Type 1 Diabetes

Definition

Type 1 diabetes is an autoimmune condition in which the pancreas stops making insulin. Insulin is a necessary hormone to regulate blood sugar (glucose). Without it, glucose can’t move out of the bloodstream and into the body’s cells for energy.

This leads to higher than normal blood glucose levels, along with symptoms of diabetes. Because Type 1 diabetes is a lifelong condition, people with diabetes need to replace insulin with daily injections or an insulin pump. 

Type 1 diabetes accounts for 5% to 10% of all types of diagnosed diabetes. And research shows it’s on the rise. As of 2021, Type 1 diabetes affects about 1.6 million people in the U.S. That’s almost a 30% increase from 2017. 

Without medication, Type 1 diabetes can cause damage to small and large blood vessels over time. This can lead to devastating problems with your:

• Kidneys

• Eyes

• Heart 

• Brain and nerves

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Causes

Type 1 diabetes is an autoimmune disease. It happens when a person’s immune system attacks its insulin-producing cells. This causes the cells of the pancreas to stop making insulin. 

Insulin is needed to move sugar out of the bloodstream and into cells for energy. After you eat, your food is digested and your blood glucose levels rise. Cells all over your body use glucose for fuel, or store it for later use.

But without insulin, glucose remains in the bloodstream and can’t be used by the body. So, as the glucose builds up in your blood, the rest of your body starves.

Type 1 diabetes can happen at any age. And experts aren’t exactly sure what causes it. While there is a genetic link, 90% of people who develop it have no family connection to Type 1 diabetes. It’s thought an environmental trigger (such as a virus) may play a part. 

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Symptoms

Type 1 diabetes begins without any symptoms. But, as the pancreas makes less and less insulin, symptoms develop suddenly, and severely. In other words, people with undiagnosed Type 1 diabetes can get very sick, quickly. 

As blood glucose levels starts to rise, you’ll likely notice:

• Increased thirst

• Increased urination 

• Tiredness

If someone goes a long time without being able to use the glucose in their blood, they enter starvation mode. The body begins to use muscle and fat for energy instead. When this happens, ketones build up in the blood, causing the following symptoms: 

• “Flu-like” symptoms including nausea, vomiting, abdominal pain, achy muscles 

• Exhaustion 

• Weight loss 

• Fruity-smelling breath (this is the smell of the ketones)

• Blurry vision

• Dizziness or confusion

If ketones continue to build up in the blood, it can lead to a dangerous condition called diabetic ketoacidosis (DKA). It’s a medical emergency because it can lead to coma, brain damage, and even death.

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Diagnosis

Diagnosing Type 1 diabetes is often straightforward with simple blood and urine tests. Other times, it can be mistaken for a cold, flu, or another type of diabetes.

Common testing includes:

• Urine test: This test can detect glucose or ketones in your urine, which shouldn’t be there if you don’t have diabetes. 

• Random fingerstick glucose: This is a quick test that requires a small drop of blood and a handheld glucose monitor. It’s often the first test that leads to other testing.

• Blood glucose: A blood sample gets sent to a lab for analysis, which can give a more accurate glucose level than a fingerstick. 

• Fasting glucose: This blood test is collected after you’ve been fasting (not eating) overnight. It shows what your glucose is when you’re not eating. So, if it’s high even after fasting, that’s a sure sign you have diabetes. 

• Electrolytes: Electrolyte levels (like sodium, potassium, and magnesium) often become abnormal when the blood sugar is high.

• Hemoglobin A1C: This blood test estimates your average glucose over the past few months. It’s not affected by your levels at the time of the test.

• Autoantibody testing: These tests look for evidence of autoimmune attack against your insulin-producing cells. This can be helpful if it’s not clear what type of diabetes you have. 

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Medications

When you have Type 1 diabetes, your body needs insulin, and your body can’t make its own — so the main treatment for diabetes is taking insulin as a medication. 

Your diabetes care team will provide support as you learn all of the “ins and outs” of diabetes management. It requires lots of learning, patience, and practice.

Several different types of insulin are available. The main difference between these types of insulin is how quickly they take effect, and how long they last in your body. If you inject insulin with a syringe or pen, you’ll likely need both a rapid-acting insulin and a long-acting insulin to cover meals and the time in between. 

Alternatively, many people with Type 1 diabetes choose to use an insulin pump. Insulin pumps deliver rapid-acting insulin in two ways:

• Basal insulin is continuously delivered in small doses.

• Bolus insulin is delivered for meals or to correct glucose levels that are out of range.

While some pumps require manual adjustments to keep glucose levels in target range, others don’t. Newer automated insulin delivery (AID) devices communicate directly with continuous glucose monitors (CGMs). This allows for automatic adjustments. AID devices can decrease the daily burden associated with managing diabetes and improve time spent in your glucose target range. 

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Living

Living with Type 1 diabetes has its challenges, and every day is different. Trying your very best is vital to your health. But it’s important to remember there’s no “perfect” when it comes to managing diabetes. 

Some days may be manageable while others aren’t. And that’s OK. It’s important to take your journey day by day, and reach out to your diabetes care team for support and guidance. 

Here are some things to keep in mind:

• Check glucose levels: Whether with a CGM or a glucometer, check your glucose throughout the day. It’s normal for your glucose level to fluctuate, and you’ll learn how to adjust your insulin in response.

• Read nutrition labels: Blood glucose levels can be affected by many foods, even healthy ones. It’s important to read nutrition labels, so you know exactly what you’re eating. A registered dietitian can be a helpful resource. 

• Keep your body healthy: Living with diabetes is not just about your day-to-day blood sugar levels. Good quality sleep, regular exercise, and a diabetes-friendly diet go a long way to helping stabilize your blood glucose and reduce the risk of long-term health complications. 

• Medical care over time: Regular checkups with your primary care provider will help with diabetes management and your health in general. 

Your diabetes care team

Most people with Type 1 diabetes also have the support of a diabetes care team, which may include the following specialists: 

• Endocrinologist

• Diabetes educator (certified diabetes care and education specialist, or CDCES), 

• Registered dietitian

• Social worker

• Ophthalmologist

• Podiatrist

• Pharmacist

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