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Type 1 Diabetes Mellitus and Driving

Several studies conducted in the United States and some countries of Europe shows several striking results such as the collision rate of individuals (drivers) with type-1 diabetes is twice as that of normal or non diabetic individuals, which shows that there is increased risk of driving collisions in the individuals with Type 1 diabetes. There are several reasons for increased risk (double) of driving collisions for drivers who are suffering from, type 1 diabetes.

The first reason is eye complication (diabetic retinopathy) of patients with diabetes (type 1 diabetes as well as type 2 diabetes), which results in loss of vision (mainly peripheral vision) and/or visual acuity. Due to visual impairment, the driver with type 1 diabetes may not be able to read street signs properly, which may lead to motor accidents such as collisions. If drivers can not read the road signs properly, it may hamper driving, e.g. signs of speed limit, if missed may lead to accident due to over speeding.

The next or second reason is peripheral neuropathy caused by type-1 diabetes. Due to development of peripheral neuropathy, the diabetic individuals may not have normal sensation in their feet, which can impair drivers ability to control speed and also apply appropriate pressure to the brakes during driving and lead to collisions and other accidents.

Hypoglycemia (lower than normal blood sugar level) can have effect on state (level) of consciousness and thinking process, both of which are essential for driving. If there is impairment in thinking process, coordination and consciousness (all of which are vital for driving and avoiding accidents) there may be increased incidence of collisions and other motor accidents.

To avoid collisions and other accidents, individuals with type-1 diabetes the following steps are recommended:

  • Do not drive when blood glucose is below 70 mg/100 ml of blood. If you need to drive, you should first treat hypoglycemia and wait till your blood sugar is above 90 mg/100 ml of blood.
  • If you are type 1 diabetes patient, learn about the causes of hypoglycemia in type 1 diabetics (you).
  • National Institutes of Health (NIH) have funded some research for safe driving by type 1 diabetics. You can find the internet version which has proved to be beneficial for type 1 diabetics.

Prevention of Type 1 Diabetes Mellitus

At present type-1 diabetes is not a preventable disease. But there are several preventive therapies currently under study and emerging and many of the preventive therapies are showing promising results. Due to promising potentials of preventive therapies we can hope to be able to prevent type-1 diabetes before it manifests, at the latent autoimmune stage, by use of different preventive therapies, if required.

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Diet in prevention of type 1 diabetes:

Several researches have shown that breastfeeding for adequate duration can reduce risk of developing diabetes in later life. There are also various other nutritional factors (some are protective and some are with potential risk for diabetes type-1) important in diabetes, but no conclusive evidence is yet available. For example, administration of 2,000 IU (international unit) of vitamin-D is found to be protective, but sufficient evidence is lacking.

Immunosuppressant drugs in prevention of type 1 diabetes:

Cyclosporine A (an immunosuppressant drug) can prevent and halt destruction of beta cells of pancreas, which produce insulin, but high side effect profile of Cyclosporine A makes it unsuitable for long term use.

Anti CD3 antibodies (such as teplizumab, otelixizumab etc.) and anti CD20 antibodies (rituximab), has been shown to preserve insulin production is type-1 diabetes patients, bt their long term effects are not satisfactory.

T-helper cell shift in prevention of type 1 diabetes:

Research is going on to find out ways to prevent immune system from attacking beta cells of pancreas and prevent development of type-1 diabetes. Researchers are trying to do it by making the activation state of the immune system to change from type 1 Helper T cells or Th1 type to Th2 type.

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GAD65 vaccine in prevention of type 1 diabetes:

Vaccines are under trial for type-1 diabetes using GAD65, which is an auto-antigen responsible for development of type-1 diabetes. In clinical trials, administration of GAD65 vaccine within 6 months of diagnosis has shown to delay destruction of beta cells.

Diagnosis of Type 1 Diabetes Mellitus

The diagnosis of diabetes mellitus (type-1 diabetes as well as type-2 diabetes and other forms of diabetes such as Gestational diabetes, other specific types of diabetes) is based on clinical features of diabetes and laboratory findings. All forms (types) of diabetes are characterized by persistent or recurrent hyperglycemia (high blood sugar levels) and symptoms such as, frequent urination, excessive thirst (may be as a result of frequent urination and passing of large volume of urine in a unit time), excessive hunger (despite excessive hunger diabetes patients are usually underweight/thin and not obese, especially if diabetes is present for long duration) and other associated symptoms (especially if any complication develop due to presence of diabetes in a patient for long duration, such as eye problems, kidney problems etc.) etc.

Diagnosis of diabetes is established (according to World Health Organization criteria for diagnosis of diabetes) if any of the following criteria is fulfilled:

  • Fasting plasma glucose of 126 mgs/100 ml (7.0 mmol/liter) or higher.
  • Plasma glucose of 200 mgs/100 ml (11.1 mmol/liter) or higher, two hours after a 75 gram oral glucose load.
  • Symptoms of hyperglycemia and a random plasma glucose of200 mgs/100 ml (11.1 mmol/liter) or higher.
  • ADA (American Diabetes Association) recommends another criterion for diagnosis of diabetes, i.e. glycosylated (glycated) hemoglobin or hemoglobin A1C of 6.5 or higher, but WHO is yet to adopt this criterion for diagnosis of diabetes.

After diabetes is diagnosed it may be required to find the type of diabetes, i.e. type-1 diabetes or type-2 diabetes. Type-1 diabetes usually occurs at an early age, in first or second decade of life. Type-1 diabetes is an autoimmune disease and demonstration of auto antibodies can differentiate type-1 diabetes from type-2 diabetes. it is also possible to predict appearance of type-1 diabetes before diabetes/hyperglycemia sets in, by demonstrating the diabetes related auto antibodies such as insulin auto antibodies, islet cell auto antibodies, auto antibodies against 65kDa etc. Appearance of diabetes before second decade of life strongly suggests type-1 diabetes.

Environmental Causes of Type-1 Diabetes

Environmental factors can trigger and express type-1 diabetes, especially among genetically predisposed individuals. The environmental factors play a major role in causation of type 1 diabetes is clear from the fact that if one identical twin has type 1 diabetes, only 30%-50% of the cases the other twin also has, type 1 diabetes, despite having exactly the same genome or genetic make up. There are various environmental factors that are considered to have role in causation of type-1 diabetes, such as virus, diet, drugs and chemicals etc.

Virus in causation of type-1 diabetes:

There are several viruses (such as rubella virus, Coxsackie virus etc.), which are implicated to have a causative role in type-1 diabetes, but in most cases the evidences are inconclusive. All individuals infected with the above mentioned viruses do not develop type-1 diabetes and it is postulated that genetic predisposition and infection with rubella virus or Coxsackie virus predispose an individual to develop type-1 diabetes and virus acting as trigger.

Diet in causation of type-1 diabetes:

The evidences are growing, that diet is responsible for or plays a role in causation of type-1 diabetes. Most likely diet influence immune function, gut flora and intestinal permeability and play a role in causation of type-1 diabetes.

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There are various diet and food items implicated to have a causative role such as wheat, cow’s milk protein (by development of antibodies against cow’s milk protein) etc., as evidenced by higher prevalence of type-1 diabetes among wheat eating population. But the relationship of diet (wheat, cow’s milk protein) and type-1 diabetes is not well understood.

Short breast-feeding period is also implicated to increase the incidence of type-1 diabetes.

Drugs and chemicals in causation of type-1 diabetes:

There are some drugs and chemicals, which can destroy the beta cells of pancreas, which secrete insulin. N-3-pyridylmethyl-N’-p-nitrophenyl urea, a rodenticide (which kills rodents) with brand name Pyrinuron, introduced in the United States in 1976 and withdrawn from market in 1979 is one example of chemical, which can cause type-1 diabetes, which destroy pancreatic beta cells after accidental or intentional ingestion and resulting in type-1 diabetes. Streptozotocin an antibiotic with brand name Zanosar, and anticancer drugs used in pancreatic cancer can destroy pancreatic beta cells and cause type-1 diabetes.

Pancreatic problems such as infection of pancreas (pancreatitis) or any trauma to pancreas can result in total loss of beta cells and result in type-1 diabetes.

Genetical Factors in Type 1 Diabetes

Type 1 diabetes mellitus occurs due to a complex interaction between genetical susceptibility, exposure to different environmental factors and a diabetogenic trigger, at least according to current evidence. Many risk factors responsible for or associated with type 1 diabetes are suggested and research is going on.

Genetic factors in causation of type 1 diabetes:

There are many genes which contribute in expression as well as causation of type 1 diabetes. The location of gene can make it dominant, recessive or in between these two. One of the most important and strongest genes responsible for causation of type 1 diabetes is IDDM-1 gene located on chromosome 6. Variation of this gene (such as DRB1 0401, DRB1 0402, DRB1 0405, DQA 0301, DQB1 0302 and DQB1 0201 and seen among Europeans as well as North Americans of European ancestry, increase risk of type 1 diabetes) can lead to increase incidence of type 1 diabetes and some variants can protect against type 1 diabetes.

It is estimated that the risk of developing, type 1 diabetes is approximately 10% if father has type 1 diabetes, 10% if any sibling (brother or sister) has it, 4% if mother has type 1 diabetes and mother’s age at time of delivery was 25 years or less and approximately 1% if mother’s age at time of delivery was more than 25 years.

Studies have shown that, if one identical twin has type 1 diabetes, the other twin has type 1 diabetes in 30%-50% cases.

Despite common belief, the genetic factor in type 1 diabetes is weaker in compare to type 2 diabetes mellitus. The reason most people think that type 1 diabetes genetic factor is more important than type 2 diabetes, may be the young age of onset of diabetes in type 1 diabetes. The fact is, type 2 diabetes has greater genetic predisposition than type 1 diabetes, i.e. if any of your first degree relative has type-2 diabetes you have a greater risk of developing diabetes type-2, in compare to having a first degree relative with type 1 diabetes and your risk of developing type 1 diabetes.

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