Type 1 diabetes is a chronic condition that occurs when your pancreas doesn't make enough insulin. Your pancreas is the digestive organ behind your stomach that helps your body turn food into fuel. Insulin is a hormone that helps move glucose (sugar) from your blood and into your cells to give you energy.

If your body doesn't produce enough insulin, glucose builds up in your bloodstream. High blood sugar levels can damage your heart, blood vessels, nerves, kidneys, eyes, feet, and skin if left untreated. Extremely high blood sugar levels can also lead to diabetic ketoacidosis (DKA), a life-threatening condition that causes your blood to become acidic.

Type 1 diabetes is a form of diabetes mellitus and accounts for about five percent of all cases. While the exact cause of type 1 diabetes remains unknown, researchers believe that a combination of genetic and environmental factors disrupts normal pancreas function.

Previously called juvenile diabetes, type 1 diabetes often develops in children and adolescents, but it can occur at any age. If diagnosed with type 1 diabetes, you might experience symptoms such as excessive thirst, weakness, fatigue, and unexplained weight loss.

Currently, there is no cure for type 1 diabetes. However, it can be effectively managed through insulin therapy and a healthy lifestyle.

On November 17, 2022, the U.S. Food and Drug Administration (FDA) approved a drug called "Tzield" to help delay the progression of type 1 diabetes in individuals over the age of eight. Tzield is an injectable treatment that works by slowing or preventing the immune system from attacking healthy cells in the pancreas.

Types

There are three subtypes of type 1 diabetes: acute-onset (AT1D), slowly progressive (SP1D), and fulminant (FT1D).

Acute-Onset Type 1 Diabetes (AT1D)
People with AT1D suddenly develop symptoms, often due to diabetic ketoacidosis (DKA). DKA happens when the liver produces too many ketones because there isn’t enough insulin to move glucose into cells. Individuals with AT1D typically develop DKA within three months after experiencing symptoms of high blood sugar, such as extreme thirst, unintended weight loss, and frequent urination. This is the most common form of type 1 diabetes.

Slowly Progressive Type 1 Diabetes (SP1D)
SP1D develops gradually. In this subtype, antibodies progressively destroy the insulin-producing cells in the pancreas. SP1D can occur in both children and adults, but because symptoms emerge slowly, it is often diagnosed later in life.

Fulminant Type 1 Diabetes (FT1D)
FT1D is a rare and aggressive form of type 1 diabetes. Symptoms can develop very rapidly, as the immune system quickly destroys pancreatic cells. This condition can be difficult to manage and may become life-threatening without prompt treatment.

Symptoms

When the pancreas fails to produce enough insulin, symptoms may appear suddenly, including:

  • Frequent urination: The kidneys attempt to remove excess sugar from the blood, causing increased urination, even at night. Children might start wetting the bed more frequently.
  • Excessive thirst: Dehydration from frequent urination leads to persistent thirst.
  • Increased hunger: Lack of insulin prevents sugar from entering cells for energy, causing increased hunger.
  • Unintended weight loss: The body burns fat and muscle for energy when it can't access sugar.
  • Fatigue: Even with adequate rest, you may feel tired because your body isn’t getting the energy it needs.
  • Tingling or numbness in hands and feet: High blood sugar levels can damage nerves.
  • Slow-healing sores: Diabetes weakens the immune system, slowing wound healing.
  • Blurred vision: High blood sugar can harm the tiny blood vessels that supply the retina.

Some individuals with type 1 diabetes may also develop diabetic ketoacidosis (DKA), which includes symptoms such as:

  • Difficulty breathing
  • Dry, flushed skin
  • Fruity-smelling breath
  • Nausea and vomiting
  • Stomach pain

DKA is a medical emergency and requires immediate treatment.

Causes

The exact cause of type 1 diabetes is unknown. It is recognized as an autoimmune condition where the body mistakenly attacks the beta cells in the pancreas that produce insulin. A combination of genetic predisposition and environmental triggers is believed to contribute to the disease. Having a family history of type 1 diabetes or specific genetic markers increases the risk. Other potential factors include infections, stress, living in colder climates, and not being breastfed as an infant.

Diagnosis

Type 1 diabetes is diagnosed through various tests:

  • A1C Test: Measures average blood sugar levels over the past three months without the need to fast.
  • Fasting Plasma Glucose (FPG) Test: Measures blood sugar after fasting for at least eight hours.
  • Oral Glucose Tolerance Test (OGTT): Measures the body's ability to process sugar over a two-hour period after drinking a sugary beverage.
  • Random Glucose Test: Measures blood sugar at any time, regardless of when you last ate.

To distinguish between type 1 and type 2 diabetes, additional testing for autoantibodies such as IAA, IA-2A, ICA, and GADA may be performed.

Stages

Type 1 diabetes develops in stages:

  • Stage 1: Blood sugar remains normal, but two or more autoantibodies are present. No symptoms are observed.
  • Stage 2: Blood sugar levels are abnormal, but symptoms have not yet appeared.
  • Stage 3: Blood sugar is high, symptoms are present, and a clinical diagnosis is made.

Treatment

There is no cure for type 1 diabetes. Treatment focuses on managing blood sugar levels through daily insulin administration and regular monitoring. Insulin may be administered via syringes, insulin pens, pumps, or through continuous glucose monitors (CGMs) that automate insulin delivery based on real-time blood sugar readings.

A comprehensive diabetes care team may include:

  • Primary care physician
  • Endocrinologist
  • Podiatrist
  • Ophthalmologist
  • Mental health professional
  • Neurologist
  • Pharmacist
  • Registered dietitian nutritionist (RDN)
  • Certified diabetes care and education specialist (CDCES)

Prevention

Tzield is the first FDA-approved drug shown to delay the onset of type 1 diabetes in high-risk individuals. Clinical trials demonstrated that nearly half of participants who received Tzield experienced a delay of approximately four years before being diagnosed. Ongoing research continues to explore new prevention methods.

Maintaining blood sugar within a healthy range through regular monitoring, timely insulin use, exercise, a healthy diet, good sleep, and stress management is essential to prevent complications.

Living With Type 1 Diabetes

Living with type 1 diabetes can be challenging, but proactive care can make a significant difference. Helpful strategies include:

  • Managing stress through mindfulness activities and social support
  • Eating a balanced diet rich in vegetables, fruits, lean proteins, and healthy fats
  • Engaging in regular physical activity
  • Prioritizing good sleep hygiene
  • Building a strong support network

A Quick Review

Type 1 diabetes happens when your pancreas does not produce enough insulin, which results in having high blood sugar. Symptoms of type 1 diabetes may include getting increasingly hungry or thirsty, feeling tired or weak, needing to use the bathroom more often, and losing weight without trying.

If you have symptoms, it is important to reach out to your healthcare provider to get tested and receive a proper diagnosis. Your healthcare provider and care team can set up a treatment plan that can help you manage your condition. Early treatment can prevent further damage to your heart, blood vessels, nerves, kidneys, eyes, feet, and skin. 

While type 1 diabetes does not have a cure, taking your insulin on time and making healthy lifestyle changes can help you manage your condition.