What is Type 1 Diabetes?
Type 1 diabetes (T1D) is a condition where the body’s immune system attacks the cells in the pancreas that make insulin. This disease can vary greatly from person to person in terms of genetics, immune responses, and how quickly insulin production decreases. How T1D shows up can also depend on a person’s age. For instance, adults tend to maintain some insulin production longer than younger individuals, who are more likely to experience a condition called diabetic ketoacidosis. Some people may also have other autoimmune diseases, weight issue, or additional health problems.
Managing Type 1 diabetes involves daily insulin treatments, which can come in the form of injections, an insulin pump, or an automated system that delivers insulin. Checking blood sugar levels, often with a continuous glucose monitor, is also important. If this device isn’t available, people with T1D should be able to test the glucose in their blood themselves. Further, education and support, along with addressing any mental health concerns, can go a long way in managing this condition.
Good care for T1D requires a team of healthcare professionals, including doctors, nurses, dietitians, pharmacists, and various specialists. Together with the individual with T1D and community resources, they can provide the most effective care for this condition.
What Causes Type 1 Diabetes?
Type 1 Diabetes (T1D) occurs when the body’s immune system destroys the beta cells in the pancreas, the cells responsible for making insulin. This destruction happens over several months or years, leading to a severe lack of insulin. The exact cause of T1D remains unclear, but scientists believe there’s a genetic link. Certain genes, known as HLA (DR and DQ), have a particularly strong connection, especially in young people with T1D. Several other genes could also play a role.
For those on the radar for T1D, triggers like viruses, environmental factors, food, or other stressors could set off this immune response against the beta cells. Certain infections, such as Coxsackie virus, enteroviruses, cytomegalovirus, rubella virus, influenza B, or mumps virus, and lately, COVID-19, have been associated with a higher risk of T1D. On the other hand, practices like breastfeeding, delaying the introduction of gluten, fruit, and cow’s milk in a child’s diet may lower the risk. However, more research is needed to gain a better understanding of what causes T1D.
When a person has T1D, they may have detectable antibodies in their blood. These include antibodies against insulin (IAA), glutamic acid decarboxylase isoform 65 (GAD65), insulinoma antigen 2/islet tyrosine phosphatase 2 (IA-2) and zinc transporter isoform 8 (ZnT8). These antibodies indicate that a person is at risk or has developed T1D. The presence of more antibodies and in higher quantities can suggest a higher risk of developing T1D.
Risk Factors and Frequency for Type 1 Diabetes
Type 1 Diabetes (T1D) is one of the most common chronic illnesses in children. However, it can start at any age. Oftentimes, T1D developed in adulthood can be mistakenly diagnosed as type 2 diabetes. Interestingly, adult-onset T1D is more frequent than T1D that begins during childhood. The occurrence of T1D has been gradually increasing, affecting about 5% to 10% of individuals with diabetes.
- The global prevalence of T1D stands at around 9.5%.
- The incidence rate of T1D is estimated to be 15 per 100,000 people.
- The rates of T1D vary significantly by geographic location.
- Finland and other Northern European nations report the highest incidences, with rates almost 400 times higher than in China and Venezuela, which report the lowest incidences.
Signs and Symptoms of Type 1 Diabetes
During the first doctor’s visit for managing Type 1 Diabetes, your doctor needs to collect a lot of information, including your medical history, surgical history, family history, lifestyle habits, any previous diabetes education you’ve had, as well as the status of your disease. Important factors include the date of your diagnosis, your treatment, any medicines you’re currently taking, whether you’ve had complications like low blood sugar or diabetic ketoacidosis, or long-term complications like vision problems, nerve damage, kidney disease, heart disease, and more. Your doctor will also ask about symptoms of other autoimmune disorders, as people with Type 1 Diabetes are more at risk for conditions like thyroid disease or celiac disease.
- Medical, surgical, and family history
- Lifestyle habits like diet, exercise, and smoking/alcohol use
- Previous diabetes education
- Date and details of your diagnosis
- Details on prior and current treatment
- Any complications you’ve had
- Symptoms of other autoimmune diseases
Your doctor will also physically examine you, weighing you, measuring your height, and checking your blood pressure. They’ll also look at your skin, especially where you inject insulin. If there are any problem spots there, they’ll tell you about the importance of rotating your injection sites. They’ll listen to your heart, look at your eyes and feet, and check your thyroid too. They’ll test your feet’s sensation – if there’s an issue, you’re at a higher risk for ulcers.
There are tools to screen for mental health issues like depression and anxiety, and these should be used to check your psychological well-being since diabetes can bring emotional distress. Doctors should also be vigilant for early signs of cognitive decline and eating disorders, as these can occur alongside diabetes.
Finally, it’s important to review data from your Continuous Glucose Monitor (CGM) device, if you use one. This device constantly checks your blood sugar levels and can help warn you when your blood sugar is getting too high or too low. It’s important to look at these results during your visit and adjust your insulin dosage, diet, and physical activity accordingly. There’s also a measure of overall management of sugar levels, called HbA1c, that can be evaluated. This, along with the CGM readings and the amount of time your sugar levels stay within the normal range, can help in managing your diabetes.
If you don’t have a CGM, we can still use readings from your blood glucose meter to make any necessary changes in your insulin dosage. The timing of your insulin doses can also be discussed.
Testing for Type 1 Diabetes
The HbA1c blood test is recommended to be done every 3 to 6 months. This test can give doctors an idea of how well a person’s diabetes has been controlled over the past 2 to 3 months. A typical goal for this test result is less than 7.0%, but the target might be higher for people with frailty, heart disease or multiple health conditions, a history of severe low blood sugar, or who aren’t aware when their blood sugar gets low. Lower targets may be used if they can be achieved safely without increasing the risk of low blood sugar.
People with diabetes should also have other tests every year. These tests include a lipid profile (cholesterol levels), serum creatinine (kidney function), eGFR (filtering ability of kidneys), and urine albumin to creatinine ratio (protein in the urine). If a person is taking an ACE inhibitor (heart medication), ARB (blood pressure medication), or diuretic (fluid pill), their serum potassium levels should be monitored. They should also get tested for liver enzymes (AST, ALT), thyroid function (TSH), celiac disease, and vitamin B12, and D levels at least once or more as needed by the doctor. These tests may be repeated more often if the results were unusual.
Because individuals with Type 1 Diabetes are more likely to develop other conditions where the body’s immune system attacks itself, such as autoimmune thyroid disease, celiac disease, primary adrenal insufficiency, and rheumatoid arthritis, they should consider getting tested for these conditions when it’s medically appropriate.
Treatment Options for Type 1 Diabetes
People with Type 1 Diabetes (T1D) require constant management such as insulin therapy, monitoring of their glucose levels, and continuous self-education about managing their diabetes. Different treatment approaches are available, including multiple daily insulin injections, using an insulin pump, or automated insulin delivery systems which can offer greater control over blood sugar levels and decrease periods of low blood sugar.
Low blood sugar or hypoglycemia is a common side effect of insulin therapy. Therefore it is vital for people with diabetes and their caregivers to recognize the signs, such as sweating, a fast heartbeat, feeling dizzy or confused, hunger, changes in vision, or shaking. If a person’s blood sugar goes below 70 mg/dL, they should consume 15-20 grams of glucose and recheck their glucose levels after 15 minutes. It is also recommended to have glucose on hand to prevent further drops in blood sugar. To manage severe hypoglycemia where the person can’t eat or drink, glucagon should be available for emergency use.
The right starting daily insulin dose is determined by a person’s body weight. Generally, a person’s needs for ‘basal’ or baseline insulin supply make up 40-50% of their daily requirement, with the rest taken before or with meals.
It’s beneficial for people with T1D to learn how to count carbohydrates and use this knowledge when determining their insulin dosage for meal times. It’s also necessary to determine how much their blood sugar level falls after the use of every unit of rapid-acting insulin. Care should be taken to avoid injecting doses too close together to prevent ‘stacking’ of doses and resulting in hypoglycemia.
Insulin needs vary throughout an individual’s life and under different conditions, such as adolescents going through puberty, pregnant women, usage of steroids, and individuals experiencing weight gain. Less insulin is needed when engaging in aerobic exercise and during the “honeymoon period,” which is a temporary recovery after the initial diagnosis.
The use of insulin can vary depending on the type of insulin and the method of administration. Insulin pumps dispense insulin every 5 minutes to meet baseline insulin needs and give additional insulin to manage meal-related glucose spikes. Continuous Glucose Monitoring (CGM) systems can be used in combination with an insulin pump to improve glucose management further and reduce hypoglycemia risk.
Performing regular physical exercise is recommended for people with T1D to enhance their sensitivity to insulin, mitigate complications, and reduce mortality. However, managing glucose control can be more challenging when the person is active due to various factors like the intensity and duration of the activity. Therefore, individuals must understand how they can balance their dietary intake and insulin doses.
People with T1D should have regular checkups with specialists such as eye doctors, podiatrists and others to monitor their health and symptoms. Quitting smoking, using cholesterol-lowering therapy, and antihypertensive therapy, which lowers high blood pressure, are important to reduce risks of undergoing cardiovascular diseases and other complications.
In addition, pancreas or islet cell transplants are treatment options that can restore control to normal blood glucose levels. These options require immunosuppressive therapy, and ongoing research provides hope for more effective future treatments.
What else can Type 1 Diabetes be?
- Type 2 Diabetes
- Diabetes due to problems with the pancreas
- Diabetes caused by steroid usage
- A rare form of Diabetes called Diabetes Insipidus
- Illnesses mistaken for real ones (Factitious illness)
- A kind of diabetes that starts before age 25 (MODY)
- Excessive thirst due to psychological issues (Psychogenic polydipsia)
- A condition where sugar is found in urine due to kidney issues (Renal glycosuria)
What to expect with Type 1 Diabetes
Improved control of blood sugar, blood pressure, and lipids, along with better foot care, has led to fewer health issues and deaths linked to Type 1 Diabetes (T1D). Instances of severe complications associated with diabetes have reduced, and for those who do develop them, the onset is typically delayed.
However, it’s important to note that people with T1D still face a mortality rate that’s 2 to 5 times higher than those without diabetes, although these rates have been declining. More details on this are covered in other sections.
Possible Complications When Diagnosed with Type 1 Diabetes
The main short-term issues associated with diabetes are low blood sugar, commonly known as hypoglycemia, and severe high blood sugar which can lead to a condition called diabetic ketoacidosis. There are also several long-term complications that may occur:
- Kidney disease (Nephropathy)
- Nerve damage affecting hands, feet, and bodily functions (Peripheral and autonomic neuropathy)
- Eye complications like damage to the retina or fluid build-up in the macula (Retinopathy/macular edema)
- Various heart conditions, including narrowing of the arteries supplying blood to the heart (Coronary artery disease), heart failure, and abnormalities in the heart muscle (Cardiomyopathy)
- A condition that limits blood supply to the limbs (Peripheral arterial disease)
- Brain conditions, including stroke and transient ischemic attack (TIA)
- Hearing loss
- Foot problems commonly seen in diabetics, like foot ulcers and the need for amputations
Preventing Type 1 Diabetes
It’s essential for patients to stick to their medication regimen and regularly see specialists and health educators to avoid health complications. Every time healthcare professionals, like pharmacists, nurses, and doctors, interact with patients, they should underscore the importance of managing blood sugar levels, understanding potential long-term complications, and setting health goals.
Patients should also be urged to make lifestyle adjustments to minimize the risk of health issues. Moreover, all patients who have diabetes need to know the indicators of low blood sugar and how to handle it. They should also be educated about what resources are available to them and the benefits of participating in support groups.
Dietitians play a key role in educating patients about what foods they can eat. Additionally, teaching patients how to monitor their blood sugar at home is a key responsibility of nurses. All these measures are crucial to manage diabetes effectively.