If you’re reading this I’m sure you’d either be a person living with Type 1 Diabetes or someone who knows one. Having been a part of multiple diabetes support groups in India for close to 5 years now, I came to realize that there was no comprehensive resource of information for someone who’s newly diagnosed. The first few days of diagnosis are undoubtedly the hardest, dealing with the shock of how your life changed altogether in a single day and there’s this cloud of uncertainty that looms over your head. It’s the fear of the unknown that can make life seem tough at the moment but I promise it gets so much better once those clouds drift away to give a glance at the whole picture. If you’re in the same situation right now, please take a deep breath and relax for a moment before proceeding further because even though life ahead might be a little different, it certainly won’t be as bad as you might have imagined. There’ll be an initial learning curve but once you’ve crossed that barrier you’ll soon be living a much more relaxed life.
Before talking about Type 1 Diabetes, we need to understand the role that Insulin plays in a normal human body.
Insulin: What is so special about it?
Insulin is a hormone which plays a number of roles in the body’s metabolism.
The most important role of insulin in the human body is its interaction with glucose to allow the cells of the body to use glucose as energy.
Any carbohydrate that we consume gets broken down into glucose in our body. This breakdown increases your blood sugar level, and in response to this higher level, your pancreas releases insulin into your bloodstream. Insulin acts as a key to open up the cells in the body to allow for glucose to be used as an energy source. Once the glucose has been used to provide the required energy, insulin signals for any excess glucose in the bloodstream to be converted and stored as glycogen in the liver, muscle, and fat cells. These stores can then be used at a later date when energy requirements are higher. In this manner, insulin helps regulate the blood sugar levels.
But is this all?
The human body needs energy 24x7 to keep our vital organs like heart, brain, lungs and digestive system functioning (even while sleeping). To ensure that the body meets this minimum energy requirements to function, the liver steadily releases its stored glucose in the bloodstream in order to provide these vital organs and tissues with a constant source of fuel.
In order to transfer the liver’s steady supply of glucose into the body’s cells, the pancreas normally secretes a small amount of insulin into the bloodstream every couple of minutes throughout the day. This is called basal insulin. Not only does basal insulin ensure a steady energy source for the body’s cells, it also keeps the liver from dumping out too much glucose all at once. Too little basal insulin or a complete lack of insulin, would result in a sharp rise in blood sugar levels.
Is 'Diabetes' a thing?
India being the so-called Diabetes capital of the world, everyone looks at the word ‘diabetes’ as if it’s perfectly okay for it to exist. Diabetes by itself DOES NOT convey any information about the state of someone. There are different types of diabetes like Type 1 Diabetes, Type 2 Diabetes, Gestational Diabetes etc. which are VERY different conditions from one another. Generalising it all under a common title of Diabetes has probably been the biggest blunder in medical history.
What is Type 1 Diabetes?
Type 1 diabetes is a chronic condition in which your immune system destroys the insulin-producing beta-cells in your pancreas resulting in zero insulin secretion in the body.
Without insulin, glucose from the blood cannot enter the cells so the body can’t convert the food you eat into energy. This lack of energy causes an increase in hunger. At the same time, it also results in the body resorting to use other sources of energy like fat and muscle. When the body starts burning fats for energy, it results in ketones as a byproduct. As the days pass by and the body continues to burn fat, the bodyweight of the person starts to drop quickly! While the body keeps burning fat, the glucose levels in bloods remain unaffected since there is no insulin in the body to regulate it. On the contrary, it rises as the hunger-induced carbohydrate intake of the person increases which finally gets broken into glucose in the body. Excessive glucose and no insulin to regulate it (known as hyperglycaemia), the body tries to getting rid of it through urination. As a result, the person experiences excessive urination. This excessive urination is followed by excessive thirst to compensate for the water loss.
This phenomenon summarizes the major symptoms of Type 1 Diabetes.
Many doctors can notice these symptoms and diagnose the concerned person with Type 1 Diabetes after conducting the necessary tests. However, in many cases one doesn’t pay a visit to a doctor until things take a turn for the worse.
Over time, as the body keeps burning fat, ketones continue to build up. Ketones make the blood more acidic and high levels of ketones can poison the body. When levels get too high, one develops Diabetic Ketoacidosis or DKA which can be life-threatening if untreated.
A simple random blood glucose test and an HbA1c test can be used to screen people for any type of diabetes. These tests basically capture the spot blood glucose levels and and an estimate of average blood glucose levels over the past couple of months respectively. Once diagnosed, the next step usually is to determine the type of diabetes i.e type 1 or 2 majorly. A GAD antibody test can be used to confirm type 1 diabetes.
It’s interesting to note that since T1D is usually diagnosed in children and teenagers, it is also called juvenile diabetes. However adults can also be diagnosed with it.
What causes Type 1 Diabetes?
Type 1 Diabetes is considered an autoimmune condition. In this condition, the body’s own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing beta cells in the pancreas. The exact reasons or triggers for the immune system acting this way is yet not known.
Some people have certain genes which make them more likely to develop Type 1 Diabetes, though many won’t develop it despite being genetically predisposed. Being exposed to an environmental trigger, such as a virus, can also cause Type 1 Diabetes.
How does it differ from the more common Type 2 Diabetes?
Compared to Type 1 Diabetes where there is no insulin production in the body, Type 2 Diabetes is caused by insulin resistance. In T2D, the body still produces insulin but it develops a certain kind of resistance to it and hence is unable to use it efficiently. As a result, insulin secreted by the beta cells fail to keep up with glucose in the bloodstream and it starts to build up.
The complexity of diagnosing Type 1 Diabetes
The onset of symptomatic Type 1 diabetes doesn’t always happen suddenly because the beta cell destruction doesn’t happen overnight. During what is known as the honeymoon phase people with T1D can be asymptomatic.
The term honeymoon phase for people living with T1D is used to describe the period immediately after diagnosis during which the body is still able to produce small amounts of insulin. When the immune system attacks beta cells, it doesn’t mean instant destruction!
Most people with T1D retain small clusters of live beta cells and when they start on artificial insulin, it may appear initially that their T1D has gone into remission or that their dosage can be decreased as the artificial insulin reduces the burden on the surviving beta cells to produce insulin, thus helping them recover. As a result, the surviving beta cells may continue producing small amounts of insulin but not for a very long time. Gradually, the beta cell count decreases and the requirement of artificial insulin grows until finally, all beta cells are destroyed which marks the end of the honeymoon phase.
The length of this phase can vary from weeks, months to even years in some individuals. A large number of people with T1D do not get to experience the honeymoon phase as many the time they are diagnosed, all beta cells have already been destroyed!
Treatment for Type 1 Diabetes
Currently, there is no cure for T1D and the only regime aims at maintaining normal blood glucose levels through regular blood glucose monitoring, insulin therapy, diet and exercise.
People with type 1 diabetes require injectable insulin because their pancreas does not produce enough on its own. There are different types of insulin and different routes of administration. Insulin can’t be taken as a pill because acids in the stomach destroy it before it can enter the bloodstream. Hence it needs to be administered externally. Most people with Type 1 Diabetes use both a long-acting insulin (also called a basal insulin), and inject additional insulin before or after meals (also called regular or short-acting insulin) to match the carbohydrate content of the meal. An insulin pump may also be used to optimize insulin delivery to the body’s needs.
Diet for Type 1 Diabetes
It’s a widespread notion that people living with ‘Diabetes’ should not consume sugary and sweet food. This however holds true only for people with Type 2 Diabetes. Since T2D is caused due to insulin resistance, it’s possible to manage it by following a balanced diet (to avoid insulin surge) and exercising regularly (to improve insulin sensitivity).
However in Type 1 Diabetes, since insulin production no longer occurs in body one needs to inject insulin externally. Earlier people living with T1D needed to have a fixed schedule for their meals based on their prescribed insulin dosages. With more flexible insulin regimens and the use of insulin pumps, those days are long gone. The way to go nowadays is to try and fit your diabetes treatment around your current lifestyle. After determining their insulin-to-carb ratio, a person’s insulin dose can be altered according to their meals.
There are some people who adopt a low-carbohydrate diet as it is easy to maintain blood glucose (BG) in the target range with low carb intake. There are others who try to incorporate proteins and fibre in their food as it lowers the Glycemic load of the meal and gives time for insulin to act, thus avoiding a huge spike in BG levels. There is no one-size-fits-all concept in diet for people with Type 1 Diabetes. One needs to find their own sweet spot and see what works for them to ensure that their chosen diet is sustainable.
Role of exercise in managing Type 1 Diabetes
Exercise is undoubtedly one of the biggest pillars of Type 1 Diabetes management. Staying fit and active throughout your life has many benefits. For people with T1D, the fact that exercise makes it easier to manage your BG levels and avoid long term complications is the cherry on top of the cake. Exercise can make a huge impact on diabetes management owing to the fact that it enhances insulin sensitivity of the body. That is, it enables the body to use insulin more efficiently, resulting in faster action and lesser BG spikes. In the long term, exercise has shown to significantly reduce the chances of developing complications, especially heart problems.
Cure for Type 1 Diabetes
For the past few decades, research has been going on in full swing to find a cure for Type 1 Diabetes. While there are updates from time to time about certain promising developments, a fully effective cure is yet to be found.
A need for more beta cells is only part of the problem in T1D. Even if people with the condition get new beta cells somehow, their immune system might still destroy those new cells. So a cure for T1D must do two things in order to be effective:
replace the insulin producing beta cells that have been lost
stop the immune system from destroying them again
However all the charlatans and quacks, who claim to have a cure for Type 1 Diabetes fail to understand this. Getting blood sugar in range is not the same as having found a cure for it. If one has to follow a very extreme diet regime coupled with certain voodoo herbs just to lower their BG, it CANNOT be claimed a cure.
People with end-stage renal disease as a result of T1D complications however have an option of getting a pancreas transplant along with kidney transplant. The new pancreas is able to produce insulin and the person will no longer need insulin or blood glucose monitoring. However because the immune system is still primed to destroy the beta cells, the person is put on a daily course of immunosuppressants to prevent the auto-immune trigger from occurring. There simply is no guarantee or certainty about when the immune system might get triggered again to destroy those beta cells again. The quality of life of a person following a transplant is never a 100%. There are stringent and life long restrictions put on the person post the transplant. So there’s really no better choice which is why this is recommended only if the kidneys fail.
How to view Type 1 Diabetes?
How you view your condition is one of the most important factors that can impact your diabetes management.
The benefits and importance of having a positive outlook in life while living with Type 1 Diabetes cannot be stressed enough. There might be lot of changes that you need to introduce in your life ranging from diet to exercise. Try to view them as enablers for a healthier and active life rather than thinking of them as restrictive: depriving you of things you used to eat. Personally, seeing T1D as a motivator to take better care of my health has made a larger impact on my life than anything else.
Type 1 Diabetes is certainly not the easiest or the most manageable conditions out there. There are days it’ll make you feel low or even question your life at times. If you ever find yourself feeling this, never shy away from reaching out to our community of warriors and asking for help.
Always remember, you are NOT ALONE.