What is Type 1 Diabetes?

Type 1 Diabetes is an autoimmune disorder, which means that your immune system mistakenly attacks and destroys the beta cells in your pancreas. When your pancreas cannot produce enough insulin, glucose cannot enter your cells and remains in your bloodstream. This lack of insulin is what causes high blood glucose levels in Type 1 Diabetics.

Persistently high blood glucose levels can lead to several serious and life-altering health complications, which is why it is important to manage your condition.

Type 1 Diabetes was previously known as insulin-dependent diabetes, as insulin administration is the only way to manage it. It was also previously known as juvenile diabetes mellitus, as it primarily occurs in children and young adults

What Causes Type 1 Diabetes?

The exact cause of Type 1 Diabetes is still unknown. The most common explanation is genetics, which means that those who get it were most likely born with an increased susceptibility to autoimmune conditions. Another possible cause could be environmental factors like exposure to viruses or harmful chemicals that can destroy your beta cells.

Unlike with Type 2 Diabetes, lifestyle habits do not play a part in the development of Type 1 Diabetes.

What are the Stages of Type 1 Diabetes?

The progression of Type 1 Diabetes can be divided into the following stages:

Pre-Stage 1: Genetic Predisposition

In this stage, genetic analysis can help identify underlying genetic risk factors that are commonly associated with Type 1 Diabetes. A specific region on chromosome six, called the HLA region, is associated with up to 50% of the risk for developing this condition, along with other factors like having a sibling or parent with Type 1 Diabetes.

Stage 1: Development of Autoantibodies

In this stage, at least one diabetes-related autoantibody (antibody directed against the person’s own body) is present in the blood. Autoantibodies start attacking the beta cells in the pancreas. Blood sugar levels remain normal, and no symptoms are present.

Stage 2: Dysglycaemia

In this stage, at least two or more diabetes-related autoantibodies are present in the blood. Beta cells continue to be destroyed by the immune system, and a lack of insulin leads to rising blood sugar levels. The individual remains asymptomatic.

Stage 3: Clinical Onset

In this stage, there is a significant loss of beta cells due to autoimmunity and symptoms are present, resulting in a Type 1 Diabetes diagnosis.

Can Type 1 Diabetes be Prevented?

Currently, it is not possible to prevent or cure Type 1 Diabetes. However, it can be effectively managed with insulin therapy and appropriate lifestyle changes

Research is ongoing on the ways to identify individuals who are at a risk for developing Type 1 Diabetes and preventing it before the beta cells in the pancreas are destroyed. 

What are the Three Levels of Prevention in Type 1 Diabetes?

Research and trials are underway for the prevention of diabetes Type 1 at different stages based on the disease progression. The prevention strategies are different for different stages of Type 1 Diabetes. They are:

Primary Prevention

This strategy focuses on preventing Type 1 Diabetes before the development of autoimmunity or autoantibodies, i.e. in Pre-Stage 1. The studies on primary prevention of Type 1 Diabetes are geared toward stopping the development of autoimmune reactions in young children (infants and toddlers) who are at a high risk of Type 1 Diabetes. 

The approaches have included dietary changes like avoiding early administration of cow milk or dairy products, delayed introduction of gluten products into the child’s diet, including omega-3 fatty acids like docosahexaenoic acid (DHA) supplements with a regular diet, etc. There have been no positive results thus far.

Experts suggest that vaccines against viral infections that may trigger Type 1 Diabetes may also be effective in primary prevention.

Secondary Prevention

Secondary prevention strategies focus on the prevention of Type 1 Diabetes after autoantibodies have developed, during Stages 1 and 2 of the condition.

Several clinical trials are studying the effectiveness of nicotinamide (niacin or vitamin B3), insulin (injections, oral, nasal spray), glutamic acid decarboxylase (GAD) vaccine, and some antibody medications like teplizumab, abatacept, etc. in the secondary prevention of Type 1 Diabetes.

Tertiary Prevention

Also known as intervention trials, tertiary prevention trials and studies are conducted in Stage 3 of disease progression, after the clinical onset of Type 1 Diabetes and the development of symptoms. The research in tertiary prevention is focused on preventing the loss of pancreatic beta cells in the first few years of the clinical onset of the disease.

Several immunotherapeutic approaches have been proposed to prevent beta cell loss. Trials are ongoing to test the effectiveness of GAD vaccine, Bacille Calmette-Guérin (BCG) vaccine, and medications like methotrexate, cyclosporine, rituximab, teplizumab, abatacept, etc.Stem cell transplantation and vitamin D supplementation are also being studied as potential approaches to slow down or halt the progression of beta cell loss in Type 1 Diabetes.

How is Type 1 Diabetes Treated or Managed?

Type 1 Diabetes is a chronic condition that requires lifelong care and treatment. However, you can successfully manage it by taking the following measures:

• Regular administration of insulin as per your doctor’s instructions.
• Consuming a healthy, well-balanced diet.
• Counting the amount of macronutrients you consume, especially carbohydrates.
• Exercising regularly and being physically active.
• Frequently monitoring your blood glucose levels using a glucometer or other devices.
• Managing stress in a healthy way.
• Quitting smoking.
• Limiting or avoiding alcohol consumption.