Diabetes - Type 1

Last week, we started our discussion of diabetes with some basics about the relationship between blood sugar and insulin as well as the symptoms of diabetes that you should know.  Let's talk more today about type 1 diabetes in particular.

What causes type 1 diabetes?

Type 1 diabetes develops when the pancreas doesn't make enough insulin or stops making insulin altogether.  Usually this happens because the immune system attacks and destroys the cells within the pancreas that produce insulin.  When the immune system mistakes the body's normal cells for foreign invaders and attacks them, that is called an autoimmune disorder.  Most type 1 diabetes is considered an autoimmune disorder.  

This destruction of insulin-producing cells can happen over a few weeks to a few months.  The symptoms of type 1 diabetes usually come on suddenly and can become severe (even life-threatening) within a few weeks or sometimes even a few days.  

Type 1 diabetes usually starts during childhood, which is why it used to be called "juvenile diabetes", but it can happen at any age.  We don't really know why the immune system attacks the pancreas, but we think it is due to genetic susceptibility combined with certain environmental factors.  

Type 1 diabetes can also develop if the pancreas suffers significant damage from repeated infections, or if the pancreas is removed for some reason, such as cancer.

Being overweight is not believed to be a cause of type 1 diabetes.

What are the risk factors for developing type 1 diabetes?

• Family history - If you have a parent or sibling with type 1 diabetes, you are more likely to develop it.
• Environmental factors - Exposure to a viral illness likely plays some role in the development of type 1 diabetes.
• Geographic location - Some countries have higher rates of type 1 diabetes, including Finland and Sweden.

Can type 1 diabetes be prevented?

No.  Unfortunately, type 1 diabetes cannot be prevented.

How is type 1 diabetes diagnosed?

We talked last week about the symptoms of diabetes, which are the same for all types of diabetes, including type 1.  If you or your child develop sudden onset of symptoms consistent with diabetes, the following testing will be done:

• Blood sugar level - Either random or fasting.
• Hemoglobin A1c test - This measures average blood sugar levels over the past 90 days.
• Urine test for glucose - High blood sugar levels cause the kidneys to release sugar into the urine.
• Urine test for ketones - Ketones are a by-product of your body breaking down muscle and fat to use for energy.  

How is type 1 diabetes treated?

• Insulin - Because the underlying problem is a lack of insulin, the primary treatment is insulin.  Insulin can be given by injections or with the use of an insulin pump.
• Frequent blood sugar checks - The blood sugar level is one of the things we use to calculate how much insulin should be given.  This can be measured with a glucometer that requires you to prick your finger to get a drop of blood or with a continuous glucose monitor (CGM).  A CGM can significantly reduce the number of fingersticks needed to monitor blood sugar and it can provide important information about trends in blood sugar levels.
• Healthy eating - While there is not a specific "diabetic diet", a person with diabetes should center their diet on more fruits and vegetables, lean proteins, and whole grains.  They should cut down on refined carbohydrates and sweets.  It is ok to eat sugary foods occasionally, as long as they are counted as part of your meal plan when calculating how much insulin is needed.
• Physical activity - Just like the rest of us, people with diabetes need regular aerobic exercise.  Activity level is also included in calculating your insulin needs.
• Transplantation - A pancreas transplant may be an option for some people with type 1 diabetes.  Because of the serious risks involved with this surgery and the lifetime of immune-suppressing medications required, this is usually reserved for people whose diabetes cannot be controlled or for people who also need a kidney transplant.

Next week we will talk about type 2 diabetes.

If you have any questions about diabetes, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor