Type 1 Diabetes

Type 1 diabetes (T1D) is a lifelong autoimmune disease that prevents your pancreas from making insulin, a hormone. T1D was previously known as juvenile or insulin-dependent diabetes.

If you don’t have enough insulin, too much sugar builds up in your blood, causing hyperglycemia (high blood sugar). This can lead to serious health problems or even death if it’s not treated.

T1D is one of the most common chronic diseases that affects children in the U.S. But adults can develop it, too. In the U.S., over 1.7 million people live with it.

Receiving this diagnosis is a life-changing event. But many tools and technologies can help you manage T1D. Healthcare providers will be by your side, too.

Symptoms of Type 1 diabetes

Type 1 diabetes symptoms include:

• Excessive thirst
• Peeing frequently, including frequent full diapers in infants and bedwetting in children
• Extreme hunger
• Unexplained weight loss
• Fatigue
• Blurred vision
• Slow healing of cuts and sores
• Vaginal yeast infections

Symptoms usually start mild and get worse over days, weeks or months. If you have these symptoms or notice them in your child or family member, see a healthcare provider as soon as possible. Ask to be tested for Type 1 diabetes.

Emergency signs of undiagnosed T1D from a complication called DKA include:

• Fruity-smelling breath
• Nausea and vomiting
• Abdominal pain
• Rapid breathing
• Confusion and extreme tiredness

Go to the emergency room immediately if you have these symptoms. DKA is life-threatening.

Type 1 diabetes causes

Scientists don’t know the exact cause of Type 1 diabetes. It happens when your immune system mistakenly attacks the insulin-making cells in your pancreas. But they don’t know why this happens. The destruction ultimately results in a total lack of insulin.

Studies show that genetics likely play a role. The odds vary based on the genetic connection. Your risk of developing Type 1 diabetes is:

• 1 in 250 if you don’t have a biological family history of it
• Between 1 in 25 and 1 in 100 if your biological mother has T1D
• 1 in 17 if your biological father has T1D
• Between 1 in 10 and 1 in 4 if both parents have T1D

Certain factors, like a virus or environmental toxins, may trigger your immune system’s attack if you have a genetic predisposition for T1D.

Complications of this condition

Over time, continuous high blood sugar can damage many parts of your body. Potential complications of T1D include:

• Eye problems, like retinopathy, macular edema, cataracts and glaucoma
• Foot problems, including ulcers and infections that can lead to gangrene
• Heart disease
• High blood pressure
• Kidney disease
• Oral health problems
• Neuropathy (nerve damage)
• Skin conditions, like dry skin, bacterial and fungal infections and diabetes-related dermopathy
• Stroke

Close to half of people with Type 1 diabetes will develop a serious complication over their lifetimes. But consistently keeping your glucose in range can help prevent these issues. If you reach the first 20 years after diagnosis without any complications, your prognosis (outlook) is usually good.

People with diabetes are also two to three times more likely to have depression and are 20% more likely to be diagnosed with anxiety than those without diabetes. Taking care of your mental health — and getting professional help when needed — is key.

How doctors diagnose this condition

Type 1 diabetes is usually easy to diagnose. Your healthcare provider will use the following tests:

• Blood glucose test: Blood glucose levels are often very high at diagnosis.
• Glycosylated hemoglobin test (A1c): This measures your average blood sugar levels over three months.
• Antibody test: This blood test checks for autoantibodies to determine if you have Type 1 or Type 2 diabetes. The presence of certain autoantibodies means you have Type 1.

Your provider may do the following tests to check your overall health and for DKA:

• Basic metabolic panel (blood test)
• Urinalysis (to check for ketones)
• Arterial blood gas test

How is it treated?

You’ll need to take insulin several times a day to manage Type 1 diabetes. Keeping your blood sugar in range is key. Several factors affect your glucose level. So, T1D management is complex and highly individualized.

An endocrinologist and other diabetes specialists will help you set the framework for treatment. But T1D is mainly a self-managed disease. You’ll make several decisions every day to stay healthy.

The main components of management include:

• Insulin therapy
• Glucose (sugar) monitoring
• Education

Insulin

There are several different types of insulin. They start working at varying speeds and last for different lengths of time. You may need to use more than one type.

You’ll have a background level of insulin (often called basal insulin or long-acting insulin). And you’ll need to give yourself specific amounts of it when you eat and to correct high blood sugar levels.

You can take insulin in the following ways:

• Multiple daily injections (MDI): With each injection (shot), you use a syringe to draw a dose of insulin out of a vial. You give the shot in the fatty tissue under your skin.
• Pen: Insulin pens are pre-filled with insulin. You inject doses into the fatty tissue under your skin.
• Pump: Insulin pumps deliver insulin continuously and on demand through a small tube inserted under your skin. They mimic the way your pancreas would naturally release insulin.
• Rapid-acting inhaled insulin: You inhale this insulin through your mouth (much like an asthma inhaler). Only one type of insulin is inhalable.

The amount of insulin you need from day to day will vary across your lifespan and under specific circumstances. For example, you typically need more insulin during puberty, pregnancy and when you’re taking a steroid medication.

Too much insulin at any given time can lead to low blood sugar. This needs treatment right away — often by eating or drinking sugar.

Glucose monitoring

You’ll need to monitor your glucose level closely throughout the day. You may use a blood glucose meter and/or continuous glucose monitoring (CGM).

Your healthcare provider will give you a target glucose level range or time in range (TIR) to aim for. The right range for you depends on a variety of factors.

Some CGMs and insulin pumps can pair together to create a hybrid closed-loop system. The pump automatically gives you insulin based on your glucose level to keep it in range. But this system isn’t totally automatic. You still have to provide input to the pump in certain situations.

Education

Type 1 diabetes and glucose management are very complex. Because of this, you and your family will need to learn a lot. Most of the education will be right after diagnosis. But you’ll likely learn more as you continue to live with T1D. Especially as your body or life changes.

A team of healthcare providers will help you understand all the aspects of T1D. Education topics include:

• Nutrition and meal planning: Nutrients like carbs, protein and fat affect your blood sugar in different ways. Carb counting is especially important.
• Physical activity: Exercise affects your blood sugar in different ways. You’ll learn how to plan accordingly to stay in range.
• Detecting and treating low blood sugar: You’ll learn the signs and symptoms of low blood sugar and how to treat it.
• Treating high blood sugar: How much insulin you give for high blood sugar can vary depending on the underlying cause of it.
• Sick day planning: Illness can increase your risk of DKA. Your provider will give you tips on how to adjust your insulin doses when you’re sick.
• Diabetes technology: Many options are available for insulin therapy and glucose monitoring. A provider can help you understand your options and how to use the tools and devices.
• Diabetes management at school or work: Going to school or work with diabetes can take extra care and planning.
• Overall health: Diabetes can lead to complications that affect many parts of your body. You’ll learn about the importance of going to routine appointments for things like eye and oral health.

Is there a cure for Type 1 diabetes?

There’s currently no cure for Type 1 diabetes. But scientists are working on ways to prevent or slow down the progression of the condition through studies like TrialNet.

T1D can run in families. So, your healthcare provider may be able to test your family members for the autoantibodies that cause the disease. Type 1 Diabetes TrialNet also offers this testing.

The presence of autoantibodies, even without diabetes symptoms, means you’re more likely to develop the condition. If someone has early signs of the autoantibodies, they may be able to take a medication that delays T1D. It’s called teplizumab. It can delay the development of T1D symptoms and the need for insulin injections. It’s an infusion you get once a day over several days.

Two types of transplants may “cure” T1D. But they come with significant risks, like surgery complications and health risks involved with taking immunosuppressants. Providers only approve them for a small number of people with T1D. The transplants include:

• Islet cell transplant: In 2023, the U.S. Food and Drug Administration approved the use of pancreatic islet cell transplantation for people who have a difficult time managing T1D. These cells make insulin. This transplant may completely eliminate or significantly reduce your need for insulin injections.
• Pancreas transplant: You may qualify for a pancreas transplant if you also need a kidney transplant. You’d no longer have diabetes if it’s successful.

When should I see my healthcare provider?

You’ll need to see your endocrinologist multiple times a year throughout your life to adjust your management plan. Otherwise, reach out to your diabetes provider if you:

• Have frequent high or low blood sugar episodes
• Want to change your activity level or eating patterns
• Want to try a different kind of diabetes therapy or device
• Are getting a surgery or starting a new medication that may affect diabetes management
• Are thinking about getting pregnant
• Have symptoms of any diabetes complications

What can I expect if I have this condition?

With Type 1 diabetes, you must make countless decisions every day to stay healthy. It’s a complex condition that requires a lot of effort and planning. This can be tough. But it’s also very doable with the right diabetes technology, education and healthcare providers by your side. Getting support from your family and friends is a big help, as well.

You’ll need to prioritize both your physical and mental health to stay healthy in the long term. Maintaining in-range blood sugar levels is key to preventing serious complications.