Type 1 diabetes used to be known as a disease that typically develops in younger adults, teens and kids. But according to some experts, that is not the case. “It’s not a childhood disease,”  Dr. Kathleen Wyne, Endocrinologist and director of the Adult Type 1 Diabetes program and the Adult Cystic Fibrosis-Related Diabetes program at The Ohio State University Wexner Medical Center tells us. “Over 50% are diagnosed as adults.” 

Type 1 diabetes is a condition where the pancreas doesn’t make enough insulin and Dr. Wyne emphasizes that people with the disease, “are still normal people who just have to take insulin when they eat (plus a basal shot or a pump). They DO NOT need a diet, but should eat heart healthy as a lifelong plan. It is not their fault.  They did not do anything to cause it nor could they have predicted or prevented it.” 

Anyone is at risk and the cause is still a mystery. “While the exact cause of Type 1 diabetes is unknown, it most likely appears to be an auto-immune situation where the body’s own immune system, normally responsible for fighting infection, attacks and destroys the cells within the pancreas responsible for producing insulin,” Robert Alesiani, PharmD, BCGP, Chief Pharmacotherapy Officer at Tabula Rasa HealthCare says. “Some other possible contributing factors might include environmental insults like viruses, toxins as well as genetic predisposition.”

Type 1 Diabetes is a serious condition that affects nearly 1.9 million Americans. When left untreated, the disease can lead to major complications, so knowing the signs can be lifesaving. Eat This, Not That! Health spoke with doctors who explain what to know about type 1 diabetes and symptoms to watch out for. 

Dr. Alesiani says, “The onset is usually rapid. When one develops Type 1 diabetes, it is a chronic disease where the pancreas no longer produces insulin hence the primary treatment for Type 1 diabetes is insulin replacement.” Dr. Donna O’Shea, chief medical officer of population health at UnitedHealthcare shares, “Type 1 diabetes is not preventable and there is still no cure so it is crucial parents understand the symptoms and warning signs that come with it. Parents and caretakers should look for the following signs in young adults: drinking too much water; frequent urination; unintended weight loss; mood changes; blurred vision and chronic fatigue.”

Dr. Camillo Ricordi, Director of the Diabetes Research Institute and the Cell Transplant Program at the University of Miami, Stacy Joy Goodman Professor of Surgery, Distinguished Professor of Medicine, Professor of Biomedical Engineering, and Microbiology and Immunology at the University of Miami (UM), Florida tells us, “Type 1 diabetes is a condition in which the insulin producing cells of the pancreas are selectively destroyed by the patient’s own immune system (autoimmunity), and as a result, there is a total or near-total lack of insulin production. Insulin is a hormone that helps cells convert sugars from the blood into energy, among other important metabolic functions. When you don’t have insulin, your body can’t absorb enough blood sugar, and it starts to accumulate in your blood. To survive, patients with Type 1 diabetes have to rely on insulin injections, but despite insulin treatment over time, the disease can damage your heart, blood vessels, and other important organs in your body. Type 1 diabetes can develop at any age, but it is most often diagnosed in people when they are young, which is why it used to be called juvenile diabetes. While there is currently no cure, it can be managed with insulin injections, following a healthy lifestyle, and working with your care team to keep your blood sugar levels under control.” 

Dr. Alesiani says, “Like Type 2 diabetes, typically the long-term effects of high blood sugar are separated into two categories: Macrovascular and Microvascular. Macrovascular include damage or injury the high glucose levels cause in the larger vessels of the circulatory system (coronary arteries, arteries of the extremities and those that supply blood to the brain). Microvascular complications are from glucose induced damage to the micro-vessels responsible for blood flow to the nervous system, eyes and some organs like the kidneys (diabetic nephropathy, neuropathy and retinopathy)

A problem limited almost exclusively to T1D is an increased risk of life-threatening ketoacidosis. As mentioned above, insulin allows glucose to enter muscle and other cells to use as fuel. When there is no insulin available, the liver begins to break down triglycerides and other fatty acids for fuel. The process produces acids called ketones which when produced too fast, can accumulate to dangerous levels in your body. Over the last 2 plus years, we’ve learned those with diabetes are more likely to have difficulty dealing with the COVID-19 virus. Those with diabetes don’t necessarily have a higher chance of contracting the virus — but experience more symptoms, complications and poorer outcomes when infected with the virus.”

The American Diabetes Association states, “People with diabetes are more likely to have serious complications from COVID-19. In general, people with diabetes are more likely to have more severe symptoms and complications when infected with any virus. Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed. Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because more than one condition makes it harder for your body to fight the infection.”

Dr. Wyne explains, “Type 1 diabetes is an absolute deficiency of insulin   It is due to autoimmune attack of the pancreas. Type 2 diabetes is a relative deficiency of insulin. Eventually they will need insulin therapy but not at first. Family history is one of the strongest risk factors.  The risk is due to genetics (we do not yet know what genes) that cause the pancreas to not be able to increase insulin secretion when stressed (weight, sedentary, surgery, steroids, pregnancy etc).  Also Pancreas is not programmed to keep making insulin for 70-100 years because of these genetic issues and is not able to make enough insulin to keep sugar normal.  It used to fail around age 50 but since the 1990s-2000 we have seen type 2 diabetes diagnosed earlier in their 40s then 30s and not in teens and youth.”

Dr. Alesiani adds, “Type 1 diabetes is a disease of pancreatic dysfunction and lack of insulin production. Type 2 diabetes is often considered a disease of two problems: 1) lack of insulin recognition or resistance where cells in muscles, fat and the liver become resistant to insulin which is needed for absorption and proper utilization of circulating blood sugar (glucose). There may also be a reduction of insulin production over time by the pancreas, creating a more slow and insidious onset than type 1 diabetes.”

Dr. O’Shea says, “Type 1 diabetes results from an autoimmune reaction and usually appears in adolescents and young adults, whereas type 2 develops over time and is usually associated with excessive weight and lack of activity. Type 1 diabetes can be treated, but there are complications to watch out for. Some of these include heart and blood vessel disease; nerve damage (neuropathy); kidney damage; eye damage; skin and mouth conditions and more. Type 1 diabetes can cause disruptions to insulin and glucose levels so it’s important that both of these are closely monitored. It’s critical that type 1 diabetics follow insulin prescriptions given to them by their doctors and maintain a consistent diet to keep blood sugar levels steady. A blood glucose monitor is a great tool to manage and prevent any blood sugar spikes throughout the day.”

Dr. Ricordi says, “Signs of type1 diabetes may include rapid and unexplained weight loss, extreme hunger, weakness or fatigue, blurred vision, increase in thirst and urination, unusual irritability, itchy skin and nausea, vomiting or abdominal pain.  Symptoms and signs of type 1 diabetes typically occur quickly, as compared to type 2 diabetes, where symptoms occur over longer periods of time and may be less noticeable.”

The Mayo Clinic says, “Type 1 diabetes symptoms can appear suddenly and may include:

• Feeling more thirsty than usual
• Urinating a lot
• Bed-wetting in children who have never wet the bed during the night
• Feeling very hungry
• Losing weight without trying
• Feeling irritable or having other mood changes
• Feeling tired and weak
• Having blurry vision”

Dr. Ricordi explains, “With type 1 diabetes, the body’s immune system attacks the insulin-producing islet cells in the pancreas. This is a challenge because everyone needs insulin to survive. Once the insulin-producing islet cells are destroyed in a person with type 1 diabetes, they can no longer produce their own insulin, and without insulin, the body can’t normalize its own blood sugar. So, the sugar stays in the blood and builds up. As a result, the body’s cells starve, which is why type 1 diabetes patients must be treated through a daily regimen of insulin therapy.”

Dr. Alesiani says, “For those with type 1 diabetes, insulin is essential. Insulin is injected just under the skin, either as an injection given multiple times daily or continuously via an insulin pump. Dosing is patient specific and involves many adjustments based on blood sugar testing throughout the day. Over time, the patient, with the help of the physician and/or nurse will determine the proper dose based on the current blood sugar levels and lifestyle needs. Diet, infection, exercise, stress, changes in weight, pregnancy can all affect the amount of insulin needed to control blood sugar. Insulin pumps increase flexibility in the timing of meals and other day-to-day events. Once the process is learned, use of an insulin pump can be of great benefit for children or adults whose schedule varies from one day to the next. People who use an insulin pump do not require multiple daily injections and need only change the injection site every 48 to 72 hours.”6254a4d1642c605c54bf1cab17d50f1e

Dr. Ricordi tells us, “Islet cells sense glucose in the blood and produce the right amount of insulin to normalize blood sugars. In patients without diabetes, their bodies produce insulin and normalize blood sugars on their own. Because people with T1D don’t have insulin-producing islet cells, they can experience high levels of blood glucose (or sugar) and must be treated with a daily regimen of insulin therapy. In addition, these patients are exposed to the feared risk of severe hypoglycemic episodes (low blood glucose) as a result of exogenous insulin treatment and because of a progressive loss of the ability to sense the symptoms of low blood glucose levels (hypoglycemia unawareness). Severe hypoglycemia can be debilitating and life threatening.”

Dr. Alesiani adds, “Normally, blood glucose is one’s main source of fuel and comes mainly from one’s diet. While the primary goal of treatment seems to be suppression of glucose levels, overshooting the mark (=hypoglycemia) can be dangerous as well. The need for “rescue” glucose supplements (oral tablets and gels) are typically kept on hand for times of symptomatic hypoglycemia (rapid heart rate, tremor, sweating, anxiety, etc.).”