Normally, the beta cells in the pancreas continually produce a steady amount of insulin (known as baseline, basal or background insulin) that is just enough to move glucose (blood sugar) into cells. Insulin production automatically increases when the body senses higher levels of glucose circulating in the blood, such as just after a meal.

However, damage to the beta cells can interfere with insulin production and cause type 1 diabetes or latent autoimmune diabetes of adulthood (LADA).

The cause of these forms of diabetes is not completely understood. Many scientists believe that the pancreas stops producing insulin because the beta cells are attacked by T-cells. Part of the immune system, T-cells are programmed to defend against possibly harmful elements. They may mistake the body’s beta cells as being dangerous – an autoimmune response. When the beta cells are attacked, the pancreas stops making insulin.

It has generally been held with type 1 diabetes that the pancreas has no more beta cells. However, several recent studies have found that the pancreas of a person with long-standing type 1 diabetes sometimes still has these insulin-secreting cells. Researchers hope to find a way to keep the pancreas from destroying these cells.

The initial disease process of type 2 diabetes does not involve a malfunction of the pancreas. With type 2, the pancreas is usually producing enough insulin, but the body has developed insulin resistance and is unable to use the insulin effectively, resulting in hyperinsulinemia (excess insulin in the blood).

However, after years with type 2 diabetes, the pancreas sometimes slows production of insulin, and regular insulin administration may be needed. Malfunction of the pancreas is not necessarily part of type 2 diabetes but does cause type 1 diabetes and LADA.

People with type 1 diabetes, LADA and other cases of insulin-depended diabetes get insulin through regular syringe injections or other devices such as an insulin pump or inhaled insulin. Other treatment options may include a pancreas transplant or an islet cell transplant. Scientists are trying to develop an artificial pancreas that can detect glucose levels and deliver the needed amount of insulin.