The ultimate guide to type 1 diabetes
What is type 1 diabetes?
Type 1 diabetes mellitus is a chronic condition where the pancreas is unable to produce insulin, leading to excessive amounts of glucose (“sugar”) accumulating in the blood. The precise cause of type 1 diabetes is unknown, but the disease is usually triggered by an autoimmune response that causes the immune system to target its own insulin-producing beta cells. Approximately 1.6 million Americans are living with type I diabetes.
What are some risk factors for type 1 diabetes?
- family history
- genetics
How does my family history influence my risk of type 1 diabetes?
A family history of type 1 diabetes increases the likelihood of developing the disease. For example, the child of a man with type 1 diabetes has a 1 in 17 chance of developing type 1 diabetes while the child of a woman with type 1 diabetes has a 1 in 25 chance. And if both parents have type 1 diabetes, the risk is between 1 in 10 and 1 in 4 for their children. These are significantly higher than the average risk of 4 in 1000.
How do my genetics influence risk of type 1 diabetes?
Genetics impacts the likelihood of developing the disease; an analysis conducted on 2 million children drawn from the Taiwan National Health Insurance Database found the heritability of type 1 diabetes to be approximately 66%. One specific locus, HLA DQ, confers a disproportionate share of genetic risk, as we explain in our whitepaper.
At what age is type 1 diabetes usually diagnosed?
Type 1 diabetes is typically diagnosed between the ages of 4 and 14, though adulthood diagnoses do also occur.
What are some symptoms of type 1 diabetes?
The typical symptoms include increased thirst and urination, fatigue, weakness, irritability and other mood changes, and blurred vision.
What are some complications of type 1 diabetes?
Over time, poorly controlled diabetes can cause many complications, such as kidney failure, neuropathic pain, heart disease, and blindness. An acute complication to watch out for is Diabetic Ketoacidosis (DKA), which occurs when a lack of insulin causes an overload of ketones in the blood. Common symptoms include frequent urination, thirst, nausea and vomiting, fatigue, and in severe cases, coma. This is a medical emergency, and people with diabetes experiencing DKA should immediately go to the hospital.
How is type 1 diabetes managed?
Type 1 diabetics require insulin administration in order to stay alive and should regularly see a endocrinologist to help manage their diabetes. A useful measure of how well someone’s blood sugar is controlled is their hemoglobin A1C. The higher an A1C, the more likely they are to get complications from diabetes. Treatment for diabetes depends on several patient factors but mostly centers on safely reducing blood sugar levels and otherwise reducing risk for diabetic complications. The American Diabetes Association recommends having an A1C goal of 7% or below.
Is there anything I can do to reduce my child’s risk of developing type 1 diabetes?
There are ongoing efforts aimed at preventing type 1 diabetes among high-risk individuals, but these are still experimental. These range from immunosuppressants for individuals who are in the early stages of an autoimmune response to preventing autoimmunity from developing in the first place.
As explained in the type 1 diabetes whitepaper, genetics plays an important role in determining the risk of diabetes. Using Orchid’s embryo scoring, you can prioritize the embryo with the lowest genetic risk and reduce their risk of diabetes.
Is there anything I can do to prevent complications from type 1 diabetes?
Nearly half of all children who develop type 1 diabetes are not aware they have developed it until they are hospitalized. There is a significant risk for coma or even death for these children. Early awareness of risk with a genetic test can help to catch the disease early in development to avoid these complications.
Once type 1 diabetes has developed, there are no cures for it, other than a pancreas transplant. The goal for treatment is to balance avoidance of high blood sugar (“hyperglycemia”) with staying away from dangerously low blood sugar (“hypoglycemia”). This is done through a combination of dietary planning and insulin injections.
Since type 1 diabetes increases the risk of heart disease, controlling other risk factors for coronary artery disease like blood pressure and cholesterol are important. Type 1 diabetes also increases the risk for kidney disease and so controlling blood pressure is important as well.
Medication
Though some complications from diabetes are not prevented with better blood sugar control, many are. For that reason, treatment of type 1 diabetes is designed to normalize blood sugar levels, while avoiding the risks of hypoglycemia (low blood sugar).
Since diabetes also raises the risk of kidney disease and heart disease, better control of other risk factors in selected patients, such as high blood pressure and high cholesterol, is prioritized as well. Though there is less firm evidence for these risk-reducing interventions for people with type 1 diabetes compared to people with type 2, it is likely that they will help.
Lowering blood sugar levels is done through administering insulin through either injections or a pump. Exact dosing of insulin depends on the individual’s insulin sensitivity, the size and macronutrient breakdown of a meal, and other factors, such as an infection (which can increase insulin requirements.)
Regular insulin can be used, but there are many different formulations available which have different durations to help with blood sugar control. These range from fast-acting Insulin Aspart, which takes effect within 5-15 minutes and lasts for 3-4 hours, to long-lasting Insulin Glargine, which takes effect within 90 minutes and lasts for 24 hours. Patients use different formulations at different times to keep their blood sugar stable by trying to approximate what their body would have normally done.
Correct dosing, as well as timing, is helped by checking blood sugar levels multiple times a day by finger-stick. There may be an additional advantage with continuous glucose monitoring (CGMs), which are sensors attached to one's body capable of monitoring glucose levels in real time without the need for a finger pricking, though they are more expensive.
How is it diagnosed?
Diabetes is diagnosed through any one of the following:
- Blood glucose levels above 126 mg/dL after 8 hours or more of fasting
- A1C ≥6.5%
- In a patient with symptoms of hyperglycemia, a random plasma glucose ≥200 mg/dL
To distinguish type 1 diabetes from type 2, doctors may test for specific autoantibodies which indicate autoimmunity.
Takeaways
- Type 1 diabetes is a chronic condition with large effects on your health: it raises the risk of heart attacks, strokes, kidney disease, vascular disease, erectile dysfunction, neuropathic pain, and more.
- Regulating blood sugar levels through insulin injections allows individuals with type 1 diabetes to survive and reduce the complications listed above.
- There is ongoing research into preventing type 1 diabetes in high-risk individuals
Where can I learn more?
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