Type 1 Diabetes

  • Medical Author:
    Erica Oberg, ND, MPH

    Dr. Erica Oberg, ND, MPH, received a BA in anthropology from the University of Colorado, her doctorate of naturopathic medicine (ND) from Bastyr University, and a masters of public health (MPH) in health services research from the University of Washington. She completed her residency at the Bastyr Center for Natural Health in ambulatory primary care and fellowship training at the Health Promotion Research Center at the University of Washington.

  • Medical Editor: Jerry R. Balentine, DO, FACEP
    Jerry R. Balentine, DO, FACEP

    Jerry R. Balentine, DO, FACEP

    Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Type 1 Diabetes Symptoms, Causes, Diagnosis

Type 1 diabetes definition and facts

  • Type 1 diabetes (insulin dependent diabetes, juvenile) is a condition in which the body stops making insulin. This causes the person's blood sugar to increase.
  • There are two types of diabetes, type 1 and type 2.
    • In type 1 diabetes, the pancreas is attacked by the immune system and then it cannot produce insulin.
    • In type 2 diabetes the pancreas can produce insulin, but the body can't use it.
  • Causes of type 1 diabetes are auto-immune destruction of the pancreatic beta cells. This can be caused by viruses and infections as well as other risk factors. In many cases, the cause is not known. Scientists are looking for cures for type 1 diabetes such as replacing the pancreas or some of its cells.
  • Risk factors for type 1 diabetes are family history, introducing certain foods too soon (fruit) or too late (oats/rice) to babies, and exposure to toxins.
  • Symptoms of type 1 diabetes are
  • Sometimes, there are no significant symptoms.
  • Type 1 diabetes is diagnosed by blood tests. The level of blood sugar is measured, and then levels of insulin and antibodies can be measured to confirm type 1 vs. type 2 diabetes.
  • Type 1 diabetes is treated with insulin and lifestyle changes. Specifically, meal planning to ensure carbohydrate intake matches insulin dosing.
  • Complications of type 1 diabetes are kidney disease, eye problems, heart disease, and nerve problems (diabetic neuropathy) such as loss of feeling in the feet. Poor wound healing can also be a complication of type 1 diabetes.
  • Type 1 diabetes cannot be prevented, however, keeping blood sugar at healthy levels may delay or prevent symptoms or complications. There is currently no cure, and most cases of type 1 diabetes have no known cause.
  • The prognosis or life-expectancy for a person with type 1 diabetes is good if blood sugar control is kept within a healthy range. The life expectancy traditionally has been about 11 years less than average, but that is changing as the prevention of complications improves and technology such as insulin pumps makes it easier for people to keep their blood sugar in a healthy range.

What is type 1 diabetes?

Type 1 diabetes is an autoimmune disease that affects blood sugar regulation. A person's immune system makes antibodies that destroy the insulin-producing islet beta cells in the pancreas. The pancreas then fails to make insulin. Without insulin, blood sugar increases and cannot be delivered to the muscles and brain where it is needed. Over time, high blood sugar can lead to a number of complications such as kidney, nerve, and eye damage, and cardiovascular disease. Moreover, cells do not receive the glucose necessary for energy and normal function. Type 1 diabetes is an autoimmune disease, which means cures for type 1 diabetes will likely involve replacing the damaged pancreas or promoting regeneration or functioning of the pancreas. Because people with type 1 diabetes can no longer produce their own insulin, they must inject doses of insulin. They must match the amount of insulin they inject with their diet. Keeping blood sugar in a normal, healthy range (what doctors call "good glycemic control") is the key to preventing long-term complications.

What is the difference between type 1 and type 2 diabetes?

The major process that happens in type 1 diabetes is that the pancreas can no longer produce insulin. Type 2 diabetes is more a result of insulin resistance (cells not being able to use insulin effectively or at all), that is, it takes a large amount of insulin to move glucose out of the blood and into the cells. Over time, people with type 2 diabetes also may experience decreased insulin production in the pancreas. In type 1 diabetes, over time, the body can also develop insulin resistance; especially in people who gain a lot of weight while using insulin. This means there is some overlap in treatment and diet for people who have had diabetes of either type for a long time.

Type 1 Diabetes Diet

Foods to Eat and Foods to Avoid

Glycemic index and glycemic load are scientific terms used to measure he impact of a food on blood sugar. Foods with low glycemic load (index) raise blood sugar modestly, and thus are better choices for people with diabetes.

Foods to eat for a type 1 diabetic diet include complex carbohydrates such as

  • brown rice,
  • whole wheat,
  • quinoa,
  • oatmeal,
  • fruits,
  • vegetables,
  • beans, and
  • lentils.

What are the signs and symptoms of type 1 diabetes?

Type 1 diabetes can be subtle or life threatening. Some people have no symptoms (asymptomatic) and type 1 diabetes isn't detected until blood or urine labs are run. If a person does have symptoms, early signs and symptoms are

  1. weight loss,
  2. thirst, and
  3. excessive urination.

Other signs and symptoms are

  1. an unusual odor to the urine,
  2. urinary tract infections (UTIs),
  3. yeast infections,
  4. unexplained weight loss,
  5. feeling hungry even after meals,
  6. stomach pain,
  7. diarrhea,
  8. fatigue,
  9. swollen ankles,
  10. darkening skin round the armpits or groin,
  11. night sweats,
  12. blurry vision,
  13. fruity or unusual breath,
  14. hair loss, and
  15. generally feeling unwell (malaise).

People with type 1 diabetes may experience more frequent infections of the skin or respiratory tract.

Undiagnosed type 1 diabetes can become life threatening if a person goes into ketoacidosis (a state where an elevated blood sugar leads to other metabolic changes).

What causes type 1 diabetes?

Type 1 diabetes is caused by the auto-immune destruction of the pancreatic beta-cells which produce insulin. It isn't known why the auto-immune destruction happens. However, there are some known triggers. Genetics, including family history and the prenatal environment of the mother, can put someone at risk for developing type 1 diabetes. Exposures to chemicals, especially ones called endocrine disruptors, found in plastics, are known triggers. Viral infections also can trigger the auto-immune process. Early or late introduction of certain foods to infants can trigger type 1 diabetes. Introducing fruit before 5 months of age or waiting until later than 7 months to introduce grains such as oats and rice increases the risk of diabetes. Although, research shows that breastfeeding reduces these risks . Most of the time, the underlying cause isn't known.

Is type 1 diabetes a genetic (inherited) disease?

There is a strong genetic link with type 1 diabetes. This can be tested for by looking at the human leukocyte antigen (HLA) genotype . First degree relatives are at higher risk. However, with any genetic condition, it is important to remember that gene expression changes in response to the epigenetic (nutritional) environment, and risk factors can be addressed with a health-care professional or nutrition/functional/naturopathic practitioner knowledgeable about epigenetics.

What environmental or other factors increase the risk of developing type 1 diabetes?

Risk factors for developing type 1 diabetes include: prenatal exposures, exposures to foods and environmental toxins early in life, and geography.

  • Prenatal exposures include whether the mother had preeclampsia or had metabolic syndrome .
  • Environmental exposures include chemicals, especially those found in plastics and foods, specifically introduction of gluten, casein (the protein in dairy) or fruit before four months of age or late introduction (after seven months of age) grains (gluten, oat, and rice) and casein.
  • Viral infections, such as Epstein-Barr virus or EBV (mononucleosis), Coxsackie, CMV, and other infections can also be risk factors for developing type 1 diabetes.
  • Living in a northern climate is a risk factor that has not been fully explained.

What if I have type 1 diabetes and become pregnant?

Pregnant women with type 1 diabetes need to be extra careful to maintain good blood sugar control. If blood sugar runs too high during pregnancy, there is an increased risk of complications including having a very large baby, having the baby too early, and having pre-eclampsia, a condition that can be life-threatening to the mother and baby. You can minimize the risk for complications by paying close attention to blood sugar, eating a low glycemic load diet, and staying regularly active.

Is there a test to diagnose type 1 diabetes?

  • Type 1 diabetes is diagnosed with a blood test for blood glucose.
  • If it is greater than 125 when fasting or greater than 200 randomly, a diagnosis of diabetes is made. To confirm whether it is type 1 or type 2 diabetes, blood tests measure antibodies.
  • Additionally, a presumptive diagnosis can be made based on glucose or ketones in the urine.
  • A c-peptide test can determine how much insulin the pancreas is producing.
  • Genetic testing, such as HLA subtyping, can add further understanding of the disease.

Which specialties of doctors treat type 1 diabetes?

Adult and pediatric endocrinologists, specialists in treating hormonal disorders and disorders of the endocrine system, manage patients with diabetes. Now, people with diabetes may also be cared for by a number of primary care providers including family or internal medicine, naturopathic doctors, or nurse practitioners. When complications arise, people with diabetes often consult other specialists, including neurologists, gastroenterologists, ophthalmologists, surgeons, and cardiologists. Nutritionists, integrative and functional medicine doctors, and physical activity experts such as personal trainers are also important members of a diabetes treatment team.

Is there a type 1 diabetes diet?

The basics of a type 1 diabetes diet include making sure carbohydrate intake is matched with insulin and choosing healthy options to maximize nutrition in each calorie. People with type 1 diabetes will find it is easiest to match carbohydrates to insulin if they follow a low glycemic load (index) diet, so that the impact of carbohydrates on blood sugar is slow and gradual. This also makes it easier to predict and match to required insulin.

Because weight gain can be a side effect of injecting insulin, a type 1 diabetes diet should be healthy and low in calories to help the person maintain or lose weight. Food lists of low glycemic load options can help people learn what to include in their diet.

What is the treatment for type 1 diabetes?

  • Because type 1 diabetes is characterized by the loss of insulin production in the pancreas, insulin must be provided in the form of an injection.
  • In addition to insulin, treatment includes diet changes to minimize sugars and make sure carbohydrates are matched with the appropriate dose of insulin.
  • There are different forms of insulin and different ways it can be administered.
  • A type 1 diabetes diet should focus on lots of vegetables and healthy proteins such as fish, chicken, and beans; and should be low in sweets and processed baked goods.
  • A healthy diet helps blood sugar control, and helps with weight loss.

What about exercise and type 1 diabetes?

  • Exercise is important for everyone, including people with type 1 diabetes.
  • People with type 1 diabetes need to be careful to monitor their blood sugar before, during, and after exercise and have snacks with them in case blood sugar goes too low.
  • When people exercise, the muscles use insulin to access blood sugar for fuel.
  • This can lead to lower than expected blood sugar.
  • Exercise also may trigger release of stored glucose from the liver. This can lead to higher than expected blood sugar. This is why it is important to check blood sugar, especially when beginning a new exercise program.
  • People with type 1 diabetes may see their blood sugar go up or down with exercise.

What are the complications of type 1 diabetes?

Uncontrolled blood sugar can lead to a number of complications associated with diabetes such as

Complications can be prevented by maintaining a healthy low blood sugar, eating a healthy diet rich in vegetables, and staying physically active.

What role does insulin play in type 1 diabetes?

People with type 1 diabetes require injectable insulin because their pancreas doesn't produce enough on its own. There are different types of insulin and different routes of administration. Most people with type 1 diabetes use both a long acting insulin, sometimes called a basal insulin, and inject additional insulin before or after meals, sometimes called regular insulin, to match the carbohydrate content of the meal. Unfortunately, one of the major side effects of insulin is weight gain. People with type 1 diabetes can reduce weight gain by

  • Eating a healthy low carbohydrate (low glycemic load) diet,
  • getting plenty of exercise, and
  • learning to use their insulin correctly so that they use just the right amount for their diet and level of activity.

Can type 1 diabetes be prevented?

While there isn't any definitive way to prevent type 1 diabetes, parents can be aware of the risk factors in the prenatal period, and in early childhood to minimize risk. For people who already have type 1 diabetes, prevention of complications through good glycemic control and regular medical screening is key.

What is the life-expectancy for someone with type 1 diabetes?

Research published in the Journal of the American Medical Association reported that people with type 1 diabetes live about 11 years less than average; however, new research also suggests this differential can be reduced with good glycemic control. Most people with type 1 diabetes die from complications of type 1 diabetes such as heart disease or kidney disease. Thus, preventing complications and following a healthy lifestyle that prevents heart disease and controls your blood sugar are the best things people with type 1 diabetes can do to live a long, healthy life.

REFERENCES:

Akerblom HK, Vaarala O, Hyöty H, Ilonen J, Knip M. "Environmental factors in the etiology of type 1 diabetes." Am J Med Genet. 2002 May 30;115(1):18-29.

Antvorskov JC, Josefsen K, Engkilde K, Funda DP, Buschard K. "Dietary gluten and the development of type 1 diabetes." Diabetologia. 2014 Sep;57(9):1770-80.

Bodin J., et al. "Can exposure to environmental chemicals increase the risk of diabetes type 1 development?" Biomed Res Int. 2015;2015:208947.

Frederiksen, B., et al. "Infant Exposures and Development of Type 1 Diabetes Mellitus: The Diabetes Autoimmunity Study in the Young (DAISY)." JAMA pediatrics. 2013;167(9):808-815.

Morgan, MP., et al. "Imunogenetics of type 1 diabetes mellitus." Mol Aspects Med. 2015 Apr;42:42-60.

Moss SE, Klein R, Klein BEK, Meuer MS. "The association of glycemia and cause-specific mortality in a diabetic population." Arch Int Med 154:2473–2479, 1994.

Schuppan D, Hahn EG. "Celiac disease and its link to type 1 diabetes mellitus." J Pediatr Endocrinol Metab. 2001;14 Suppl 1:597-605.

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Reviewed on 10/3/2016
References
REFERENCES:

Akerblom HK, Vaarala O, Hyöty H, Ilonen J, Knip M. "Environmental factors in the etiology of type 1 diabetes." Am J Med Genet. 2002 May 30;115(1):18-29.

Antvorskov JC, Josefsen K, Engkilde K, Funda DP, Buschard K. "Dietary gluten and the development of type 1 diabetes." Diabetologia. 2014 Sep;57(9):1770-80.

Bodin J., et al. "Can exposure to environmental chemicals increase the risk of diabetes type 1 development?" Biomed Res Int. 2015;2015:208947.

Frederiksen, B., et al. "Infant Exposures and Development of Type 1 Diabetes Mellitus: The Diabetes Autoimmunity Study in the Young (DAISY)." JAMA pediatrics. 2013;167(9):808-815.

Morgan, MP., et al. "Imunogenetics of type 1 diabetes mellitus." Mol Aspects Med. 2015 Apr;42:42-60.

Moss SE, Klein R, Klein BEK, Meuer MS. "The association of glycemia and cause-specific mortality in a diabetic population." Arch Int Med 154:2473–2479, 1994.

Schuppan D, Hahn EG. "Celiac disease and its link to type 1 diabetes mellitus." J Pediatr Endocrinol Metab. 2001;14 Suppl 1:597-605.

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