Type 1 Diabetes: A Working Definition

Most people are aware that there are several different types of diabetes including type 1, type 2, gestational diabetes and prediabetes. Type 1 diabetes is different than the other forms of diabetes since it involves total damage to the islet cells of the pancreas, preventing the production of insulin. The other types of diabetes are a result of insulin resistance within the cells of the body to the insulin produced by the pancreas.

All types of diabetes, including type 1, result in high levels of blood sugar, known as glucose, which spikes and falls based on food digestion. The body is unable to regulate glucose storage and release to create a balance. Instead the blood sugar rises dramatically during digestion and afterwards and the cells of the body are not able to utilize the glucose present. Glucose is needed as the fuel energy for the body and must be kept at a constant level to prevent serious health risks and complications.

Causes Of Type 1 Diabetes

Type 1 diabetes is also known as juvenile diabetes. This is because it is most commonly diagnosed in older children and young teens when symptoms of diabetes start to occur. However, it is possible for older teens, young adults and even seniors to be diagnosed with type 1 diabetes depending on specific types of exposures or injury. Remember that type 1 diabetes includes the destruction of the cells of the pancreas that produce insulin. This can occur because of injury such as a fall or accident, as well as infections and other medical conditions.

The most common cause of type 1 diabetes is due to the immune system of the individual attacking and destroying the pancreas beta cells which are responsible for insulin production. The specific reasons why this occurs in some individuals but not in others is not clearly understood, however it is believed to include a genetic component as well as environmental factors and a trigger that causes the incorrect response of the immune system.

A strong genetic component is seen as a major factor in the development of diabetes. The autoantibodies which attack the beta cells of the pancreas are attributed to the HLA region or the human leukocyte antigen region on the chromosomes.  These are part of the larger major histocompatability complex (MHC). This is the genetic information that is highly geared towards immune responses in the body. Specific antibodies to insulin, glutamic acid decarboxylase, islet cells, and some proteins have now be classified and defined. Studies indicate that the presence of these antibodies is not the major issue but the actual number of antibodies is critical to determine if a person will develop type 1 diabetes in their lifetime. 1

Other contributing causes to the development of type 1 diabetes are less clearly understood. Environmental factors are seen as important if genetic factors that predispose an individual to diabetes are also present. This can include exposure to certain viruses including the Coxsackie virus and Rubella. Other factors may include specific foods in the diet including whole milk and high levels of foods containing wheat. Not all research shows a direct relationship, but like the viral infections, it is likely a combination of factors. New research tends to indicate that even the intestinal microbiota and a weak intestinal mucosal barrier may be contributing factors. This is because these conditions may actually prevent the body from developing a normal tolerance to glucose and triggers the autoimmune response to destroy its own cells. 2

Symptoms of Type 1 Diabetes

Type 1 diabetes causes significant symptoms that may develop very quickly, or they can develop more slowly depending on the response of the immune system. Since it does take time for the destruction of the islet cells in the pancreas these symptoms may initially seem as “normal” to the individual, especially if they develop slowly in the life of a child. These symptoms most commonly seen include:

  • Vision problems
  • Weight loss that is unplanned and not due to dieting or exercise
  • Fatigue and exhaustion since the cells are depleted of energy
  • Feelings of constant and chronic hunger
  • Increased desire for consumption of liquids
  • Increased volume and frequency of urination

Children and individuals that have type 1 diabetes may be small for their age and may be very thin with little ability to gain any weight. They may also complain of feeling cold or having tingling or numb sensations in the hands, fingers, toes and feet. They may have difficulty in body temperature regulation and may complain of being cold.

Treatment And Management Of Type 1 Diabetes

As with all forms of diabetes, type 1 diabetes can be treated and managed but not currently cured. There are many new options for people diagnosed with diabetes type1 to help deal with the regulation of blood glucose through enhanced insulin supply options. These can include insulin pumps with sensors that help to provide a constant supply of insulin just as the beta cells of the pancreas would provide.

Other options include various types of insulin injections from rapid acting to long acting, allowing for immediate management of blood sugar levels as well as options for planning to reduce the number of injections required per day. Still other research is ongoing concerning the transplantation of cells into the pancreas for the production of insulin.

Other promising research into the specific types of foods and diets that are beneficial for those diagnosed with type 1 diabetes has shown promising results. Studies linking low glycemic index (GI) diets in helping to manage type 1 diabetes have been very positive. While these diets do not eliminate the need for insulin, they can be key in reducing the amount of insulin needed. These diets can be used by children, teens and adults and encourage self-monitoring of food intake, blood glucose levels and the need for insulin. 3

Researchers continue to make strides in developing new options for those diagnosed with type 1 diabetes to treat and manage their health. Still others continue looking for ways to cure all types of diabetes, which would certainly be the ideal solution.

References

1 Taplin, C. E., & Barker, J. M. (2008). Autoantibodies in type 1 diabetes. Informa Healthcare , 11-18.

2 Vaarala, O., Atkinson, M. A., & Josef, N. (2008). The “Perfect Storm” for Type 1 Diabetes. Diabetes , 2555-2562.

3 University of Nottingham Malaysia Campus. (2011). A low Glycaemic Index (GI) diet is an effective, under-utilized tool in the management of type 1 diabetes mellitus (T1DM). Universitas 21 Graduate Research Conference on Food Proceedings (pp. 18-23). Smenyih: J Wiley.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.