Type 1 diabetes is a disease that develops when the pancreas stops producing insulin. Insulin is a hormone needed to move glucose (blood sugar) from the blood into the cells of the body. The human body needs insulin to function. Without it, the glucose remains in the blood and the body does not receive fuel for energy. High glucose (hyperglycemia) can cause many complications.
Though type 1 diabetes can develop at any age, it usually appears in children and young adults. For this reason, it was formerly called juvenile diabetes. It was also commonly referred to as insulin–dependent diabetes mellitus (IDDM), although some people with type 2 diabetes and other forms of diabetes also require insulin therapy.
Type 1 diabetes is an autoimmune disease. It occurs when the body’s immune system mistakenly attacks the insulin-making cells of the pancreas. Genetics is a factor in the disease, and viral infections or other environmental factors may play a role. Type 1 diabetes is more common in whites and people with a family history of the disease.
The early signs of type 1 diabetes are often overlooked. They may include excessive thirst, increased urination, increased appetite and unexplained weight loss. The accumulation of a waste product called ketones can lead to a medical emergency called diabetic ketoacidosis.
All patients with type 1 diabetes should closely monitor their blood glucose levels. Glucose monitoring is performed with a glucose meter several times a day.
Patients with type 1 diabetes must take insulin to live. One recently approved injected medication, synthetic amylin, is the only other drug approved to treat type 1 diabetes. Physicians may also prescribe exercise and diet to help control glucose and to prevent insulin resistance and double diabetes.
A pancreas transplant or an islet cell transplant may be an option for some patients. Scientists are conducting many studies to find other treatments or a cure for type 1 diabetes.
Uncontrolled, type 1 diabetes can lead to multiple medical complications that can affect the kidneys, eyes, nerves and blood vessels. The best way to prevent complications is by following the diabetic treatment plan prescribed by the physician.
About type 1 diabetes
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.
Risk factors and causes
Type 1 diabetes is an autoimmune disease, in which the body’s own immune system destroys the body's capacity to produce or use insulin. Insulin is the principal hormone that helps move glucose (blood sugar) into cells to be used for energy.
In a healthy person, the immune system protects the body by attacking foreign invaders. In patients with type 1 diabetes, the the immune system’s antibodies mistakenly attack the beta cells of the pancreas that produce insulin and other proteins involved in insulin production.
Because the antibodies can be present several years before the diagnosis of type 1 diabetes, researchers have found their identification helpful in screening high-risk individuals with autoantibody testing. Having certain antibodies means that person has a greater chance of developing type 1 diabetes.
Why this occurs is not completely understood, but researchers have found many factors that appear to be linked to type 1 diabetes. It is important to note that, although these factors may increase the risk of diabetes, researchers have not identified any single cause or characteristic. Risk factors and causes may include:
Family history and genetics. Family medical history can contribute to the risk of developing the disorder. If a mother or father has diabetes, there is a greater chance their child will develop diabetes than a child without diabetic parents. The risk for diabetes also increases if a brother or sister has diabetes. This risk varies according to which relative has the disease.
Children born to women who experience high stress during pregnancy may be at higher risk of type 1 diabetes, according to recent research. The researchers suggested that maternal stress might, in offspring, increase stress hormones that damage the pancreas.
Race and nationality. Type 1 diabetes is found more often in white people, particularly those of Northern European descent. In contrast, people of other races are more prone to type 2 diabetes, which is far more common. Places where above-average rates of type 1 diabetes are reported include Finland, Scandinavia, the Italian island of Sardinia, the United Kingdom, Canada, the United States, Puerto Rico, the Virgin Islands, Australia, New Zealand and Kuwait.
Environmental factors. Many researchers suspect that free radicals may contribute to the development of type 1 diabetes. Free radicals are formed as a result of chemical reactions in the body. Smoke, air pollution and even genetics contribute to the formation of free radicals in the body. When these radicals build up, they can destroy the body’s own cells, including those involved in the production of insulin.
Cold weather is another possible environmental trigger for this condition. Type 1 diabetes is more common in cold climates and develops more often in the winter than the summer. Researchers are unsure of the reason for this connection between the cold and type 1 diabetes.
Viruses. Many scientists suspect that certain viruses may be a factor in type 1 diabetes. People are often diagnosed with type 1 diabetes after a viral infection. The viruses thought to be related to type 1 diabetes include:
Mumps
Rubella (German measles)
Coxsackie virus (related to the virus family that causes polio and hepatitis)
It is suspected that virus cells share a protein or part of a protein found in the insulin-producing beta cells. The immune system attempts to destroy cells containing the virus, but it may mistakenly attack the beta cells, confusing them for the viral-infected cells. Instead of destroying bad virus cells, the body is destroying the good cells that produce insulin.
Another theory regarding the role of viruses and type 1 diabetes involves the way a virus affects cells. Some researchers suspect that when a virus infects the body, it changes the characteristics of the islet cells, which produce insulin. If this process occurs, the islet cells appear as foreign and are attacked by the immune system. If the cells are destroyed, insulin cannot be produced, leading to type 1 diabetes.
Chemicals and drugs. Several chemicals have been shown to contribute to type 1 diabetes, such as a type of rat poison called pyriminal. In addition, some prescription drugs may cause or contribute to type 1 diabetes, such as pentamidine (used to treat pneumonia) and L-asparaginase (an anti-cancer drug).
Other diseases. Some research has found higher rates of type 1 diabetes in people with conditions including celiac disease (gluten intolerance) and some forms of epilepsy. Cystic fibrosis has been linked to a form of diabetes that has some features of type 1 and type 2 diabetes.
Diet. Scientists have studied certain foods and their possible role in the development of type 1 diabetes. Some researchers suspect that being fed cow’s milk early in life may be connected to the development of type 1 diabetes. Other scientists have been unable to support this association, and the role of cow’s milk in the development of type 1 diabetes remains controversial.
The studies that support this hypothesis appear to show that children with newly diagnosed type 1 diabetes have a higher amount of antibodies specific to cow’s milk. These antibodies may be responsible for inducing the immune system to destroy the beta cells that produce insulin. These researchers concluded that:
Children who are fed cow’s milk before 3 or 4 months of age have a greater chance of developing type 1 diabetes.
If a baby is breastfed for a short period and then given cow’s milk, there is no increased risk for type 1 diabetes.
Studies in diabetes-prone animals have shown that withholding wheat and soy helps delay or prevent diabetes. These studies have not demonstrated the same results in humans. Additional research must be completed to understand the role of diet and the development of type 1 diabetes.
Genetic or environmental factors by themselves probably do not cause type 1 diabetes. However, if an individual is at high risk for developing type 1 diabetes because of genetic reasons, exposure to other risk factors may trigger the disease.
Signs and symptoms of type 1 diabetes
The symptoms of type 1 diabetes appear rapidly during a period of several weeks to a few months and often occur after an illness. In children and some adults, symptoms of diabetes may be similar to those of the flu. The most common symptoms of diabetes include:
Extreme thirst (polydipsia)
Excessive urination (polyuria) and bedwetting in children
Increased appetite (polyphagia)
Drowsiness, lack of energy or fatigue
Changes in vision, such as increased myopia (nearsightedness)
Unexplained weight loss
Mood changes
Sweet, fruity smelling breath, a sign of ketosis
A number of diabetic reactions may occur when glucose (blood sugar) is poorly managed. These conditions have specific symptoms and can cause additional medical problems. The most common reactions include:
Hypoglycemia. When blood glucose is too low.
Hyperglycemia. When blood glucose is too high.
Diabetic ketoacidosis. Serious condition involving severe hyperglycemia and ketosis.
The first symptoms of type 1 diabetes may be ignored, leading to life–threatening ketoacidosis. This condition includes a buildup of ketones (acids) in the blood that can poison the body. Ketoacidosis can lead to a diabetic coma or even death.
Diagnosis methods for type 1 diabetes
People may first suspect diabetes if they experience warning signs, such as extreme thirst or unexplained weight loss. For some individuals, the condition may not be diagnosed until they experience severe symptoms. Diabetic ketoacidosis, a life-threatening condition that can lead to a diabetic coma, may be the first indication that an individual has type 1 diabetes. Because this is a dangerous condition, early symptoms of diabetes should not be ignored.
Children and adolescents who are considered at high risk for diabetes should be screened every two years after the age of 10 or at the time of puberty if puberty occurs at an earlier age. Physicians may complete more extensive tests on children and young adults if they are in a high-risk group or exhibit signs of diabetes.
There are several diagnostic tests that are administered to measure the glucose (sugar) level in the blood. Although the amount of glucose in a person’s blood varies, the range is relatively narrow. After fasting all night, most people have levels between 70 and 100 milligrams of glucose per deciliter of blood (mg/dL). If an individual consistently has a fasting glucose level greater than 126 mg/dL, it is likely that person needs to be evaluated for diabetes.
Common tests for diagnosing type 1 diabetes include:
Fasting plasma glucose test (FPG). A sample of blood is taken from a fingerstick after an individual has not had anything to eat or drink for eight to 10 hours. The blood is tested for the amount of glucose that is present in the sample. If the glucose level is elevated, the physician suspects diabetes. Physicians usually make a firm diagnosis of diabetes when two FPG tests, done on different days, are elevated.
Random plasma glucose test(RPGT). This test may be performed when a person has a routine physical examination. A sample of blood is taken from a vein and tested for the amount of glucose present in the blood. This is not done after fasting, so the glucose in the blood may be high. However, the level should not be over 200 mg/dL. If the level is higher than 200 mg/dL, diabetes is a very likely diagnosis. An FPG test may be ordered to confirm the diagnosis.
Oral glucose tolerance test (OGTT). This test requires an individual drink 8 ounces of a sweet sugar solution after fasting for six hours. The blood glucose is measured before drinking the liquid, then every hour for a three-hour period. If blood glucose rises more than 200 mg/dL and does not return to a normal level, diabetes is suspected. This test is also routinely performed for gestational diabetes.
Once the glucose tests confirm diabetes, the physician must determine if the individual has type 1, type 2 diabetes or another form of diabetes, such as maturity-onset diabetes of the young (MODY). The physician will check the medical history to determine if there are other members of the family with either type 1 or type 2 diabetes. A blood test called the C-peptide test can determine if the pancreas is producing insulin. C-peptide is a byproduct of insulin production.
If the patient’s pancreas is not producing insulin, c-peptide levels will be near zero. If the patient’s blood has higher-than-normal C-peptide levels, type 2 diabetes will be diagnosed (because the pancreas is producing insulin, but the body is unable to use it efficiently).
Autoantibody tests can also help distinguish type 1 from other forms of diabetes.
Patients who are diagnosed with type 1 diabetes, especially pregnant women, may wish to ask about having a thyroid blood test because they are at greater risk for some thyroid diseases.
Treatment options for type 1 diabetes
The first goal of treatment for type 1 diabetes is control of glucose (blood sugar). This goal can be achieved with insulin, a healthy diet and physical activity.
Because the pancreas does not produce insulin to control glucose, all people with type 1 diabetes must take insulin. It cannot be taken orally as the stomach will digest the insulin before it has a chance to reach the body. Insulin can be taken by methods including syringe injection, pen, pump and jet injector. A new option for some patients is inhaled insulin, although people with type 1 diabetes will still need to inject some insulin. A physician can discuss the best method of delivery for an individual.
Specific treatment will be determined by a physician based on:
Age, overall health and medical history
Extent of the disease
Tolerance for specific medications, procedure or therapies
Expectations for the course of the disease
Personal opinion or preference
A pancreas transplant or islet cell transplant may be an option for some patients with type 1 diabetes.
The U.S. Food and Drug Administration (FDA) in 2005 approved pramlintide (Symlin), the only medication other than insulin for treating type 1 diabetes. It is synthetic amylin, an injectable version of amylin, a hormone made by the beta cells. It may be prescribed for certain individuals who have difficulty controlling their glucose with insulin alone. It is taken at mealtimes and must be injected separately from insulin in a different syringe.
Patients should not use pramlintide if they have gastroparesis or hypoglycemia unawareness, according to the FDA. Women are advised to notify their physician if they are breastfeeding, pregnant or planning to become pregnant. Possible side effects include hypoglycemia, nausea, decreased appetite, vomiting, stomach pain, fatigue, dizziness or indigestion.
In addition, scientists are developing medications to treat complications of type 1 diabetes, including diabetic nephropathy, retinopathy and neuropathy.
People with type 1 diabetes must closely monitor their blood glucose to keep it as near normal as possible. Glucose monitoring is the primary means for checking glucose levels in the blood.
Keeping track of glucose numbers over several days allows the patient with type 1 diabetes to see patterns. The log may show periods of high glucose (hyperglycemia) at certain times of the day or after eating specific foods. Glucose monitoring is important for determining the correct type of insulin and dosage to maintain normal glucose levels.
Physicians use an additional test in the treatment of type 1 diabetes. The glycohemoglobin test gives a picture of glucose control over the past two to three months. This blood test does not replace daily glucose testing. Instead, it provides additional information to confirm test results, judge whether a treatment plan is working and make adjustments as needed. In some cases, a fructosamine test may be used to monitor glycemic control over the previous few weeks.
Periodically, individuals with type 1 diabetes need to have a ketone test performed. Ketones are chemicals that are produced when the body uses stored fat instead of glucose for energy. A high level of ketones (ketosis), combined with severe hyperglycemia, causes diabetic ketoacidosis, which can cause a potentially fatal diabetic coma. A sick-day plan devised by the physician can help prevent such complications.
Diabetes organizations recommend that diabetic patients have a pneumonia vaccination and annual flu shots. Patients should see an ophthalmologist for regular dilated pupil exams to screen for eye diseases such as diabetic retinopathy, glaucoma and cataracts. They are advised to ask their physician how often they should have a physical examination, a complete foot exam, a neurological exam and tests of kidney function, such as microalbuminuria testing or glomerular filtration rate. Patients may also be advised to undergo cardiovascular assessments or other testing.
Insulin is the primary tool for keeping blood glucose within the normal range. There are other factors, though, that should be included in the diabetic treatment plan. A nutritious and appropriate diet and exercise help manage glucose, promote general health and reduce the risk of developing insulin resistance and double diabetes.
A diabetes treatment plan will help an individual maintain a healthy life with normal or near–normal glucose levels. By controlling glucose, diabetic patients will have as few medical complications as possible.
Prevention methods for type 1 diabetes
Because scientists do not know the exact cause of type 1 diabetes, there is no known way to prevent the disorder. The strong link to family history and genetics indicates that certain individuals are more prone to developing the disease.
Once an individual has type 1 diabetes, there is no known cure. However, diabetic complications can often be prevented. The Diabetes Control and Complications Trial (DCCT) and other studies have shown that keeping blood glucose levels as close to a normal range as possible reduces the risk of developing complications such as diabetic retinopathy.
Patients should avoid obesity because, among other health risks, it can lead to insulin resistance and double diabetes. They should perform regular self-care, including glucose monitoring, foot care and skin care.
Patients are advised to establish with their physician a plan to prevent serious complications of type 1 diabetes and unstable diabetes by promptly treating problems such as hypoglycemia, hyperglycemia and dehydration. For example, a strategy for reversing hypoglycemia may include a glucagon kit. A sick-day plan can help patients cope with infections and illnesses.
To ensure proper treatment, an individual with type 1 diabetes should be carefully monitored by physicians. Endocrinologists specialize in treating diabetes and other endocrine disorders. Patients can also benefit from consulting a certified diabetes educator and a registered dietitian. They should regularly see an ophthalmologist and may also be referred to other specialists, such as a:
Podiatrist
Neurologist
Cardiologist
Dermatologist
Nephrologist
Regular dental care is important to reduce the increased diabetic risk of gum disease, tooth decay and other dental problems. Because diabetes increases the risk of sexual dysfunction, women are advised to see a gynecologist and men a urologist or andrologist.
Ongoing research regarding type 1 diabetes
In recent years, many organizations have conducted research on type 1 diabetes. Scientists have developed better ways to manage diabetes and treat its complications. Some of these advances include:
Development of inhaled insulin
Development of synthetic amylin, the only medication other than insulin approved for type 1 diabetes
Improved methods of glucose monitoring, including continuous monitoring
Improvements in insulin pumps, including implantable insulin pumps
Research continues through organizations such as the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Joslin Diabetes Center. The research has focused on:
Using stem cells, spleen cells or other cells to create beta cells that secrete insulin
Creating insulin-secreting artificial beta cells
Conducting clinical trials of antibodies that may protect beta cells from the immune system, including an antibody therapy (rituximab) that is already used to treat the autoimmune disease rheumatoid arthritis
Conducting a clinical trial in which dendritic cells are removed from the blood, combined with protective molecules and then injected near the pancreas and lymph nodes in an effort to spare the beta cells
Determining whether anti-inflammatory molecules such as lisofylline and the incretin exendin-4 may reverse the course of recent type 1 diabetes
Developing vaccines that may prevent type 1 diabetes, help protect or regenerate beta cells, or reduce the needed dosage of insulin
Developing new methods of insulin administration, such as patches and pills
Investigating genes or markers for screening high–risk individuals
Improving pancreas transplants and islet cell transplants
Refining an artificial pancreas
Developing medications to treat complications of diabetes, including diabetic nephropathy, retinopathy and neuropathy
A significant amount of research has been devoted to identifying people at risk for diabetes. The glutamic acid decarboxylase (GAD) test measures antibodies to glutamic acid. The presence of these antibodies in an individual may indicate an increased risk of developing type 1 diabetes. At this time, the GAD test is used primarily in diabetes research. It is hoped that in the future, this test can be used with the general population. Autoantibody testing can identify those at risk for type 1 diabetes and provide the opportunity for earlier treatment. With earlier treatment, the individual has a greater chance of reducing the risk of medical conditions and complications.
Physicians have no easy, direct way to detect pancreatic inflammation, an early sign of type 1 diabetes. Biopsies are rarely performed because taking tissue samples from the pancreas is potentially risky. Scientists in Boston are developing a technique that uses MRI (magnetic resonance imaging) technology to highlight this inflammation after iron particles injected into blood vessels travel to the pancreas. People with type 1 diabetes are being recruited for clinical trials of the new technology.
Researchers in Pittsburgh recently reported improving the ability to predict who is at risk of type 1 diabetes. By using older chemical tests identifying islet cell antibodies along with newer tests relying on biochemical markers to find islet autoantibodies, they found that:
Participants who had the two most frequently recognized autoantibodies had a 14 percent chance of developing type 1 diabetes after a decade.
Those who had the two autoantibodies as well as islet cell antibodies had an 80 percent risk after less than seven years.
Identification of those at high risk of type 1 diabetes shows who could benefit from a preventive vaccine, according to the scientists.
American scientists in 2005 reported what they described as the first evidence in long-standing type 1 diabetes that the pancreas can keep making insulin-secreting beta cells. Researchers hope to find a way to keep the pancreas from destroying these new cells. Such findings could lead to treatments for type 1 diabetes.
Questions for your doctor on type 1 diabetes
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about type 1 diabetes:
How much insulin should I take for my type 1 diabetes? How often, and when?
Should I use syringes, a pump, inhaled insulin or other means of insulin administration?
Do I need any other medication for my diabetes or diabetic complications?
What diet and exercise plan should I follow?
What other treatments might I need?
Could a pancreas transplant or islet cell transplant be an option for me?
How often should I see a physician? Do I need to see any specialists?
What checkups and tests do I need, and when?
How often do I need to measure my glucose?
What is the best glucose range for me?
How do I know if I’m having hypoglycemia or another diabetic emergency?
What equipment might I need to treat emergencies?
If I have type 1 diabetes, can I still get type 2 diabetes (double diabetes)?
If I have type 1 diabetes, are others in my family at higher risk of diabetes?
Can I reduce my child’s risk of getting type 1 diabetes?
If my child has type 1 diabetes, what do I need to know?
