The Centers for Disease Control and Prevention (CDC) estimates that 20.8 million Americans have diabetes. Of these, about 5 to 10 percent are classified as type 1. This means that about 1 million to 2 million people have type 1 diabetes in the United States. The National Institutes of Health estimates that 1 in every 400 to 600 American children has type 1 diabetes and that more than 13,000 are diagnosed every year.

Although type 1 diabetes may develop in anyone, it most commonly appears:

• Before the age of 30
• In whites
• In individuals with a family history of type 1 diabetes

A variation of type 1 diabetes can occur later in life. This is known as latent autoimmune diabetes of adulthood.

Type 1 diabetes is an autoimmune disorder that affects the way the body processes and uses nutrients. When a person eats food, most of it is broken down into glucose, the form of sugar that is used to fuel the body.

The glucose is absorbed into the bloodstream, where it is used by cells for energy. For the glucose to pass into the cells, insulin must be present. Insulin is produced by beta cells in areas of the pancreas called the islets of Langerhans. The pancreas is an endocrine and digestive organ located behind the stomach.

As the insulin enters the blood, it allows the receptors in muscle, fat and other cells to remove glucose from the bloodstream. Normally, the pancreas produces enough insulin to remove the glucose from the blood.

In type 1 diabetes, the immune system destroys the beta cells that produce the insulin. Without insulin, the glucose cannot reach the cells and remains in the bloodstream. The cells in the body starve because they are not receiving the necessary fuel from glucose. Eventually, some of the glucose is excreted from the body in urine, a condition known as glucosuria.

Scientists do not completely understand what causes the body’s immune system to destroy the beta cells, but specific genetic abnormalities make a person more susceptible. Because these genes can be passed down from generation to generation, heredity is an important factor with type 1 diabetes. Antibodies, viruses and environmental factors are suspected to contribute to the development of this disease, by producing antibodies that cross–react with the beta cells.

Type 1 diabetes is not caused by obesity or eating excessive amounts of sugar, two common myths about the disease. In addition, people with type 2 diabetes do not develop classic type 1 diabetes, even if they are prescribed insulin. Type 1 and type 2 are different diseases that share the same characteristics – an inability to absorb glucose from the bloodstream.

However, it is possible for a person with type 1 diabetes to develop insulin resistance, a condition known as double diabetes. For instance, children who have type 1 diabetes and become obese often develop insulin resistance, increasing their risk for reactions. In addition to overeating and lack of exercise, risk factors for double diabetes may include certain genes and a family history of type 2 diabetes.

The rising twin epidemics of obesity and type 2 diabetes are well known, but scientists also report a growing incidence of type 1 diabetes. Excess weight might play a role in this development as well. A recent theory called the accelerator hypothesis holds that excessive weight may hasten the development of type 1 diabetes. However, the increase in type 1 diabetes may also be due to environmental or other factors.

Elevated blood glucose (hyperglycemia) can damage multiple organ systems in the body. Possible complications of type 1 diabetes, which are more common in patients with a long history of the disease, include:

• Atherosclerosis, diabetic angiopathy, high blood pressure, heart conditions and stroke

Diabetic nephropathy and end-stage renal disease (ESRD).


Eye diseases including diabetic retinopathy, glaucoma and cataracts


The nerve diseases diabetic neuropathy and gastroparesis


• Low bone density and increased risk of fractures and osteoporosis and certain other musculoskeletal disorders
  
  
• Skin conditions  and foot problems that increase the risk of amputation
  
  
• Sexual dysfunction
  
  
• Incontinence
  
  
• Infections such as gingivitis, thrush, yeast infections and urinary tract infections

Recent research suggests that type 1 diabetes may also cause vascular and structural damage the inner ear and impair hearing.

In addition, people with type 1 diabetes are at greater risk for other autoimmune diseases, including Hashimoto’s thyroiditis, Graves’ disease and autoimmune polyglandular syndrome.

Scientists have found some complications of type 1 diabetes, notably chronic kidney failure, have declined in recent decades, but others, such as heart disease, remain a formidable challenge.

In addition, people with type 1 diabetes or others who are using insulin are at increased risk of low blood glucose. Complications of low glucose can range from dizziness to seizures to diabetic coma. Patients, especially those with hypoglycemia unawareness, may be advised by their physician to carry an emergency kit containing the hormonal medication glucagon.

There is a recently discovered variation called fulminant type 1 diabetes. The destruction of beta cells and the development of hyperglycemia and diabetic ketoacidosis are rapid. These patients often experience symptoms similar to those of a cold or gastrointestinal upset, and the condition has sometimes been linked to pregnancy. The treatment of fulminant type 1 diabetes includes prompt attention to resolving ketosis and ketoacidosis.

Patients can reduce their risk of complications by controlling glucose and otherwise following the management plan devised by their physician. For example, a recent follow-up analysis of the landmark Diabetes Control and Complications Trial showed that those treated with intensive glycemic control have lowered their incidence of cardiovascular problems by about 50 percent.

Although there is no cure for type 1 diabetes, it can be controlled, and patients with diabetes can lead healthy, fulfilling lives.  They must closely monitor their glucose levels and take insulin according to their prescribed schedules and changes in glucose levels. All patients with diabetes should maintain a close relationship with their physicians to ensure proper treatment.