diabetes mellitus) is a disease that can develop for up to several years before it starts to show its first symptoms. Fortunately for sufferers, the greatest threat to their health and life is when diabetes begins to present its typical clinical picture. In the natural course, we can distinguish four basic stages (phases) of the disease:

• pre-clinical stage - this is a completely asymptomatic stage. The body begins to produce antibodies that attack and destroy the beta cells of the pancreatic islands. There is a slow reduction in the insulin faculty, but the cellular reserves are so large that no general deficiency of the hormone is observed and blood glucose levels oscillate within normal limits. The pre-clinical stage can last from a few weeks to several years. The only method to diagnose diabetes at this stage is to carry out immunological tests that show the presence of specific antibodies against pancreatic islet antigens. The diagnosis of the disease may also be suggested by a reduction in insulin secretion on examination after intravenous glucose administration.
• disclosure of diabetes - this is a key moment in the course of the disease. A previously healthy child begins to manifest the first symptoms. It usually starts with a slight deterioration of mood. The child may appear light-headed. The appetite worsens. The young patient avoids eating, but begins to drink very large quantities of water. This is known as polydipsia, or increased thirst. Some patients even drink about 5 to 10 litres of water a day! Polyuria is also observed. As a result of the large volume of fluids, glomerular filtration rate increases and, in addition, so-called osmotic diuresis occurs - the kidney, overloaded with glucose, is unable to save glucose, which "pulls" water with it. A very worrying symptom is also weight loss or a stable weight in growing children. Above this, the following may occur: visual disturbances, fungal infections, especially of the genital area, skin infections.
• partial remission - this stage is often referred to as the "honeymoon period". After the onset of diabetes, when the level of insulin secreted by the pancreas is very low, the beta cells regain part of their production capacity. Insulin levels begin to rise and the need for insulin in the form of medication begins to decrease. This period usually occurs within the first few weeks of starting diabetes treatment with exogenous insulin (i.e. administered as a drug). Unfortunately, usually after a period of several weeks (rarely several years) the period of remission ends.
• full insulin dependence - this is the final stage of the disease and always occurs, regardless of whether diabetes treatment has been introduced. It involves a complete loss of insulin production by the beta cells of the pancreas. It is a lifelong condition and is incurable in today's medical conditions.

Difficult diagnosis in a child - are you sure it's diabetes?

Childhood (and especially early childhood) is an extremely important stage in a person's life. It is in the case of rapidly developing children that various congenital or metabolic diseases manifest themselves. This is why appropriate diagnosis (including differential diagnosis) of diseases in paediatrics is extremely important. This also applies to type 1 diabetes mellitus. The differential diagnosis should primarily take into account other causes of increased thirst and polyuria (poiuria and polydipsia), such as diabetic uremia. The doctor making the diagnosis should also consider the possibility that the young patient may have other, rarer types of diabetes caused by:

• a genetic defect in beta-cell function,
• diseases manifested by damage to the pancreas - for example, the dangerous and fatal cystic fibrosis,
• endocrinopathies - Cushing's syndrome, hyperthyroidism,
• medications (e.g. glucocorticosteroids),
• infections (rubella, cytomegalovirus).