The Stages Of Type 1 Diabetes (it Starts Earlier Than We Thought)
My daughter Bisi was diagnosed with type 1 diabetes three years ago at the age of six. The first night after she was diagnosed, once she finally fell asleep in her hospital bed, tossing and turning despite the IV in her arm, I remember standing outside in the hall with my husband and a couple of medical residents, talking with them about her diagnosis. “Could this have been coming on for a while?” we asked them. I described how for a couple of years, Bisi had been almost unbearably cranky when she was hungry—to the point where I’d asked her pediatrician more than once if something might be wrong. No, the residents told us. Type 1 diabetes comes on very suddenly, in a matter of weeks, as the body’s beta cells suddenly die out under attack from the immune system. Every doctor or nurse we spoke with during the three days in the hospital (except for one, who said that our instincts were probably right), echoed what the two residents, fresh from medical school, told us. But it turns out they were wrong. JDRF and the American Diabetes Association, supported by other organizations in the field, recently put forth a new staging system for type 1 diabetes, where full-blown disease, like what landed Bisi in the hospital, is characterized as stage 3, part of an extended auto-immune process that often starts in infancy. This fall, Dr. Richard Insel, JDRF’s Chief Scientific Officer, explained the classification system to a group of reporters, talking through the importance of early diagnosis, and the hope that diagnosing the disease at an earlier stage could lead to breakthroughs in stopping the beta-cell destruction process—essentially, stopping the disease before it starts. Insel explained that stage 1 is when people test positive for multiple pancreatic islet auto-a Continue reading >>
Type 1 Diabetes
Type 1 diabetes is much less common than type 2 diabetes and typically affects younger individuals. Type 1 diabetes usually begins before age 40, although there have been people diagnosed at an older age. In the United States, the peak age at diagnosis is around 14. Type 1 diabetes is associated with deficiency (or lack) of insulin. It is not known why, but the pancreatic islet cells quit producing insulin in the quantities needed to maintain a normal blood glucose level. Without sufficient insulin, the blood glucose rises to levels which can cause some of the common symptoms of hyperglycemia. These individuals seek medical help when these symptoms arise, but they often will experience weight loss developing over several days associated with the onset of their diabetes. The onset of these first symptoms may be fairly abrupt or more gradual. To learn more about type 1 diabetes basics, see our type 1 diabetes slideshow. It has been estimated that the yearly incidence of type 1 diabetes developing is 3.7 to 20 per 100,000. More than 700,000 Americans have this type of diabetes. This is about 10% of all Americans diagnosed with diabetes; the other 90% have type 2 diabetes. What You Need to Know about Type 1 Diabetes Type 1 Diabetes Causes Type 1 diabetes usually develops due to an autoimmune disorder. This is when the body's immune system behaves inappropriately and starts seeing one of its own tissues as foreign. In the case of type 1 diabetes, the islet cells of the pancreas that produce insulin are seen as the "enemy" by mistake. The body then creates antibodies to fight the "foreign" tissue and destroys the islet cells' ability to produce insulin. The lack of sufficient insulin thereby results in diabetes. It is unknown why this autoimmune diabetes develops. Most often Continue reading >>
Disease Progression And Search For Monogenic Diabetes Among Children With New Onset Type 1 Diabetes Negative For Ica, Gad- And Ia-2 Antibodies
Disease progression and search for monogenic diabetes among children with new onset type 1 diabetes negative for ICA, GAD- and IA-2 Antibodies Hvidre Study Group on Childhood Diabetes Prksen et al; licensee BioMed Central Ltd.2010 To investigate disease progression the first 12 months after diagnosis in children with type 1 diabetes negative (AAB negative) for pancreatic autoantibodies [islet cell autoantibodies(ICA), glutamic acid decarboxylase antibodies (GADA) and insulinoma-associated antigen-2 antibodies (IA-2A)]. Furthermore the study aimed at determining whether mutations in KCNJ11, ABCC8, HNF1A, HNF4A or INS are common in AAB negative diabetes. In 261 newly diagnosed children with type 1 diabetes, we measured residual -cell function, ICA, GADA, and IA-2A at 1, 6 and 12 months after diagnosis. The genes KCNJ11, ABCC8, HNF1A, HNF4A and INS were sequenced in subjects AAB negative at diagnosis. We expressed recombinant K-ATP channels in Xenopus oocytes to analyse the functional effects of an ABCC8 mutation. Twenty-four patients (9.1%) tested AAB negative after one month. Patients, who were AAB-negative throughout the 12-month period, had higher residual -cell function (P = 0.002), lower blood glucose (P = 0.004), received less insulin (P = 0.05) and had lower HbA1c (P = 0.02) 12 months after diagnosis. One patient had a heterozygous mutation leading to the substitution of arginine at residue 1530 of SUR1 (ABCC8) by cysteine. Functional analyses of recombinant K-ATP channels showed that R1530C markedly reduced the sensitivity of the K-ATP channel to inhibition by MgATP. Morover, the channel was highly sensitive to sulphonylureas. However, there was no effect of sulfonylurea treatment after four weeks on 1.0-1.2 mg/kg/24 h glibenclamide. GAD, IA-2A, and ICA negative Continue reading >>
What Is Type 1 Diabetes?
Type 1 diabetes is an autoimmune disease in which the body destroys insulin-producing beta cells in the pancreas. Insulin is required by the body to use glucose, the simple sugar that most foods are broken down into by our digestive system. Without insulin, the body starves to death. It's important to note that everyone is insulin-dependent. People without diabetes make insulin in their pancreas. People with Type 1 diabetes must inject insulin. According to the National Institutes of Health, an estimated 850,000 to 1.7 million Americans have Type 1 diabetes. Of those, about 125,000 are kids 19 and under. An additional 30,000 Americans develop Type 1 diabetes every year, 13,000 of whom are children. Type 2 diabetes is much more prevalent, with an estimated 16 million Americans having Type 2. Millions of people with type 2 diabetes have not yet been diagnosed. Diabetes Develops Gradually The process of developing diabetes is gradual. Studies performed by the Joslin Clinic1 have shown changes as much as nine years before the actual presentation of diabetes symptoms. The development of Type 1 diabetes can be broken down into five stages: Genetic predisposition Environmental trigger Active autoimmunity Progressive beta-cell destruction Presentation of the symptoms of Type 1 diabetes People with Type 1 diabetes have a genetic pre-disposition to the disease, but one or more environmental insults is required to trigger disease. This fact can be derived from studies of identical twins with Type 1 diabetes. When one twin has Type 1 diabetes, the other twin gets diabetes only half the time. If the cause of Type 1 diabetes were purely genetic, both identical twins would always have Type 1 diabetes. One environmental trigger is thought to be the Coxsackie B virus. Researchers at UCL Continue reading >>
Defining Three "early Stages" Of Diabetes
"What stage of diabetes do you have?" That question could become a common one soon, if some leading diabetes experts succeed in establishing an official three-tiered delineation of the early stages of D in order to pursue research and treatments in preventing the autoimmune condition. In other words, the kind of multi-stage disease model that exists for a handful of other conditions like Alzeimer's, cancer, kidney disease and beyond could soon be coming to the type 1 diabetes world. A precise set of definitions is being proposed for three early stages of T1D, aimed at putting specific labels to those who don't yet have type 1 but could be predisposed and at higher risk for eventually developing the autoimmune condition. And no, we're not just talking "pre-diabetes" here. This goes way beyond that, into an actual scientific definition and screening process rather than the vague abyss drawing in millions of souls who may someday develop type 2 diabetes. Yesterday, we published an interview with a diabetes endo-researcher who's pursuing insulin independence for those of us already living with type 1. Today, we're looking at another side of that research coin. "Currently, you either have T1D or don't, but that does not fully capture the complexity of T1D for all people," said JDRF's Chief Scientific Officer Dick Insel at an October workshop in Bethesda, MD, that brought a handful of researchers and industry experts together to discuss this issue. This push for a new three-stage scheme of early type 1 diabetes comes on the heels of two decades of screening and research by entities like TrialNet, which have helped get a better look at the early onset of type 1 -- even if we don't have a full grasp at this point on what causes the body to attack the immune system and kill off Continue reading >>
The Interplay Of Autoimmunity And Insulin Resistance In Type 1 Diabetes
Specialty: Pediatrics, Endocrinology, Immunology Institution: Section of Endocrinology, Department of Pediatrics, University of Colorado Denver and Children's Hospital Colorado Address: Aurora, Colorado, 80045, United States Author: Marian Rewers Specialty: Endocrinology, Pediatrics, Immunology Institution: Department of Pediatrics, University of Colorado School of Medicine Address: Aurora, Colorado, 80045, United States Institution: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine Address: Aurora, Colorado, 80045, United States Author: Melanie Cree Green Specialty: Endocrinology, Pediatrics, Immunology Institution: Department of Pediatrics, University of Colorado School of Medicine Address: Aurora, Colorado, 80045, United States Institution: Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine Address: Aurora, Colorado, 80045, United States Abstract: Type 1 diabetes (T1D) is a common chronic disease characterized by selective autoimmune destruction of the pancreatic islet beta cells and subsequent dependence on exogenous insulin. Certain alleles including the high-risk HLA genotype, HLA-DR3-DQ2/DR4-DQ8, place individuals at increased risk of developing T1D. Autoantibodies to beta cell antigens are used in the diagnosis of T1D, and studies have shown that they can be used to predict risk of developing T1D in first degree relatives of probands. The annual global incidence of T1D is increasing by 3-5% per year. Many environmental factors have been implicated in the rising incidence of T1D. Proponents of the accelerator hypothesis argue that T1D and type 2 diabetes (T2D) are the same disorder of insulin resistance, although with different genetic backgrounds. While insulin resistance is a recognized ha Continue reading >>
Changing Perspectives On The Progression Of Type 1 Diabetes
Type 1 diabetes remains an enigmatic disease from both a scientific and a clinical viewpoint. The symptoms are widely understood to present when the insulin-secreting beta cells in the islets of Langerhans are destroyed via a process of autoimmunity.1,2 For this reason, the immediate therapeutic approach at diagnosis is to supplement the endogenous insulin deficiency with an exogenous supply. This has been the status quo over many years and, for the majority of patients, it provides an appropriate means to stabilise their condition and allows for effective glucose control over the longer term. However, this is not universally true and despite the best efforts to maintain glucose homeostasis, the disease is still associated with significant morbidity and mortality. Therefore, important questions remain about whether alternative therapeutic approaches which prevent rather than treat the condition might be developed in future. At present, identifying those individuals who are progressing to type 1 diabetes among the background population is a difficult task because presentation of the disease occurs sporadically and is usually unheralded. It develops most frequently in subjects with a specific genetic predisposition and considerable efforts have been invested to identify the genes involved.3 However, this information has not stimulated widespread attempts to screen for such individuals. There are various reasons for this, not least the fact that many members of the general population have the ‘high risk’ genetic profile yet do not develop the disease. Allied to this is a still more basic problem which, in our view, defines the nub of the issue most starkly; namely that we still have only a rudimentary understanding of the processes that cause the disease in the pancrea Continue reading >>
Type 1 Diabetes: Causes And Symptoms
While type 2 diabetes is often preventable, type 1 diabetes mellitus is not.1 Type 1 diabetes is an autoimmune disease in which the immune system destroys cells in the pancreas. Typically, the disease first appears in childhood or early adulthood. Type 1 diabetes used to be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus (IDDM), but the disease can have an onset at any age.2 Type 1 diabetes makes up around 5% of all cases of diabetes.3,4 What is type 1 diabetes? In type 1 diabetes, the pancreas is unable to produce any insulin, the hormone that controls blood sugar levels.2,3 Insulin production becomes inadequate for the control of blood glucose levels due to the gradual destruction of beta cells in the pancreas. This destruction progresses without notice over time until the mass of these cells decreases to the extent that the amount of insulin produced is insufficient.2 Type 1 diabetes typically appears in childhood or adolescence, but its onset is also possible in adulthood.2 When it develops later in life, type 1 diabetes can be mistaken initially for type 2 diabetes. Correctly diagnosed, it is known as latent autoimmune diabetes of adulthood.2 Causes of type 1 diabetes The gradual destruction of beta cells in the pancreas that eventually results in the onset of type 1 diabetes is the result of autoimmune destruction. The immune system turning against the body's own cells is possibly triggered by an environmental factor exposed to people who have a genetic susceptibility.2 Although the mechanisms of type 1 diabetes etiology are unclear, they are thought to involve the interaction of multiple factors:2 Susceptibility genes - some of which are carried by over 90% of patients with type 1 diabetes. Some populations - Scandinavians and Sardinians, Continue reading >>
Type 1 Diabetes New Staging System Promotes Early Detection
For most people with type 1 diabetes, the disease seems to occur suddenly, often resulting in a trip to the emergency room with life-threatening complications. But a new recommendation calls for a diabetes staging classification that could mean earlier diagnosis and better outcomes for patients in the long run. The recommendation was made by the JDRF, the American Diabetes Association and the Endocrine Society in the January issue of the journal Diabetes Care and is based on research from TrialNet, an NIH-funded international network of research centers, including Baylor College of Medicine and Texas Childrens Hospital . The research indicates that type 1 diabetes can now be most accurately understood as a disease that progresses in three distinct stages. Stage 1 is the start of type 1 diabetes. Individuals test positive for two or more diabetes-related autoantibodies. The immune system has already begun attacking the insulin-producing beta cells, although there are no symptoms and blood sugar remains normal. Stage 2, like stage 1, includes individuals who have two or more diabetes-related autoantibodies, but now, blood sugar levels have become abnormal due to increasing loss of beta cells. There are still no symptoms. For both stages 1 and 2, lifetime risk of developing type 1 diabetes approaches 100 percent. Stage 3 is when clinical diagnosis has typically taken place. By this time, there is significant beta cell loss and individuals generally show common symptoms of type 1 diabetes, which include frequent urination, excessive thirst, weight loss and fatigue. Clinical research supports the usefulness of diagnosing type 1 diabetes early before beta cell loss advances to stage 3. The earlier diagnosis is made in the disease process, the sooner intervention can take pla Continue reading >>
Type 1 Diabetes
Type 1 diabetes (T1D) is an autoimmune disease in which the pancreas is under an on-going attack by the immune system, interfering with the production of a hormone called insulin. Without insulin, glucose (sugar) accumulates in the blood and cannot be used to produce energy. Insulin is necessary for survival. With Type 1 diabetes, lifestyle, diet, or exercise changes will not make insulin available again. Instead, the missing insulin must be replaced. Children and adults with Type 1 diabetes have to monitor their blood glucose and inject or pump insulin into their bodies everyday for the rest of their lives to carefully regulate glucose levels. Too much insulin (hypoglycemia) or too little insulin (hyperglycemia) is dangerous. Balancing blood glucose levels and insulin dosages is a minute-by-minute job, even while sleeping. Insulin is a hormone made by the pancreas that unlocks cells to allow the entry of glucose (sugar) for energy production. Excess insulin causes fat to be stored for later use as energy. A healthy pancreas is very sensitive to the amount of glucose in the bloodstream and speeds up or slows down insulin production, as needed, to maintain perfect balance. To keep people with Type 1 diabetes alive, synthetic insulins have been developed and are taken as multiple daily injections (MDI) or continuously via an insulin pump. Normal pancreatic function is so complex that it's not possible for someone with Type 1 diabetes to have perfect balance. The complexity of counting the carbohydrate, protein, and fat intake, combined with overall health, activity, stress, and glucose levels to determine insulin dosages creates a reality that is not only difficult, but life-threatening. It also causes a tremendous emotional and financial burden for both patient and ca Continue reading >>
Is It Time To Screen The General Population For Type 1 Diabetes?
Type 1 diabetes mellitus (T1D), also referred to as insulin-dependent, childhood-onset, or juvenile diabetes, is an autoimmune disease that occurs when insulin-producing β cells in the pancreas are aberrantly targeted and destroyed by a person’s immune system, usually leading to an absolute insulin deficiency.1 A diagnosis of T1D is made when a patient has glycemic abnormalities, which often result in clinical symptoms. The American Diabetes Association annually publishes guidelines for diagnosis of T1D using these metabolic measurements, which are widely accessible for use. Of importance, the autoimmune disease process begins long before clinical onset of T1D and can be identified by the presence of serum islet autoantibodies (IAs) that are directed against proteins in insulin-producing β cells. Currently four major antibodies are measured, including insulin, glutamic acid decarboxylase (GAD), islet antigen 2 (IA-2), and zinc transporter 8 (ZnT8). The ability to accurately measure multiple IA makes T1D a predictable disease. To date, targeted screening for IA has been performed in first-degree relatives (FDRs) of people having T1D or those having high-risk human leukocyte antigen (HLA) genes. HLA genes confer more than 50 % of the genetic risk for T1D. After the development of two or more IAs, an individual will almost always develop clinical T1D given enough time.2 The incidence of developing clinical T1D after ≥2 IAs are present is 11 % each year and approximately 70 % in the ensuing 10 years. With the ability to measure IA and predict T1D risk, the next step in disease prevention is screening the general population. There are a number of reasons to screen the general population for T1D risk by measuring IA but also an equal number of arguments against screenin Continue reading >>
Striving For A Happy Childhood, The Happiness Of Every Home
Type 1 Diabetes Progression, Incidence and Protective Factors Type 1 Diabetes (T1D) progresses through 4 stages. Liked what you read just now? Pay it forward! Age of clinical presentation of T1D: Type 1 Diabetes attributes for 85% of all childhood diabetes cases. The clinical disease commonly appears during middle childhood, at the onset of puberty or through teenage development. But it can present at any age. 50% of all T1D cases have clinical presentation of the disease during adulthood; usually below 30 years of age. The incidence of T1D is on the rise all over the world. An average yearly increase of 1.5% has been documented. Western Europe, USA and Australia have higher incidence than that in Asia, Africa and South America. Documented prevalence of clinical diabetes of type 1 variety. It varies in different countries for various reasons. And the statistics are changing far too rapidly for me to pinpoint what percentage of children are likely to be affected. However, a rough estimate would be; 1 to 3 children could be hit by the disease in group of ten thousand. Protective effect of common childhood infections have been noted. Strict hygiene jeopardizes the health benefits of good bacteria on our immune system. Breastfeeding is believed to lower the risk of Type 1 Diabetes The beneficial effect of breastfeeding is attributed to- 1. Goodness of mother’s milk. 2. Human milk is a natural prebiotic. 3. Delay in exposure to cow’s milk protein. 4. Helps delay introduction of weaning foods, especially those containing gluten. Related pages of interest are indexed in the right column Liked what you read just now? Pay it forward! Can't find answer to your concern? Search the site! Continue reading >>
How Type 2 Diabetes Can Change Over Time
You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once. The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA). If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications. How Your Diabetes Treatment Plan Might Change Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California. After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, rec Continue reading >>
New Insights Into The Progression Of Type 1 Diabetes
If you have Type 1 diabetes or know someone who does, you’re likely aware that this type of diabetes is an autoimmune disorder that results in the destruction of the beta cells (the cells that make insulin) in the pancreas. Having Type 1 diabetes means having to take lifelong insulin injections, and people who are diagnosed with this condition must start on insulin right away. Type 1 diabetes progresses Type 2 diabetes, the “other” type of diabetes, is a whole different ball of wax. This type of diabetes partly stems from insulin resistance, meaning that the pancreas produces insulin but the body has a hard time using it. Type 2 diabetes is often described as being “progressive”: caught in the early stages, for example, it’s possible to manage it through healthy eating, weight loss (if necessary), and physical activity. But over time, many people require the help of medication, often in the form of diabetes pills, and then, perhaps, noninsulin injectable meds. Eventually, insulin injections may be needed. In the case of Type 1 diabetes, researchers now believe that this disease also progresses at predictable rates and stages before a person develops signs and symptoms. The discovery of these stages is a big deal, as it will enable researchers to find ways to intervene to delay and hopefully prevent progression to the onset of symptoms and lifelong insulin dependence. Stages of Type 1 diabetes The discovery of the various stages leading up to symptomatic Type 1 diabetes are outlined in the October 2015 issue of the journal Diabetes Care. The paper is entitled “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” Here’s a closer look at the crux of this paper. Stage 1: Auto Continue reading >>
Is It Possible To Prevent Or Delay Type 1 Diabetes?
A partnership between JDRF and Janssen Pharmaceuticals seeks ways to intercept the disease before it progresses. What if there was a way to determine exactly who would develop type 1 diabetes (T1D) and doctors could intervene to prevent it altogether or at least delay the onset by years? JDRF, a leading research advocacy organization, and the Disease Interception Accelerator (DIA) group of Janssen Pharmaceuticals announced a joint venture earlier this year to take on this challenge.1 The goal is to identify the root cause of T1D and intercept its progression to disease before symptoms arise. There have been many questions about the actual cause of T1D. Work in recent years suggests there is a window of opportunity to stop or delay the disease before the onset of clinical symptoms of the disease.2,3 The autoimmune response directed against beta cells is suggested to be secondary to tissue damage and unrelated to disease pathogenesis.4 The presence of antibodies against the islets of Langerhans that were detected in the serum of patients diagnosed with T1D, but not in healthy individuals, led to the suggestion of the autoimmune etiology of T1D.4 Although T1D has been referred to by many names, such as juvenile diabetes or insulin-dependent diabetes, the treatment has always been the same: insulin. T1D is a pancreatic beta cell specific disease that results in absolute insulin deficiency.4,5 Data from the United Kingdom suggest life expectancy of adults with T1D is reduced by up to 13 years.6,7 The symptoms of T1D are similar to type 2 diabetes, including frequent urination and feeling thirsty, hungry, or tired. Additionally, with T1D, there is the possibility of sudden weight loss, nausea and vomiting from the build-up of ketones in the body, and diabetic ketoacidosis.8 A Continue reading >>
