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Type 1 diabetes

The Type 1 diabetes accounts for 5 to 10% of all diabetes cases. This form of the disease appears most often during childhood or adolescence, hence its old name of “juvenile diabetes”.

At the very beginning, type 1 diabetes causes no symptoms, as the pancreas remains partially functional. The disease only becomes apparent when 80 to 90% of pancreatic insulin-producing cells are already destroyed.

n fact, individuals with type 1 diabetes produce very little or no insulin because of an autoimmunereaction that partially or completely destroys the beta cells of the pancreas. These are used to synthesize insulin, which is essential for the body’s use of blood glucose as a source of energy. In this type of diabetes, it is absolutely necessary to take insulin regularly, hence the name often attributed to him as “insulin-dependent diabetes (IDDM)”. Moreover, this disease was fatal before it could be controlled with insulin.

Causes of Type 1 diabetes

It is unclear exactly what causes the immune system to react to beta cells. Some individuals are predisposed to the disease by their inheritance . There is a family history of type 1 diabetes in just under 10% of cases. It is likely that the disease results from a combination of genetic and environmental factors. Exposure to certain viruses or foods early in life could, for example, play a role in the onset of the disease.

Possible complications

For information on acute complications (hypoglycemia and hyperglycemia caused by adjustment of treatment, ketoacidosis in untreated diabetics), see our Diabetes fact sheet (overview) .

In the long term, type 1 diabetes increases the risk of several health problems  : cardiovascular disease, kidney problems, loss of sensitivity to fingers and feet, vision problems that can lead to blindness, etc.

The best way to prevent these complications is to regularly monitor blood glucose , blood pressure and cholesterol on a regular basis . For more information, see our Complications of Diabetes fact sheet.

Attention to celiac disease

The celiac disease is particularly common in people with type 1 diabetes 20 times more than in the general population, according to a study. Celiac disease is another autoimmune disease whose symptoms (mainly digestive) are triggered by the consumption of gluten, a protein contained in several cereals. Therefore, screening for celiac disease is recommended in type 1 diabetics, even in the absence of obvious symptoms.

Symptoms of type 1 diabetes

  • An excessive elimination of urine (it is frequent to get up at night to go to urinate);
  • An increase in thirst and hunger;
  • Significant fatigue
  • Weight loss;
  • A blurred vision.

Note. More frequent infections, slower wound healing, or loss of foot sensitivity are some of the possible signs of complications. It is then necessary to consult your doctor without delay . See also our Complications of Diabetes fact sheet.

People at risk

  • People with hereditary predisposition (family history). When a close relative has type 1 diabetes (father, mother, brother or sister), the risk of having it also varies between 5% and 10%. In identical twins, when one of them is affected, the other develops the disease in 30% to 50% of cases;
  • As epidemiological studies indicate, type 1 diabetes is more common in populations living far from Ecuador. In Finland, for example, the disease is 2 to 3 times more common than in the United States, and 400 times more so than in Venezuela. An inadequate intake of vitamin D, whose production depends on sun exposure, may partly explain this phenomenon.

Risk factors for Type 1 diabetes

There is no established risk factor. Here are some  hypotheses .

  • Cow milk.  Early consumption of cow’s milk in infants may contribute to allergies and type 1 diabetes in children with a family history of diabetes. The public health authorities advise not to give cow’s milk to newborns before the age of 12 months. Type 1 diabetes is less common in individuals who have been breastfed;
  • Early introduction of cereals . An early introduction of cereals (before the age of 4 months) could contribute to the disease; do not give it to the baby before the age of 6 months. Respect the recommended age for introducing foods to a baby.
  • Viral infection.  Epstein-Barr virus, Coxsackie virus or cytomegalovirus infection, for example, could trigger the autoimmune response against the pancreas.

Prevention of type 1 diabetes

Basic preventive measures
To prevent type 1 diabetes, the destruction of pancreatic cells responsible for insulin production in individuals at high risk of developing the disease should be prevented. According to the Canadian Diabetes Association, there is still no safe and effective method for preventing this disease , even if you are consulting early in life for a child at risk. Therefore, any attempt to prevent type 1 diabetes should be made in close collaboration with a physician and in some cases as part of an experimental study.

Current research

  • Vitamin D. Several observational studies have shown that vitamin D supplementation in infants significantly reduced the risk of developing type 1 diabetes (daily dosages ranged from 400 IU to 2000 IU) . However, no clinical trial has yet confirmed . Given the lack of risk associated with taking vitamin D and its many health benefits, some doctors recommend it as a preventive measure;
  • Immunotherapy . This is the most promising avenue, and one in which scientists invest the most. Immunotherapy aims to allow the immune system to “tolerate” pancreatic cells responsible for producing insulin. Several forms of immunotherapy are being tested, for example: a vaccine composed of antigens from the pancreas of the person to be treated; an autograft of immune cells to remove the destructive cells and allow the development of new tolerant cells; and transfusion of umbilical cord blood at the time of birth (in young children);
  • Vitamin B3. In vitro data and animal testing have reinforced the hypothesis that niacinamide (vitamin B3) may have a protective effect on beta cells of the pancreas. Some preliminary clinical trials have also fed this hope . However, larger studies have not yielded convincing results. For example, in the context of the European Nicotinamide Diabetes Intervention Trial (ENDIT) , high doses of niacinamide or placebo were given to 552 people at risk of type 1 diabetes (close relative affected, presence of autoantibodies against the pancreas and normal glucose tolerance test). Niacinamide did not reduce the risk of developing diabetes.
  • Injection of low doses of insulin . One of the preventive approaches tested is to administer small doses of insulin in people at risk. This approach was evaluated in the context of the Diabetes Prevention Trial – Type 1. Insulin therapy did not have a preventive effect, except in a high-risk subgroup, in which the onset of diabetes was slightly delayed.

One of the research challenges is to target the people most likely to develop the disease. The appearance in the blood of antibodies against beta cells of the pancreas (autoantibodies) is one of the indicators studied. These antibodies may be present years before the onset of the disease. Since there are several types of these antibodies, it is necessary to discover which ones are the most likely to announce the disease, and from what quantity.

Measures to prevent complications
Consult our fact sheet Complications of diabetes.

Medical treatments of Type 1 diabetes

Diabetics can hope to live an active,autonomous and dynamic life provided that they respect, throughout their existence, a strict disciplineby:

  • control of blood glucose level using a glucose meter ;
  • an appropriate diet ;
  • a program of physical exercises .

In our chart Diabetes (overview), you will find:

  • a diagram of glucose uptake;
  • a table of glycemic values ​​for adolescents and adults with diabetes;
  • a diet plan;
  • suggestions of physical exercises;
  • ways to better manage stress.

People with type 1 diabetes often need to be treated for health problems that may be associated with this disease.

Medication

People with type 1 diabetes need to inject insulin to make up for the insufficiency of the pancreas to produce it. The injection rather than the insulin intake by the mouth is necessary because it is destroyed by the digestive juices. As the treatments are daily (often several times a day), the patient must learn to self-administer the injections.

The dosage and type of insulin used varies according to the real needs of the subject in insulin, at any time of the day. Hence the need for close medical follow-up . At the beginning of treatment, it may take a little time to find the right dosage.

There are various types of insulin, with different speed of action. The majority of patients use  3 to 5 injections a day , or use a ” insulin pump “, a small device installed on the body and designed to provide 24-hour continuous infusion of insulin. The goal is to ensure, at all times, that the blood glucoseis as close to normal as possible. In this way, the incidence and severity of complications associated with type 1 diabetes are substantially reduced. Long-acting insulins, which require only one injection per day, are also available. The choice of insulin type should be made with the treating physician.

Surgery

In recent years, researchers have been increasingly interested in the therapeutic benefits of pancreas or islet transplantation in type 1 diabetics. Because of the risks, pancreas transplantation is reserved for cases where diabetes does not occur. can be controlled by insulin injections or in case of serious complications. Less expensive and less risky, the transplantation of islets of Langerhans is still at the experimental stage.

Complementary approaches

Some natural products can help prevent the complications associated with  type 1 diabetes . Consult our fact sheet Complications of diabetes.

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