What is type 1 diabetes?
Type 1 diabetes is a form of diabetes caused by damage to the insulin-producing cells (beta cells) in the pancreas. This condition is different from the more commonly seen type 2 diabetes, which is associated with age, lifestyle, and genetic factors.
The onset of type 1 diabetes tends to occur during childhood, adolescence, or young adulthood; however older adults can also develop type 1 diabetes although less common.
The damage to beta cells in people with type 1 diabetes is caused by abnormal antibodies produced by the person’s body. Once the beta cells are completely damaged, the person will experience high glucose (hyperglycaemia) and a form of diabetes emergency called diabetic ketoacidosis.
What is diabetic ketoacidosis?
Diabetic ketoacidosis is a medical emergency caused by very high glucose and the accumulation of ketone bodies in the blood. These ketone bodies are the byproduct of fat breakdown when the body does not have enough insulin to utilize glucose as the main energy source. Once there are too much ketone bodies in the blood, it causes the blood to become too acidic, and causes other organ systems to fail (heart failure, coma).
How is type 1 diabetes diagnosed?
The majority of patients with type 1 diabetes are diagnosed when they experience diabetes ketoacidosis in the absence of a prior diagnosis of diabetes. In less common scenarios, it is possible to diagnose type 1 diabetes when a child or a young adult experiences unexplained weight loss, lethargy, and increased frequency of urination. However, the period from the onset of these symptoms to the development of diabetes ketoacidosis is often short, leading to most patients being diagnosed only after they experience diabetic ketoacidosis.
How is type 1 diabetes treated?
All patients with type 1 diabetes require insulin treatment for the rest of their lives, otherwise they will relapse back into diabetic ketoacidosis. However, insulin treatment in people with type 1 diabetes can be complex and requires a continuous learning process.
Studies have shown that despite insulin treatment, people with type 1 diabetes can still develop long-term diabetes complications such as kidney failure, blindness, amputations, and cardiovascular diseases. These complications can be prevented by aiming for lower HbA1c with an intensive insulin treatment. Patients with type 1 diabetes are also prone to experience low blood glucose (hypoglycaemia) from insulin treatment. In order to achieve the target HbA1c and minimize the risk of hypoglycaemia, such an intensive insulin treatment often involves multiple daily insulin injections, frequent blood glucose monitoring by finger pricking, estimation of carbohydrate intake, and matching insulin doses to carbohydrate intakes. Acquiring these skills and self-managing type 1 diabetes on a daily basis requires continuous learning and constant interaction with the diabetes care providers.
However, new technologies have been developed to make self-management of type 1 diabetes easier. The continuous glucose monitoring (CGM) system is designed to track glucose levels in the skin, which corresponds to glucose levels in the blood, on a continuous basis. Some newer systems do not require finger pricking and have been used by people with type 1 diabetes with very positive feedback. Insulin pumps are small devices that deliver continuous infusion of insulin into the skin without requiring multiple injections. These devices can be programmed to deliver different rates of insulin at different times of the day, as well as for different amounts of carbohydrate intakes. The newer closed-loop systems combine the best of both CGM systems and insulin pumps to create an automated insulin delivery system based on continuous glucose data from the CGM. These closed loop systems are often also called the “artificial pancreas” although they still have some limitations as compared to the normal human pancreas.
Most importantly, type 1 diabetes is an uncommon, complex condition that requires a lifelong learning process and a team of experienced diabetes care providers for the best treatment outcome. Hence it is essential for people with type 1 diabetes to have access to these diabetes care providers throughout their lives.
Can type 1 diabetes be cured?
Currently there are no cure for type 1 diabetes. Islet cell transplantation (which contains beta cells) have been used to provide short-term remission for patients with type 1 diabetes; hopefully this treatment will be accessible for more patients in the future.