Type 1 diabetes is an autoimmune disease that results in the destruction of cells that produce insulin.
Those with type 1 diabetes require lifelong insulin therapy for survival. However, they can lead relatively healthy lives with proper treatment.
This article will take a look into the symptoms, causes, and treatments behind the disease.
Diabetes mellitus is a group of conditions defined by having too much sugar in the blood.
Diabetes is incredibly common and affects over 400 million people worldwide. Most people with diabetes have type 2 diabetes, and about 5% have type 1 diabetes.
Usually, when food is eaten, it is broken down into sugar in the bloodstream. This activates the pancreas to release the hormone insulin. Insulin then ferries the sugar into body cells, where it is then used for energy.
In all types of diabetes, insulin is not able to function correctly, which leads to elevated blood sugar (blood glucose).
Diabetes is classified into a few main types:
• Type 1 diabetes is also known as insulin-dependent diabetes as the body cannot produce any insulin on its own.
• Type 2 diabetes is when some insulin is produced but is not working correctly. Insulin medication may or may not be needed.
• Gestational diabetes is diabetes that starts during pregnancy; it is more similar to type 2 diabetes.
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Causes of Type 1 Diabetes
Unlike type 2 diabetes, which is strongly linked to lifestyle factors, the exact cause of type 1 diabetes is unknown.
Scientists have uncovered a number of genes that are involved. These genes can be turned on by certain environmental factors.
Type 1 diabetes typically affects young people and used to be known as juvenile diabetes, but the disease can happen at any age.
When the disease is activated, there is an attack on the body’s own pancreatic insulin-producing cells. These cells are quickly destroyed, and soon, the body is unable to produce any insulin.
Without insulin, there is no way to decrease blood sugar, which leads to the classic signs of uncontrolled diabetes.
Type 1 vs. type 2 diabetes
Type 1 and Type 2 diabetes are both conditions characterized by high blood sugar levels, however, they have very different causes. Type 1 diabetes is an autoimmune disease, where by the immune system mistakenly attacks healthy parts of the body. In the case of type 1 diabetes, the immune system incorrectly attackes beta cells in the pancreas.
People with type 1 diabetes have little to no beta cell function left, and must inject insulin in order to live a healthy life.
Type 1 diabetes is the rarest of the types of diabetes, affecting about 2-5% of the world’s population and about 1 in 300 American adults before the age of 18. Type 1 usually occurs before age 18, which is why it’s also referred to as juvenile diabetes.
Type 2 diabetes is much different than type 1. It can occur in adolescence, but is more common in older adults. Unlike type 1 diabetes, it isn’t an autoimmune disease.
Type 2 diabetes occurs when the pancreas stops producing enough insulin, or the body doesn’t respond to insulin the way it should. When the body doesn’t use insulin effectively, it’s called insulin resistance.
Unlike type 1, people with type 2 diabetes may not always need to inject insulin to manage it. Other diabetes medications, many in pill form, can be used to treat type 2 diabetes. Some people with type 2 diabetes are even able to manage it through lifestyle alone, without the need for medication.
Symptoms of Type 1 Diabetes
A person with uncontrolled type 1 diabetes may experience the following diabetes symptoms when the disease has taken hold:
• Extreme thirst
• Weight loss
• Mood changes
As blood sugar rises, the body tries hard to get rid of the extra sugar. Since insulin is not available, this blood sugar must be released through the urine, which explains the thirst and urination.
At the same time, even though a person may be eating, the food is not able to be absorbed, which results in hunger and fatigue.
Essentially, in type 1 diabetes, the body is starving because it is unable to use most of the food that is eaten.
If these symptoms are not resolved soon, the blood sugar can rise to dangerous levels. This could result in hospitalization for diabetic ketoacidosis.
In diabetic ketoacidosis, the starving body resorts to burning fat for fuel instead, which causes the build-up of dangerous by-products known as ketone bodies.
These ketone bodies will acidify the bloodstream. As a result, new medical treatment will be necessary.
Diagnosing Type 1 Diabetes
Once diabetes is suspected, a medical provider will run basic blood sugar tests such as fasting plasma glucose and hemoglobin A1c. These tests will verify if the blood glucose is too high.
According to the American Diabetes Association, a fasting blood glucose greater than or equal to 126 mg/dl (7 mmol/L) or an A1c level of 6.5% or higher will support a diagnosis of diabetes.
Next, if type 1 diabetes is suspected, additional antibody testing will be run to check for signs of an autoimmune process, where the body attacks itself. High blood glucose, symptoms of diabetes, and positive antibody tests will confirm the diagnosis of type 1 diabetes.
Complications of Type 1 Diabetes
When type 1 diabetes is formally diagnosed, the goal is to keep blood sugar controlled within normal limits.
Typically, this is 80-130 mg/dl (4.4-7.2 mmol/L) when fasting (eating nothing for 8 hours) or <180 mg/dl (10 mmol/L) 2 hours after meals.
Tight control of blood sugar is essential because high blood sugar is toxic and starts to damage blood vessels and organ systems over time. There are several complications of type 1 diabetes:
Hypoglycemia is when blood sugar is too low, and it can be very dangerous if not corrected quickly. Incorrect usage of insulin medication is the primary cause of hypoglycemia.
Skipping meals, excessive alcohol consumption, and exercising more than normal can also cause hypoglycemia.
In the long-term, high blood sugar will damage the small vessels that support the eyes, nerves, and kidneys.
The kidneys, the bean-shaped organs responsible for filtering blood and producing urine, are especially vulnerable to high blood sugars.
Nerves are everywhere in the body. Nerve damage can cause a variety of issues from pain and numbness to digestion, bladder, heart rate, and sexual problems.
Loss of feeling can lead to being unaware of infections on the bottom of the feet. These infections can lead to amputations if left untreated.
The most common cause of death in those with type 1 diabetes is heart disease. High blood glucose, along with other factors such as high cholesterol and blood pressure, can lead to a process known as atherosclerosis.
Atherosclerosis is when plaque builds-up inside artery walls and restricts blood flow. Atherosclerosis can damage large blood vessels leading to the macrovascular complications of heart disease and stroke.
Risk factors for type 1 diabetes
Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. Known risk factors include:
- Family history: Having a parent, brother, or sister with type 1 diabetes.
- Age: You can get type 1 diabetes at any age, but it’s more likely to develop when you’re a child, teen, or young adult.
Treatments for Type 1 diabetes
Although there is no cure for type 1 diabetes, those affected by the disease can live a healthy life with appropriate treatment.
The mainstay of type 1 diabetes treatment is the use of insulin medications. Insulin medication has been around since the 1920s and is made from the pancreas of pigs and cows. Special DNA techniques also create newer insulin types.
The person with type 1 diabetes will require insulin treatment for the rest of their life. The goal of insulin treatment is to mimic the action of a regular pancreas closely.
Normally, the pancreas secretes small doses of ‘background’ or basal insulin to keep blood sugar in normal limits. The pancreas also secretes more significant ‘bursts’ or boluses to cover the spike in blood sugar following meals.
There are several different types of insulin used today:
• Rapid-acting: used as bolus insulin, taken directly before meals.
• Short-acting: used as bolus insulin, taken shortly before meals.
• Intermediate-acting: has a duration of action that is in-between short-acting and long-acting insulin -usually divided into two doses.
• Long-acting: used as basal (background) insulin, typically taken in the morning or at night.
• Combination insulin: combines intermediate-acting insulin with long-acting insulin for a more straightforward diabetes regimen. They are typically taken twice per day, in the morning and evening.
Most commonly, insulin is given by injection into the fat tissue. Alternatively, an insulin pump can be used to deliver rapid-acting insulin directly into the body without injections.
An insulin-pump provides greater flexibility but requires more skill to use. In-addition, inhaled insulin is a newer form of delivering rapid-acting insulin.
Those with diabetes will need to regularly consult with their diabetes medical provider to come up with a plan that works for them.
Checking blood glucose
Besides taking insulin, it is important to frequently check blood glucose levels to make sure they are at acceptable levels.
Traditionally this is done using a standard glucometer, lancing device, and test strips.
One would prick their finger with the lacing device, place a drop of blood on the test strip, and insert the strip onto the glucometer, which would give a reading.
A newer way to test blood glucose is the use of a continuous glucose monitor (CGM). This device is attached to the body and allows blood glucose to be monitored 24/7. CGMs can make it easier to identify patterns in blood glucose but usually, still, require a finger prick to confirm readings.
These glucose readings are used to give the correct amount of insulin and help medical providers drive treatment decisions.
Frequent checking of blood glucose is also very important to avoid hypoglycemia.
Typically blood glucose should be tested first thing in the morning, before meals, during extended exercise, and at bedtime. When a blood glucose level less than 70 mg/dl (<3.9 mmol/L) is found, quick correction with a fast-acting sugar such as juice will be required to treat it.
Pancreas transplant and Artificial pancreas
A pancreas transplant from an organ donor can restore normal insulin production without the use of medications.
However, this procedure is not commonly performed for type 1 diabetes. This is as the recipient will require life-long anti-rejection medications, which have serious side-effects.
Because these side-effects can be worse than living with type 1 diabetes, this surgery is reserved for those with severe diabetes complications.
Currently, scientists are working to develop an artificial pancreas that would allow insulin to delivered automatically in response to blood glucose.
This treatment is not yet available but could revolutionize how type 1 diabetes is treated.
Type 1 diabetes and diet
Type 1 diabetes is a difficult disease to live with because it requires not only frequent injections and finger pricks but also close attention to eating habits.
This is because food directly impacts blood sugar and meal size will determine how much insulin medication to administer.
Carbohydrate counting is a foundational skill for the person with diabetes. It involves identifying which foods contain carbohydrates and the amount of carbohydrates they have.
Carbohydrates are a major nutrient found in foods containing starches, fruit, milk, yogurt, and sweets. Carbs are the nutrient with the most direct effect on blood sugar.
A heavy carb meal, such as pasta with garlic bread, will require much more insulin than a light carb meal, such as salmon with a salad. Getting the carb amounts correct is vital to control blood sugar.
At first, carbohydrate counting may seem a daunting task but soon becomes second nature as the skill Is used so often. There are also smartphone apps and guidebooks that help make diabetes management easier.
Building a balanced diet
In theory, those with type 1 diabetes can eat as many carbs as they want as long as they have the insulin to cover it. However, although this approach may be enough to keep blood sugar controlled, eating a balanced diet is important for overall health.
One of the simplest ways to improve eating habits is to follow the diabetes plate method.
First, visualize a standard plate. Half of the plate should include non-starchy vegetables. Examples of these include broccoli, spinach, tomatoes, cauliflower, and carrots.
Choosing a variety of vegetables will provide a rich source of vitamins, minerals, and antioxidants. Non-starchy vegetables also have very little carbohydrates.
A quarter of the plate should include protein, such as lean meats, chicken, turkey, fish, tofu, and eggs. Protein helps build muscles and forms the building block of several structures in the body. Most people get enough protein.
Starches do not have to be eliminated in diabetes; they need to be controlled to help minimize the effect on blood glucose. Whole grain forms such as whole-wheat bread and brown rice offer more health benefits than the refined versions.
Supplements for Type 1 diabetes
Many people are curious about the best supplements for treating type 1 diabetes. Certain supplements can help support a medical and nutrition plan for type 1 diabetes. But the tricky part is finding which supplements are worth taking.
A multivitamin contains a variety of essential vitamins and minerals. Doses and compositions vary by brand but are generally used to fill in nutrient gaps from the diet.
Research is mixed on the usefulness of multivitamins. Some studies find no benefit, while others support their use in certain circumstances. In general, if eating a reasonably balanced diet, a multivitamin is unlikely to be of much help.
If a diet is lacking in variety or a person limits entire food groups, a multivitamin can help ensure that nutrient needs are being met.
Vitamin D is a vitamin that is produced in the body after exposure to sunlight. It is also found in certain foods but small amounts. Vitamin D is important in bone health, the immune system, and many other functions.
People living in climates where there is less sunlight can struggle to get enough vitamin D. Furthermore, those with diabetes are also at a higher risk for vitamin D deficiency.
Some research suggests that vitamin D deficiency can increase the risk of developing type 1 diabetes. In those with the disease and a lack of vitamin D, supplementation with vitamin D is recommended.
Gymnema Sylvestre is a plant extract traditionally used in Indian Ayurvedic medicine. The herb is known as the “sugar destroyer” because it is used to reduce sweet cravings.
Gymnema Sylvestre is thought to work by reducing glucose intake and stimulating the function of pancreatic beta cells (insulin-producing cells). Some small studies in type 1 diabetes patients have shown improvement in blood glucose with the supplement.
Chromium is a micromineral often used in the management of diabetes. It works by helping to lower fasting blood glucose levels.
A four-month study, published in 2015, analyzed the effect of chromium on 71 patients with poorly controlled Type 2 diabetes. The patients were administered with 600 mcg of chromium daily. The results showed a significant improvement in fasting and postprandial (after-meal) glucose levels, along with an improvement in A1C levels.
A further meta-analysis, published in 2017, looked at 28 studies. Overall, it concluded that chromium supplementation reduced fasting glucose and A1C levels. It also improved triglycerides and HDL (“good”) cholesterol.
Alpha Lipoic Acid
Alpha Lipoic Acid is a compound that acts as an antioxidant in the body. An antioxidant reduces oxidative stress, a form of damage that results from high blood glucose.
Research into Alpha Lipoic acid is limited to type 1 diabetes. However, some studies suggest improvement in nerve pain, blood glucose, and blood vessel cells.
Type 1 diabetes is an incurable disease that requires a lifetime of medical and lifestyle management. Those with type 1 diabetes must work hard to maintain normal blood sugar levels but can live long and healthy lives if they stay on top of the disease.