What is Type 1 Diabetes?

Type 1 diabetes (T1D) is an autoimmune disease in which your immune system, which is designed to fight infection, goes haywire and attacks the cells in the pancreas that make insulin. Insulin is a hormone required to get the sugar in your blood—glucose—into your cells, which then use glucose as fuel to provide energy. In T1D, the attack on insulin-producing cells leads to your body being unable to make enough insulin. As a result, you will require insulin therapy to ensure that your cells can take up glucose.1 This is different than type 2 diabetes, in which the body either does not produce enough insulin or cannot use it effectively.

T1D is caused by a combination of genes and environmental factors such as viruses. It typically occurs in children and young adults, although it can appear at any age. Although having a parent or sibling with the disease increases your risk, 90 percent of people with T1D have no family history. Your risk is also higher if you have any other autoimmune conditions, such as celiac disease, Hashimoto’s disease, and others, or if these conditions run in your family.2–5

Symptoms of T1D include6:

  • Increased thirst and urination
  • Increased hunger
  • Blurred vision
  • Fatigue
  • Unexplained weight loss

These symptoms can come on quite quickly and require immediate medical care. About 30 to 60 percent of the time, people develop a life-threatening condition called diabetic ketoacidosis (DKA). It occurs when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down muscle and fat for fuel, which produces acids called ketones. When too many ketones are produced too fast, they can build up to dangerous levels in your body.7

Symptoms of DKA include7:

  • Fruity smelling breath
  • Dry or flushed skin
  • Nausea or vomiting
  • Stomach pain
  • Trouble breathing
  • Trouble paying attention or feeling confused

An episode of DKA early in the disease can lead to8:

  • More DKA events
  • Severe low blood sugar
  • A greater risk of death
  • Longer hospital stays
  • Higher levels of insulin required over time
  • A shorter remission period (called a “honeymoon” period during which the pancreas still makes some insulin)
  • Worse control of blood sugar over time

All of this increases the risk of diabetes-related complications like heart disease, kidney disease, and eye diseases.8

References

  1. Atkinson MA, Mirmira RG. The pathogenic “symphony” in type 1 diabetes: A disorder of the immune system, β cells, and exocrine pancreas. Cell Metab. 2023;35:1500-1518.
  2. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391:2449-2462.
  3. Noble JA. Immunogenetics of type 1 diabetes: A comprehensive review. J Autoimmun. 2015;64:101-112.
  4. Pociot F, Lernmark Å. Genetic risk factors for type 1 diabetes. Lancet. 2016;387:2331-2339.
  5. Redondo MJ, Jeffrey J, Fain PR, Eisenbarth GS, Orban T. Concordance for islet autoimmunity among monozygotic twins. N Engl J Med. 2008;359:2849-2850.
  6. Katsarou A, Gudbjörnsdottir S, Rawshani A, et al. Type 1 diabetes mellitus. Nat Rev Dis Primers. 2017;3:17016.
  7. Centers for Disease Control and Prevention (CDC). Diabetic ketoacidosis. (www.cdc.gov/diabetes/basics/diabetic-ketoacidosis.html). Accessed 3/18/24.
  8. Simmons KM, Sims EK. Screening and prevention of type 1 diabetes: Where are we? J Clin Endocrinol Metab. 2023;108:3067-3079.

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