Medical Minute: Type 1 Diabetes

This post was inspired by an article I saw on Twitter from the New York Times- entitled “Mystery & Danger of type 1 Diabetes”.  Based on the title of the article – I was convinced “oh ok, another article about hypoglycemia unawareness” – but then I read it, and I was pleasantly surprised.

Really the article was a call for folks to remember that Type 1 Diabetes is still “a thing”.  Although many (if not every single one) individuals who have Type 1 Diabetes- would beg to differ, Type 1 Diabetes – it has always been “a thing”, and it will continue to be “a thing” until a cure is found.

With obesity on the rapid rise for decades now, which is causing a surge in Type 2 Diabetes in both adults, and children, Type 1 diabetes has kind of been left in the shadows – a place where it should not be.

What is noted in this article is that while we have all been frantic about the rise in obesity rates, and type 2 diabetes – there has also been an increase in Type 1 Diabetes as well, in fact from 2001-2009 there was about a 23% increase in Type 1 Diabetes in America’s youth.

So let’s back up a second.  Type 1 Diabetes – it has gone by many names: “Insulin Dependent Diabetes”, or “Juvenile/Juvenile Onset Diabetes”.  However the more it has been studied the more knowledge has been gained regarding this disease.  Type 1 Diabetes can actually come on or rather, be diagnosed at any age.  In fact in my practice, I have seen someone at age 75 be diagnosed with Type 1 Diabetes, just because a child is diagnosed with diabetes – does not mean they are automatically “Type 1”.

The various types (oh yeah, there’s more than Type 1 and Type 2 Diabetes – but that’s a different topic for a different day!

Type 1 Diabetes is actually an autoimmune disease, in which the insulin producing beta cells of the pancreas are attacked, damaged, and essentially…kaput.

In many cases with Type 1 diabetes there is a genetic predisposition – and with autoimmune disease in general – once one is there, there are greater odds that other autoimmune diseases can rise up to the surface (i.e. type 1 diabetes and celiac disease).

Currently there is a lot of research underway in regard to trying to better understand the “who” of Type 1 Diabetes- as in who is at risk.  One large study that is looking at family members (siblings) of those diagnosed with Type 1 Diabetes is Trial Net, and will be better able to under score who is at risk.  In the article above it was discussed that really one of the main areas of focus in research regarding Type 1 Diabetes – is who is at risk, and how does it happen/how is it “triggered”.  Researchers are examining introduction of gluten, to environmental factors in an effort to better understand this disease, and if in fact it is able to lie dormant – what makes this dormant monster wake up?

Many of these same questions and topics are also being examined and studied for those with celiac disease.

But because I created this blog to be a tool for sharing information – I will do some of that now.

As I said before Type 1 Diabetes is essentially an all out deficiency of insulin.  Individuals who have Type 1, require insulin (injections or pump) to survive.

Now in many cases when Type 1 is diagnosed, individuals are still able to produce some insulin as in many cases Beta Cells are damaged over time- this is called a “Honeymoon phase”.  Once people are diagnosed and their blood glucose levels are brought down with insulin – their numbers drop and drop and drop until their insulin requirements (from injection or pump) become minuscule.  For adults and children alike this can be very difficult to understand- it can lull many into a false sense of security, and create confusion for young children.  In the sense if someone is started on a pump, and the pump is disconnected- it may lead individuals to falsely believe that their diabetes has “gone away”.

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Insulin is an important part of our metabolic equation.  In the most simple of terms it essentially serves as a key that unlocks a door.  When we carbs – they digest to glucose, glucose is absorbed and heads to our blood stream, when it does this a healthy pancreas is signaled – and pumps out some insulin, that insulin shuffles that glucose out of our blood, by ushering it into our body’s cells.  Glucose is our energy source, however it’s useless to us if it just sits in our blood stream.


If there is a shortage of insulin – it will do just that – which leads to high blood glucose levels – which over time that can lead to long term complications (any where our blood can flow a complication can arise- kidneys, sexual health, eyes, nerves, heart, GI).  What can happen in the short term is if blood glucose levels build up – (so no glucose in the cells) – the body continues to signal the brain that it is “starving” or requires fuel – as there is no glucose in the cells due to insulin deficiency – in people with type 1 diabetes – this can rapidly lead to the body beginning to break down fat as a fuel source.


As appealing at that may sound- it is not and it is very dangerous, fat breakdown has a byproduct of ketones, which in large to even moderate amounts can be dangerous, as they have the ability to even change the pH of blood.  When individuals have Type 1 diabetes they are typically advised to test for urine ketones once blood sugars reach 250 or above.

The other side of the coin of managing very high blood sugars, is managing and preventing low blood sugars.  Low blood sugars are alarming and scary experiences, the best way to describe them to someone who has never felt a low – is think about a time when you were so hungry that you were nauseated, irritable, maybe a little loopy.  Multiply that by 5, and you have hypoglycemia.

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For individuals who experience hypoglycemia too often – they can even get to the point where they become less aware of their symptoms of low blood sugar, until it is dangerously low.  Continuous glucose sensors – like the Dexcom I wore and posted on here- can be valuable tools to help manage both highs and lows.

I want to end this post by sharing an anecdote.  A few weeks ago I was at brunch with my sister, and we sat at the bar, a lady sat down next to us, ordered, and as her food came out, she discretely tested her blood sugar, and dialed her dose of insulin.

Since we were at the bar – one of the waitresses began a barrage of questions at this poor woman: “what are you doing”, “why, do you have to do that”, “how do you live that way” , “is that insulin”?

I was shocked.  And a little embarrassed.

The patron, politely answered these questions… stating that she does have Type 1 diabetes, yes she needs to check her blood sugar before she eats and gives insulin (I mean from a diabetes educator standpoint- this lady get’s a gold star).

Finally the patron, (bless her heart), kindly said “if it is ok with you, I would like to go ahead and eat now”.  And the questions stopped.

I do not expect the average individual to possess enough diabetes related knowledge that an Endocrinologist or a CDE would have.  However, what I do ask of people is that they educate themselves- I believe that’s what the waitress in this situation was trying to do- albeit in a very misguided attempt.  However, I also work with enough people that tread that line between not wanting to be treated differently, but also wanting to educate others about Type 1 Diabetes.

In closing, I hope I’ve shared some information that will help my readers become more aware and more compassionate to what individuals who have diabetes experience.  It’s not easy, or anecdotal, or “cool”.  You always have to have back ups on back ups of pump supplies, meter supplies, insulin supplies etc.

Technology is making management much much easier – for all types of Diabetes, however, Diabetes will still be a significant chronic disease until a cure is found.

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