What is Type 1 Diabetes?
Type 1 diabetes (sometimes called Juvenile Diabetes) is an autoimmune disease in which a person’s pancreas stops producing insulin. Insulin is a hormone produced by the pancreas to control blood sugar. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:
- A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
- The pancreas makes insulin which moves glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. Without a properly functioning pancreas to generate insulin, blood sugars build up in the bloom stream and never arrive at their intended storage destination.
Uncontrolled diabetic blood sugar levels can kill in many different ways:
- High blood sugar (also called hyperglycemia) can cause damage to arteries and veins, leading to heart disease, stroke, blood clots, and heart attack. It can also damage kidneys, leading to kidney failure, and it can cause damage to the nerves, resulting in blindness or an injury or cut that the person can’t feel.
- Hypoglycemia, or extremely low blood sugars, is sometimes caused by too much insulin used to treat high blood sugars. This is an immediate danger because the brain needs glucose, or blood sugar, to work properly. If a person has a hypoglycemic attack, the brain doesn’t get the glucose it needs, and the person can pass out, have seizures, and if it doesn’t get fixed immediately, organs will shut down, leading to death.
People with type 1 diabetes (T1D) must take multiple injections of insulin daily – they are “insulin dependent” just to survive. But, taking insulin does not “cure” diabetes, nor does it prevent the possibility of the disease’s devastating effects: kidney failure, blindness, nerve damage, amputation, heart attack, stroke, and pregnancy complications.
What Causes T1D?
Today, the exact cause of T1D is not known, although viral, genetic and environmental factors are believed to be involved.
- Virus. One theory proposes that T1D is a virus that triggers the autoimmune response in which the immune system attacks both the virus infected cells and the otherwise healthy beta cells in the pancreas. Beta cells are necessary for the pancreas to create insulin. Therefore, in T1D patients, the viral destruction of their pancreatic beta cells decreases or destroys their endogenous insulin production.
- Genetic. Since not everyone who is infected with the suspected virus develops T1D, researchers believe there may be a genetic vulnerability. Indeed, there is an observed inherited tendency to develop type 1. It has been traced to particular genotypes, though the connection between them and the triggering of an auto-immune reaction is still poorly understood.
- Environmental factors. One study showed that for identical twins, when one twin has T1D, the other twin has a 30% to 50% likelihood of developing T1D. Despite having exactly the same genome, one twin had the disease, where the other did not; this suggests that environmental factors, in addition to genetic factors, can influence disease prevalence.
More research is needed to better understand specific causes and triggers.
Type 1 Diabetes Treatment Today
The generally accepted medical treatment for T1D has remained basically the same for the last fifty years. The basic T1D treatment regimen consists of the following three elements
- Manage your diet to ensure that well balanced meals are consumed at regular intervals to prevent abnormal swings in blood sugar levels, typically this is accomplished through carbohydrate tracking,
- Measure your blood glucose (to make sure the appropriate levels of insulin are injected), and
- Inject insulin replacement therapy (to inject insulin that the body no longer makes)
This Manage, Measure and Inject (MMI) protocol has remained the “state of the art” for nearly half a century. The technology used in this protocol has improved (as discussed below) but the process remains the same. MMI has a number of important drawbacks that lead to complications and adverse health implications. One of our goals is to foster technology to change the accepted MMI practice and thereby improve the lives of those suffering with the disease.
Managing the Diet
Many scientists believe that the variability of a TID patient’s blood sugar contributes significantly to T1D complications. While exceptionally low blood sugar can lead to coma and death and abnormally high levels lead to cardiovascular disease, the swings between high and low blood sugar levels also takes its toll on the body. As a result, T1D patients should manage their diet to take in a balanced meal and should eat regular meals and snacks during the day to help the body balance its blood sugar levels. Most T1D patients help manage their diet through carbohydrate tracking (“carb counting“). These rules of thumb help determine what impact the meal or snack will have on the patient’s blood sugar levels. Of course, these rules of thumb are prone to error and require discipline.
Measuring Blood Sugar
A T1D patient estimates the carbohydrates he is about to consume before a meal or snack in order to determine the food’s impact on his blood sugar levels. The patient then tests his current blood sugar level. In the 1960s urine strips were developed and later more accurate blood tests were perfected. The first big measurement improvement was the introduction of a home based blood glucose meter in the early 1980′s.
Today the typical T1D patient tests his blood sugar by pricking the end of a finger with a needle and placing a drop of blood in a blood glucose meter. In a few seconds the meter tells the patient what his current blood sugar levels are. Mathematical calculations are made to determine the appropriate level of insulin therapy in order to attempt to keep the patient’s blood sugar levels close to a normal range. Drawbacks to this step include the fact that math is not everyone’s strong suit and computational error’s may compound the carb counting error. And some T1D patients forget their meter or otherwise skip this step to avoid the finger prick.
Type 1 is treated with insulin replacement therapy either via regular injections through a syringe or through a more modern insulin pump that the patient wears and changes every few days. Dr. Banting and Eli Lilly developed animal based insulins which were used until the early 1970′s. Unfortunately the “standard” animal insulins prior to 1972 contained impurities of 80,000 parts per million (about 8%), which resulted in several undesirable side effects. ”Purified” insulin was introduced in 1982 and today all U.S. insulins contain impurities of less than 10 parts per million (0.001%).
Becton-Dickinson introduced the single use syringe in 1961. This greatly reduced the amount of pain from injections as well as the time-consuming ritual of boiling needles and glass syringes. One patient remembers: “The needles were enormous, and they came with little pumice stones so that you could sharpen them. They often became dull and developed barbs on the end. And in order to sterilize them they had to be boiled for twenty minutes.”
According to Novo Nordisk, most T1D patients continue to use a syringe for their insulin replacement, technology that has been unchanged since the early 1970′s. The use of a syringe further compounds the errors in steps one and two because of the inaccuracies in dosing. Thankfully, insulin delivery technology has improved dramatically. In 1985 an “insulin pen” was introduced using a smaller gauge needle, a pre filled insulin supply and a dial to set the correct insulin dose. Despite this improvement less than 20% of Americans use the pen.
Diabetes is Widespread, Growing and Costly
Diabetes is growing to proportions that nearly merit the term “epidemic”.
According to the Center for Disease Control:
11 million Americans or 27% of U.S. population had diabetes in 2010 and an estimated 300 million worldwide have the disease (an estimated 95% of those afflicted have Type 2 Diabetes). 35% of the U.S. has pre-diabetes. By the end of this decade 35 million will have the disease. The direct cost of treating diabetes is $116 billion this year and will reach nearly $200 billion by 2020. The cost of health care for a diabetic is 2.3 times that of a non-diabetic.
Also according to CDC, diabetes is the leading cause of kidney failure, non-traumatic amputations of lower limbs, blindness and heart disease and stroke.
Diabetes is the seventh leading cause of death in the United States. The risk of death of those with diabetes is twice the risk of someone of comparable age without diabetes.
Funding T1D Research
Unfortunately, the federal government, which pays for over half of the diabetes related care in the U.S., allocates one-tenth of one percent of the cost of care to research (in other words $1 of research is spent for every $1,000 spent on caring for diabetics who can’t otherwise pay for their own care) . The federal government’s National Institute of Health (NIH) allocated $150 million for Type 1 Diabetes research in 2010. Thankfully, the largest private foundation dedicated to Type 1 Diabetes research (JDRF) funded almost as much on research as the entire federal government, nearly $120 million.