What is Type 1 Diabetes?

Type 1 Diabetes is quite different than Type 2. It is lifelong disease in which the pancreas is unable to produce the insulin the body needs to survive. Surprisingly, we still don't have the full picture of what causes type 1 diabetes, just strong theories. What we do know is that, before the discovery of insulin, a diagnosis of type 1 diabetes was essentially a death sentence. The average life expectancy after diagnosis was only a few years, as the body slowly starved despite having food available. Thank the stars we have insulin today, it is literally lifesaving.

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Insulin is produced in the beta cells of the pancreas. It is a hormone released to tell every cell in the body to open the doors to let glucose into the cell. This glucose is used for every cell, including the brain for energy; glucose is the most basic form of fuel used by the human body. Without insulin, the cell can't get more than a trickle of the glucose inside to be used. Slowly the cells starve and the organism starves (yes other animals, like your dog, can get diabetes too).

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Thankfully, in 1921, Canadians Frederick Banting and Charles Best discovered insulin. Shortly afterward, a 14-year-old boy became the first person to receive insulin therapy, and his dangerously high blood glucose returned to normal levels. Knowing this discovery would save millions of lives, the inventors sold the patent for just one dollar to help ensure insulin would be accessible to everyone who needed it.​

 

Sadly, in the United State, the cost of insulin has become a major barrier for many people despite the generosity of the inventors. Pharmaceutical companies and insurance practices have contributed to prices that can leave people paying enormous sums for a medications they cannot live without. As a result, some Americans ration their insulin or go without it entirely, but that is a whole other story. Thankfully today, people with type 1 diabetes have injectable insulin available that allow us to use glucose again and with it live full, active lives.  

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The Myth: Type 1 can develop at any age - not just childhood

One of the biggest myths about type 1 diabetes is that it's a childhood disease. While many people are diagnosed as children, type 1 diabetes can develop at any age. Teenagers, adults in their 30s, 40s, 50s, and even older adults can all be diagnosed with type 1 diabetes.

Because of this misconception, adults are often initially misdiagnosed with type 2 diabetes. This can delay the correct treatment, even though people with type 1 diabetes need insulin from the time of diagnosis.

 

For that reason, I encourage people to retire the terms "childhood diabetes" and "juvenile diabetes." They no longer reflect what we know about the disease. Type 1 diabetes can develop at any age, and outdated terminology can reinforce misconceptions that delay recognition in adults. I experienced that firsthand when my own diagnosis was missed for years. The words we use in medicine shape how we think, diagnose, and treat disease.

So why does type 1 diabetes happen? The honest answer is that we still don't know exactly what causes it. The leading theory is that it develops in people who have a genetic predisposition and are then exposed to an environmental trigger.

One proposed explanation is called molecular mimicry. The idea is that after fighting off a virus or another infection, the immune system mistakes the insulin-producing beta cells in the pancreas for the invading virus because some of their proteins look similar. Instead of shutting off after the infection is gone, the immune system continues attacking the beta cells, slowly destroying the body's ability to make insulin.

This theory helps explain why type 1 diabetes is considered an autoimmune disease, but it is still only one piece of the puzzle. Researchers are also investigating the roles of genetics, viral infections, environmental factors, and the gut microbiome. At this point, no single cause has been identified.

What we do know is that nothing a person ate, didn't eat, exercised, or didn't exercise caused their type 1 diabetes. You cannot "give yourself" type 1 diabetes, and there is currently no known way to prevent it.

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Treatment: Insulin

Insulin is the key.

There is no natural substitute for insulin. The pathology is clear. As a person with type 1 diabetes, I produce zero insulin. Without it, I will perish. (Yes, that's my favorite way to make it sound dramatic—but it's also medically accurate.)

No herb, supplement, vitamin, or special diet can replace insulin. There are many ways we can support someone living with type 1 diabetes, but none of them replace the missing hormone. Insulin isn't one treatment option among many, it's the treatment.
 

​Insulin is the only treatment that replaces what the body has lost, but it isn't the only way we care for someone with type 1 diabetes. Good diabetes care also includes:

1. Protecting cardiovascular health.

2. Diet, exercise, and supplement support. 

3. Screening for other autoimmune diseases.

4. Watching for diabetes-related complications - Regular eye exams, foot exams, kidney screening, and monitoring for nerve damage (neuropathy) can detect problems early, when they're often the most treatable.

5. Using diabetes technology when appropriate - Continuous glucose monitors (CGMs) and insulin pumps can improve glucose management and quality of life for many people.

6. Ongoing education and support - Nutrition counseling, diabetes education, and mental health support are all important parts of living well with type 1 diabetes.

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Not All Insulin is the Same
Today, insulin isn't a single medication. Today we have rapid-acting, short-acting, intermediate-acting, long-acting, and ultra-long-acting insulin, each designed to mimic a different part of the body's normal insulin production.

One misconception I frequently encounter is that all insulin products are interchangeable. They're not. Even insulin that seem very similar may have different formulations, dosing characteristics, or FDA approval as biosimilars rather than identical products. That's why your pharmacy often can't simply swap one insulin for another without your prescriber's approval. Although two products may serve the same purpose, they are still different medications, and your healthcare team needs to make sure the substitution is appropriate for you.

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Can We Prevent Type 1?

Not yet. Despite decades of research, there is currently no proven way to prevent type 1 diabetes from developing.
However, there is some exciting news. If people at high risk are identified before symptoms begin, it may be possible to delay the onset of clinical type 1 diabetes.

Researchers now know that type 1 diabetes develops over time. Long before someone needs insulin, the immune system often begins attacking the pancreas. During this stage, specific autoantibodies can be detected in the blood, even though blood glucose levels may still be normal.

For certain people in this early stage, treatment can delay the progression to insulin dependent type 1 diabetes. While it is not a cure, delaying the disease means more time before lifelong insulin therapy becomes necessary. That is a remarkable step forward and gives researchers hope that one day we may be able to prevent type 1 diabetes altogether.
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Resources for Type 1 Diabetes:

CGM (Continuous Glucose Monitor):

Dexcom Resources:

https://www.dexcom.com/support 

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Freestyle Libre Link

- number to call if your sensor malfunctions to get a replacement sent to you.

https://www.freestyle.abbott/us-en/support/sensorsupportrequest.html

Customer Care Team: 855-632-8658

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Calorie King - to help count carbs for insulin dosing

Food Nutrition Facts and Free Calorie Counter | CalorieKing

 

Insulin needle disposal location in King County​

https://kingcounty.gov/en/dept/dph/health-safety/environmental-health/healthy-water-air-soil/sharps-disposal/personal-sharps-disposal