What is Type 1 Diabetes?

Type 2 diabetes gets a lot of attention. But because only five percent of those diagnosed with diabetes have Type 1 diabetes, it might seem a little mysterious. Also, perhaps because Type 1 is not preventable, it tends to slip under the radar in many people’s minds – unless you have it. Luckily, most people with Type 1 diabetes can live a full life by following a healthy lifestyle and getting treatment.

Type 1 diabetes is caused when the body’s immune system destroys the cells in the pancreas that produce insulin. Type 2 diabetes, on the other hand, is the body’s inability to use insulin due to insulin resistance. The pancreas is still able to produce insulin but the body is desensitized to it. 

"Compared to Type 2 diabetes, Type 1 diabetes is less influenced by genetics and weight. It is typically due to an autoimmune process that damages the body’s ability to produce insulin," says Dr. Hieu Nguyen of INTEGRIS Health. "Therefore, the cornerstone of management for Type 1 diabetes is insulin replacement. Type 2 diabetes is due to insulin insensitivity, typically related to excess body weight compounded by genetic predisposition. The treatment for Type 2 is lifestyle modification, oral medications, and eventually, insulin replacement."

Despite the differences, Type 1 and 2 diabetes both ultimately result in impaired glucose regulation and hyperglycemia (elevated glucose levels.) Over time, this causes damage to small blood vessels that supply oxygen and nutrients to the nerves and other organs in your body. Diabetes (both types) elevates the risk of heart disease and stroke. In the U.S., it is the leading cause of blindness, kidney failure and lower extremity amputations.  Read our blog called diabetes in Oklahoma to learn how diabetes affects our state. 

A personal battle with type 1 diabetes

Dr. Nguyen, not only treats patients who have Type 1 diabetes, he’s fighting the battle himself.

"I was diagnosed with Type 1 diabetes during my residency at the age of 25. This is considered rare as the vast majority of Type 1 diabetes presents in childhood, which is why it is formerly known as juvenile diabetes," says Dr. Nguyen.

"It’s not a death sentence but don’t take it lightly. It is a very serious disease that can have devastating consequences if it isn’t managed properly. That being said, with due diligence, proper medical care and education, it is very manageable. A Type 1 diabetic can live a normal, healthy life."

Although Dr. Nguyen was diagnosed as an adult, he still struggled with the impact that having Type 1 diabetes has had on his life.

"I am fortunate in that I was diagnosed as an adult and I have the medical education at my disposal to properly manage my diabetes. When I was initially diagnosed, it was devastating," he says.

Dr. Nguyen restricted his diet, eating almost no carbs for two years. He exercised five to six days a week and checked his blood sugar almost obsessively.

"As I better understood how diet, exercise and insulin affected my blood sugar, I allowed myself a little more room to expand my diet. I still limit my carbohydrate consumption, but I am more aware of how different kinds of carbohydrates affect my blood sugar," he says.

"I adjust my insulin dosage daily based on how much exercise I did yesterday and how much I plan on exercising today. It becomes second nature. If I don’t tell people, most would not have guessed that I had diabetes at all."

Children diagnosed with Type 1 diabetes, however, tend to rely solely on their parents or caregivers to manage the conditions. Some have developed good habits, but other children are less fortunate and suffer from serious complications before they are able to take health care into their own hands. "Tragically, the outcome is heavily dependent on access to health care and socioeconomic circumstances," Dr. Nguyen says.  

Treatments and advances today

Insulin replacement, careful management of carbohydrate intake and regular exercise are commonly the most effective treatments for Type 1 diabetes, but research and treatments are improving regularly.

"It has only been six years since I was diagnosed but there have been a few significant improvements. Continuous glucose monitors have become much better. I currently use the Freestyle Libre 14-day monitor. It’s a temporary arm implant and I wirelessly scan it with my phone to check my blood sugar," Dr. Nguyen says. "I no longer have to prick my finger to get a blood sugar reading. I no longer need test strips. There are also longer acting and more stable basal insulins as well as faster-acting insulins for meal-time coverage."

Other treatments that show promise include an artificial pancreas, which is a closed-loop insulin delivery system. It basically combines a continuous glucose monitor and an insulin pump that will detect glucose levels and respond by providing insulin without input from the user. Though encouraging, the artificial pancreas isn’t technically a cure. 

Pancreatic islet cell transplantation is another treatment with great potential, although so far it has been done successfully only in small scale trials. Insulin-producing cells are transplanted from a donor into the patient.

"However, the patient must take immunosuppressant medications to prevent rejection," says Dr. Nguyen. "Since Type 1 diabetes is an autoimmune disease that destroys the insulin-producing cells, there needs to be a way to protect those cells once it’s inside the body. Unfortunately, that is the hard part."

Stem cells and gene editing with CRISPR is another approach being studied. Stem cells are used to create insulin-producing cells and CRISPR edits genes to help evade destruction by the body’s immune system. 

"This would effectively be a cure for Type 1 diabetes. It's very promising but quite far away," says Dr. Nguyen. "There’s a saying among Type 1 diabetes: ‘the cure is always 10 years away.’ My first endocrinologist told me the lifeboat is coming. We don’t know when, but our job is to make sure our body is still in good shape when it does finally come."

How to manage type 1 diabetes

Dr. Nguyen says the best ways to manage Type 1 diabetes starts with a good team of doctors.

“Follow-up with them regularly. I see my primary doctor every three months and my endocrinologist every six months,” he said. “The American Diabetes Association is a great organization. Their website has a lot of useful information for patients, advocates, and providers,” he says. 

Other tips include:

• Exercising regularly
• Checking glucose levels often
• Getting good health insurance
• Having a plan when traveling
• Watching your carbohydrates

Management is everything when it comes to diabetes. When it’s managed well through the partnership between you and your doctor, you can live well. Contact one of our INTEGRIS physicians for an appointment or take advantage of our INTEGRIS Diabetes Education Programs.

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