Type 1 diabetes strikes people of all ages. Nearly 1.9 million people (adults and children) in the U.S. have the condition — and the numbers are only expected to climb.
“There’s a rise in the number of cases in the world, an almost 20% increase in the last 15 years, and we don’t understand why,” says Dr. Betul Hatipoglu, director of the Case Center for Diabetes, Obesity and Metabolism at Case Western Reserve University School of Medicine. She is also the director of the Diabetes and Obesity Center at University Hospitals Cleveland Medical Center.
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What Is Type 1 Diabetes?
Type 1 diabetes is a progressive autoimmune disease. This is not to be mistaken for a much more common type of diabetes mellitus called Type 2 diabetes. Although they are similar, there are several significant differences between the two.
Type 1 diabetes occurs when the body’s immune system mistakenly attacks beta cells in the pancreas that make insulin. In Type 2 diabetes, the body does not use insulin efficiently, and eventually does not make enough of it.
Insulin is a hormone that helps the body regulate glucose (sugar), our body’s main source of energy, into cells. This energy comes from carbohydrates that are broken down into glucose. When glucose enters the bloodstream, insulin gets the glucose into cells so they can convert it into energy or store it (in the muscles, fat and liver) for later use.
But when the immune system attacks insulin-producing cells in the pancreas, called beta cells, you stop producing insulin and glucose can’t get into cells. The liver tries to help by releasing its glucose stores. Glucose then builds up in the bloodstream, a condition known as high blood sugar or hyperglycemia. If left untreated, hyperglycemia can lead to diabetic coma and even death.
Causes
Our understanding of Type 1 diabetes causes is evolving. We don’t know exactly what triggers the disease, but it’s believed that genes play a role.
That doesn’t mean that Type 1 diabetes is caused by mutated gene variations. While science has identified nearly 50 genes or gene regions linked to Type 1, they don’t all impact health. Some genes would have to be switched on by exposure to certain environmental factors, such as viruses or chemicals. And because your genes are unique, the exact “switches” may be different for everyone.
So genes might predispose a person to getting Type 1, but they wouldn’t cause the disease. What would?
“A lot of people are working on new ways to understand this. We’re finding that some things we thought to be correct were not,” says Dr. Alvin Powers, an endocrinologist and director of the Vanderbilt Diabetes Center.
It turns out, Powers says, that the insulin-producing cells in the pancreas may not be innocent bystanders. “We thought they were sitting there passively and being destroyed. Now there is growing evidence that there is some complicity on the part of the beta cell. The beta cell itself may be involved, and its interaction with the immune system is important.”
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Risk Factors
We are still learning who is at risk for Type 1 diabetes. However, some risk factors for the disease are already known.
Risk factors for Type 1 diabetes include:
— Race. Being Caucasian appears to increase Type 1 diabetes risk.
— Having a close relative with Type 1 diabetes. “Between 3% and 5% of the children of someone with Type 1 diabetes will get it,” Powers says.
— Age. Type 1 diabetes can be diagnosed at any age, but it’s most commonly diagnosed in childhood.
— Geography. Type 1 diabetes risk increases the farther you live from the equator.
The more we know about risk factors for Type 1 diabetes, the better we’ll be able to pinpoint potential candidates for the condition, which would be a step toward earlier diagnosis.
[READ: A Guide to Diabetes Symptoms, Causes and Treatments. ]
Symptoms
Symptoms of Type 1 diabetes can come on suddenly once beta cells are attacked.
“Destruction is quite fast. You’re not making enough (insulin), and then you’re not making any at all,” Hatipoglu says.
But Type 1 diabetes symptoms are easily chalked up to signs of other conditions. Type 1 diabetes symptoms in adults include:
— Extreme thirst.
— Frequent urination.
— Weight loss.
— Extreme hunger.
— Severe weakness and fatigue.
— Irritability.
— Mood swings.
— Blurry vision.
— Nausea and vomiting.
Symptoms of Type 1 as well as Type 2 diabetes in children may look like the flu (nausea, vomiting, weakness and fatigue).
If you’re not sure about signs of Type 1 diabetes, ask your doctor. And don’t assume that having some Type 1 diabetes symptoms means a person has the condition.
Diagnosis
There isn’t an average Type 1 diabetes diagnosis age.
“We used to think of it as a childhood disease, but now we know that maybe 40% of people with Type 1 diabetes develop it over the age of 20,” Powers says.
“I had a colleague who retired at age 76, and six months later he was diagnosed with Type 1 diabetes,” Hatipoglu notes. “More and more we’re seeing it at any age.”
How is Type 1 diabetes diagnosed? It may involve a number of tests, including a glycated hemoglobin or A1C test that measures the average blood glucose level over the past several months.
If blood glucose is elevated, Powers feels that the most important tests for Type 1 diabetes diagnosis include exams measuring autoantibody levels against insulin-producing cells.
There are also screenings now available for those who are at high risk for developing Type 1 diabetes. These screenings can alert you and your medical provider if you are at low to no risk (0 antibodies); medium risk (1 autoantibody) and will need to retest in a year; or at high risk with 2+ autoantibodies, which is when you will need to meet with your medical provider for confirmatory testing.
Treatments
Can Type 1 diabetes be cured? Not yet. There is no Type 1 diabetes cure or even a prescription pill to treat the condition, unlike Type 2 diabetes.
However, we do have Type 1 diabetes treatments that enable people to manage the condition. Patients must monitor their blood (via finger prick throughout the day and give themselves (or receive) insulin injections.It’s necessary before every meal as well as a basal rate throughout the day (small doses via an insulin pump or by using a long acting insulin).
But Type 1 diabetes treatments are rapidly improving.
“Rather than pricking your finger to test glucose, you can monitor blood glucose levels with a sensor placed under the skin. And insulin pumps can deliver the appropriate amount of insulin,” Powers says. He estimates 40% of patients are using insulin pumps.
One problem with Type 1 diabetes treatments, however, is affordability.
“Insulin can cost several hundred dollars per month or even a thousand dollars depending on the type of insulin and a person’s health insurance plan,” Powers explains. The rising costs of insulin have been the subject of headlines and government hearings, with no solution in sight.
The search for a diabetes Type 1 treatment without insulin is focused on stem cells — cells that can become any kind of cell in the body.
“Scientists have been able to produce cells that look like pancreatic beta cells and produce insulin. We just don’t have any appropriate devices that will work to put it inside the patient safely,” Hatipoglu explains. “But it’s advancing fast. I think we’ll be able to upload cells like we’re doing with insulin pumps in the next decade.”
The other forms of treatment equate to a Type 1 diabetes natural cure: regular exercise, which helps regulate blood glucose, and a healthy, diabetes-friendly diet.
“They can help minimize the amount of insulin you need,” Hatipoglu says.
Health Care Providers That Treat Type 1 Diabetes
Diet
Diet is an important part of diabetes care. The best diets for diabetes are typically low in refined carbohydrates — to avoid spiking blood glucose — and rich in fruits, vegetables and whole grains. Make sure to minimize added sugars by saving your sweets for truly specials occasions.
“If diabetes is well-controlled, they can enjoy anything in moderation,” Hatipoglu says. If the condition is not well-controlled, she recommends limiting carbs to 30 to 50 grams per meal, but no lower unless strict physician supervision is involved. Dramatically reducing carbohydrates forces the body to break down fats. The waste products of these fats (ketones) can produce a dangerous condition in people with Type 1 diabetes called diabetic ketoacidosis.
Complications
Even with proper treatment, there can be Type 1 diabetes complications.
“Most complications don’t develop until someone has had Type 1 diabetes for at least 10 years,” Powers says. “It takes that long for glucose exposure to cause problems.”
Complications can include vision loss, nerve damage, kidney damage (diabetic nephropathy) and hard-to-heal leg or foot ulcers that can lead to amputation.
Having Type 1 diabetes also increases your risk for developing heart disease and thyroid problems.
But there’s encouraging news for managing Type 1 diabetes too.
“Having complications had been the narrative. But the number of individuals with complications has gone down dramatically in the last 30 years,” Powers says. “If treated well, the rate of complications of diabetes is low.”
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A Patient’s Guide to Type 1 Diabetes: Causes, Symptoms and Risk Factors originally appeared on usnews.com
