What is Diabetes?

Diabetes is a metabolic condition where the pancreas does not produce enough insulin, or the body`s cells are unable to use insulin effectively. Insulin is the hormone responsible for regulating blood sugar (glucose) by moving glucose from the blood into the cells where it is used as energy. Lack of insulin results in too much sugar in the blood, a condition known as hyperglycemia. Prolonged hyperglycemia can damage organs such as the eyes, kidneys, nerves, and heart.

What`s the difference between type 1 and type 2 diabetes?

In type 2 diabetes the pancreas still produces insulin, but it may be in insufficient amounts, or there may be insulin resistance, meaning the cells are unable to use insulin properly. Type 2 diabetes normally affects people over 45, though it is becoming more common in younger people due to lifestyle factors such as being overweight and not taking enough exercise. Type 2 diabetes is much more common than type 1 and  90-95% of people with diabetes in the United States have type 2 diabetes.

Type 1 diabetes is an autoimmune disease, meaning the body`s immune system attacks and destroys its own cells. In type 1 diabetes the immune system attacks the cells in the pancreas that make insulin.

What causes diabetes?

The causes of type 1 and type 2 diabetes are very different. Type 2 diabetes is a lifestyle-related condition linked to being overweight and leading an inactive lifestyle. There is also a strong hereditary link meaning it tends to run in families.

The exact causes of type 1 diabetes remain unclear. Although we know it is an autoimmune disease, the reasons for the body attacking its own cells are not fully understood.

Research suggests a genetic component that is triggered by other factors, such as a virus or poor gut health. Environmental factors, such as pollutants, stress, and being bottle fed, are also possible triggers, though more research is needed.

Scientists have recently discovered traces of viruses known as human enteroviruses (HEVs) in pancreatic samples of people with type 1 diabetes, raising the possibility that this is a possible cause.

Another fairly recent theory is that a lack of diverse bacteria in the gut (known as the microbiome) may be a trigger for type 1 diabetes. Studies have shown that children with type 1 diabetes have a poor microbiome when compared to non-diabetic children. The microbiome plays a vital role in having a healthy immune system.

What are the symptoms of diabetes?

While type 1 and type 2 diabetes share many of the same symptoms, symptoms of type 1 diabetes tend to be more severe and come on more quickly than those of type 2. Symptoms include:

  • Extreme thirst.
  • Excessive urination.
  • Weight loss.
  • Increased hunger.
  • Blurred vision.
  • Numbness or tingling in the hands and feet.
  • Increased or recurrent infections, in particular fungal infections like thrush.
  • Slow healing of wounds.
  • Dry skin.

Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis can occur in people with type 1 diabetes when there is not enough insulin, and the sugar level in the blood becomes very high. In diabetic ketoacidosis, the body starts burning fat instead of glucose for fuel. A by-product of this is ketones which build up in the blood and are very dangerous. Diabetic ketoacidosis is a medical emergency requiring immediate treatment.

Symptoms of Diabetic Ketoacidosis (DKA)

  • Extreme thirst.
  • Frequent urination.
  • Nausea and vomiting.
  • Abdominal pain.
  • A fruity smell to the breath (like nail polish remover or pear drops).
  • Rapid, shallow breathing.
  • Confusion and disorientation.

Is type 1 diabetes genetic?

Unlike type 2 diabetes, type 1 diabetes is not hereditary, meaning it is not passed down in families and 90% of people with type 1 diabetes do not have a family member with the condition. However, there is strong evidence of a genetic component, meaning that if you have certain genetic markers, you are more likely to develop type 1 diabetes. These markers are thought to be a group of genes, rather than a single gene, which in combination with environmental factors, can cause type 1 diabetes.

How is type 1 diabetes treated?

Type 1 diabetes is always treated with insulin. There are various types of insulin, some have a rapid effect, and some are released slowly over several hours. Most people with diabetes take a combination of these. Insulin can be administered by several injections throughout the day, or continuously, using an insulin pump that delivers insulin through a tube inserted just under the skin.

It is very important that people with diabetes monitor their blood sugar level frequently to check that it is not too high or too low. Having blood sugars in the normal range ( 72-140 g/dL depending on whether it’s before or after eating) means that you will feel better and reduce the risk of diabetes-related health problems. Blood sugar levels can be checked frequently through the day using a blood glucose monitor, or via a continuous monitoring device (CGM) which is attached to the body and gives continuous readings.

Another important component of diabetes management is diet. Your dietitian will help you learn about which foods to enjoy and which to limit or avoid.

Can type 1 diabetes be cured?

Although there is effective treatment, there is currently no cure for type 1 diabetes.

The future for people with type 1 diabetes

Treatment for type 1 diabetes has improved tremendously since the discovery of insulin in 1921. While previous research has focused on improving treatment for people with diabetes, now scientists are conducting trials with the aim of reversing diabetes altogether.

Encapsulation research

It has been possible for several years to transplant insulin-producing cells, resulting in the reversal of diabetes. However, except in extreme, life-threatening cases,  transplantation is not routinely performed. This is because transplanting cells or organs from one person to another causes the recipient`s immune system to reject the donor cells. To reduce this risk, the recipient has to take strong anti-rejection drugs to suppress their immune system, leaving them unable to fight infection.

In new research, however, transplanted beta cells are being encapsulated in a protective coating before being transplanted, keeping them safe from attack by the body`s immune system and hopefully preventing rejection.

Regeneration research

Rather than transplanting cells from a donor, regeneration research aims to help people with type 1 diabetes grow their own insulin-producing cells, thus avoiding the issue of rejection. This is being trialed using three different techniques.

  • Stem cells. Using the patient`s own stem cells to grow insulin-producing beta cells.
  • Alpha cells produce glucagon in the pancreas and function normally in people with diabetes. This research aims to reprogram these cells to produce insulin.
  • Beta cells. Many people with type 1 diabetes, even after years with the condition, still have some functioning beta cells. This research studies these remaining beta cells to learn how to regenerate new insulin-producing beta cells.

Since Canadian scientists Frederick Banting and Charles Best first discovered insulin 100 years ago, diabetes treatment has progressed rapidly, meaning many people with diabetes are living full and healthy lives. In addition, exciting new research indicates that a cure can`t be far away, and type 1 diabetes may finally be a thing of the past.