Over 100 years ago, the first patient with type 1 diabetes was treated with insulin. Previously, the average survival time was only nine months.
Today, with the best medical care, type 1 diabetics have about the same life expectancy as people with a healthy metabolism. In Germany alone, around 341,000 adults and 32,000 children and adolescents suffer from type 1 diabetes. Most of them are treated with insulin daily, often for life.
Diabetes is not yet curable. However, modern technologies in the field of insulin administration and glucose measurement have contributed to the fact that the majority of patients can lead a largely normal life. Certain restrictions in everyday life remain.
What is type 1 diabetes? Type 1 diabetes is an autoimmune disease. Certain cells in the pancreas called beta cells produce the hormone insulin. In people with type 1 diabetes, these cells are attacked by their own immune system and become so damaged over the years that they only release very little or no insulin at all. Type 1 diabetics therefore have to inject insulin every day. This protects you from excessive fluctuations in blood sugar levels and symptoms caused by low and high blood sugar levels.
From the first insulin syringe to the insulin pump
The first insulin treatment of a type 1 diabetic patient in Canada in 1922 was a medical milestone. “If we consider that up to this point in time the diagnosis of type 1 diabetes was synonymous with certain death, one can appreciate what a turning point the discovery and establishment of insulin therapy represents in the history of medicine,” says Professor Andreas Neu, President of the German Diabetes Society (DGG).
Further advances in therapy followed a short time later. In 1924 the first insulin syringe came onto the market, and in 1934 the first time-release insulin. The urine glucose test strips that were common in the 1950s were supplemented by blood glucose measuring strips in the 1960s. In 1983 animal insulins were replaced by human insulins for the first time and in the same year the first insulin pump was presented.
The majority of children with type 1 diabetes use insulin pumps
“Today, more than 60 percent of all children and adolescents use an insulin pump, in infancy it is more than 90 percent,” says Neu. The use of modern technologies for glucose determination is also increasing rapidly. The combination of pumps and glucose sensors to form so-called “hybrid closed-loop” systems is already close to what constitutes glucose regulation in healthy people.
However, even today, diabetes therapy demands a lot from young patients and their families, stresses Neu. “Therefore, in addition to drugs and technologies, lifelong support by professional teams is necessary for treatment success and a high quality of life.”
Benefits of continuous glucose monitoring
The use of modern technologies for blood glucose determination is currently increasing rapidly. “More and more children and young people are using a sensor, a form of continuous glucose determination,” says Neu.
These systems have one major advantage: They can be coupled with the insulin pumps and ensure that the insulin supply is switched off automatically when the glucose values are too low or that additional insulin is administered when they rise.
New technologies make life easier, but they don’t solve all problems
Doctors speak of so-called “closed-loop” systems. In addition to improved metabolic quality and thus improved long-term prognosis, these systems primarily contribute to the fact that patients are much less restricted in their everyday lives than they used to be.
Nevertheless, those affected are not spared regular measurements of the glucose level, administration of insulin with every meal and estimating the amount of carbohydrates during meals. The problem of hypoglycaemia, which all diabetics fear, cannot be completely solved either. Care and discipline are therefore important to ensure that there are no gaffes.
Experts criticize gaps in patient care
Neu criticizes that there are still gaps in the care of young type 1 diabetics at the regional level. Inclusion in daycare centers, kindergartens and schools is still insufficient. The child diabetologist sees particularly great difficulties in families with little health competence or language problems. Therefore, Neu calls for more competent and dedicated care of patients in children and adolescents.
Specialized teams should be established across the board at every children’s hospital and ensure both good initial care and competent long-term support. This is the only way to succeed in implementing individual treatment strategies from the multitude of different forms of therapy and in shaping the everyday life of the young patients in such a way that it is age-appropriate and allows a life like that of their peers without diabetes.