Diabetes Self-Management Blog

With all the publicity about a Type 2 diabetes epidemic, an equally scary rise in rates of Type 1 has been ignored. What is causing the surge in Type 1 diabetes? Does it have anything to do with the Type 2 explosion?

First the numbers. Type 1 diabetes has always existed, but it was rare. According to an exhaustive study by Dr. Edwin A. M. Gale of the University of Bristol, rates of Type 1 were on the order of 4 cases per 100,000 children prior to 1950.

In the early 50’s, Type 1 started increasing at a rate of 2% to 4% a year in the US and Europe. That may not sound like much, but now there are 3–4 cases per 1,000 children in these countries. This increase is actually as sharp as the increase in Type 2. It just started from a much lower point, so it’s still under most people’s radar.

Sometime in the 60’s and 70’s, Asian countries also started experiencing the Type 1 increase, and now most (but not all) countries in the world are seeing it.

It’s still happening. In a June meeting of the American Diabetes Association, researchers reported a 23% rise in Type 1 in the USA over an eight-year period ending in 2009. Prevalence of Type 2 diabetes over the same period increased 21%, the researchers found. So Type 1 is going up even faster than Type 2.

What Causes Type 1?
Type 1 diabetes is considered an “autoimmune” disease. Autoimmunity is present when our immune systems damage and destroy healthy cells. Autoimmunity can hit anywhere in the body. In rheumatoid arthritis, it attacks the joints; in multiple sclerosis it’s the nerves; in lupus, mostly the kidneys. In Type 1 diabetes, the immune system destroys the pancreatic beta cells that produce insulin.

But what causes autoimmunity? We don’t know. Many experts believe it’s the thousands of new chemicals that are constantly added to our environment. Our immune systems get confused and may lose the ability to distinguish harmful invaders from the body’s own tissues.

Interviewed on our Web site, Donna Jackson Nakazawa, author of The Autoimmune Epidemic, said, “There are just too many chemicals and pollutants in the world around us. Genetics plays a role, but exposure to antigens is what ends up triggering autoimmune disease.”

We often hear from uninformed people that Type 1 is “genetic,” while Type 2 is caused by “lifestyle.” In reality, Type 2 may have a stronger genetic component than Type 1. Only about 20% of people with Type 1 have a close relative with the disease.

There are genes that predispose people to Type 1, as there are with Type 2. But without exposure to environmental stressors that turn those genes on, people don’t get sick.

Obviously, something happened around 1950 that has turned on more of those autoimmune genes. Not only are more children getting Type 1, but it’s being diagnosed at earlier ages on average, just as Type 2 is hitting younger people.

What’s in the Environment?
There are five leading theories on how environmental change has increased Type 1.

• The “accelerator hypothesis” holds that faster growth in early life is putting stress on beta cells, setting off the autoimmune attack. So diabetes is just an unfortunate side effect of kids’ getting bigger. I doubt this.

• Another theory, the “hygiene hypothesis,” holds that children in a modern society face fewer parasitic, viral, and bacterial invaders, because we’re so clean and use so many antibiotics. “Because it is getting less of a workout, the immune system turns evil on itself,” said Robin Goland, of the Columbia University Medical Center in New York.

There is some evidence for this. According to Dr. Gale, mice exposed to pinworm infections have lower rates of Type 1. People used to get pinworms, too, so perhaps eliminating them is what set off the Type 1 surge. Research is being done on using worms to prevent or treat autoimmune disease.

• Some believe that diabetes increased when people started spending more time indoors. We got less sun so made less vitamin D. Low D levels may lead to autoimmunity. People who live in sunny places tend to get less autoimmune disease than people in higher latitudes and cloudier climates.

• Cow’s milk has been blamed by many. As I wrote here, a particular milk protein, A1 beta-casein, seems to be associated with most cases of Type 1. Perhaps the increased use of cow’s milk has led to the worldwide Type 1 surge.

However, Dr. Gale found that “[22%] of American women breastfed in 1972, rising to 60% in the 1980’s and 1990’s. [But] the incidence of childhood diabetes [increased steadily.]” So maybe it’s not the cows’ fault.

• Environmental chemical pollution seems a top contender. We have been reporting for years on studies showing that air pollution, and exposure to chemicals such as bisphenol Aand phthalates lead to an increased risk of Type 2. Researchers are finding that heavy metals and organic chemicals like dioxins can disrupt the immune system.

These chemicals have already been strongly associated with Type 2, as with Agent Orange, the chemical sprayed by the military on Vietnam. So what I’m wondering is, are the two diseases more closely related than we had thought? In both cases, your genes make you vulnerable, but it’s the environment that sets them off.

To me, it seems the increased loads of starches and sugars people eat now are among the biggest environmental triggers. But the pollution, cow’s milk, and hygiene theories may explain a lot about both types. What do you think? What should we do about it?

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Comments
  1. I think the cowsmilk theory is not ruled out by the increase of breastfeeing, because nursing mothers are pushed to drink plenty of milk during pregnancy and while nursing. Cowsmilk proteins clearly come through human milk, because many babies become allergic to cowsmilk through their mothers’ milk.

    Posted by Deb |
  2. I think hyper-hygene & diet are the key contributing factors. I am a child of the 50’s and my mother left me outside pretty much to my own devices. I spent hours in the sun on my tricyle and taking apart large ants (I wanted to see if both halfs moved on their own)-I never tired of those ants. Dessert or snacks were always fresh fruit–from the peddlers truck that went down the ally–yep, among the big metal trash containers and the flies.In spring, we picked cherries from the backyard tree. We lived in 2-flat and the grass was hardly mowed–so you have to be kidding if fertilizers were ever placed on it. Before the Dutch Elm disease broke there were plenty of trees lining the street giving off lots of oxygen. I walked to grammar school (and back for lunch at home) and exercised in the playlot before school morning and lunch touching a lot of cement to play hopscotch. I am maintain my highschool weight and dimension because I exercise and restrict my calories and dietto alot of fresh veges, fruits and lean protein and I do not eat out very often. I am PCOS so I had gestational diabetes when pregnant but that is it 30 years later. I suppose this would be considered a poor standard of living by most–but sugared lattespeople consume daily are not in my vocabulary.

    Posted by Carol |
  3. Maybe the fact that Type 1 diabetics are living longer and reproducing (i.e., not dying in childhood as before the discovery and use of insulin) creates a larger pool of people with the genetic predisposition. There is some research pointing to a virus as the trigger for Type 1s.

    Posted by Cal |
  4. I’m a firm believer that corn syrup and plastics are a huge influence in T1 and to a lesser extent T2. The scientist can say until they are blue in the face that plastics aren’t harmful, except to planet Earth; I just don’t buy it. And CS, we aren’t able to digest Corn so why would we want to eat what we can’t digest? What effect does CS have on the intestines? CS is in everything and it was introduced into market to subsidize farmers. Go figure!

    Posted by John |
  5. I was DX with type 1 diabetes 8 month after I was DX with Multiple Sclerosis…I believe it has everything to do with autoimmune and stress is a huge factor as well.

    Posted by Wendy |
  6. I am 25 years old and no history of type 1 in my family that we know of. There is a few with type 2 though. I had gestational diabetes in my last pregnancy 2 years ago, but it was undiagnosed as I had bad morning sickness and couldn’t keep the glucose drink down. About 6 months after the birth of my daughter, I had a flu and then chest infection. I finished a course of antibiotics and felt much better but then almost instantly started getting symptoms of type 1. Excessive thirst, excessive urinating, blurry vision and rapid heartbeat.
    I was tested and diagnosed with type 1 and rushed to hospital with a bsl of 30. I believe the virus triggered my immune system to attack my pancreas and so does my GP. Whether it’s a strain of a certain virus I’m not sure but there seems to be no other reason why I would have type 1

    Posted by Krystle |
  7. My sister and I were both diagnosed when we turned 8 years old,1980’s.We both played outside and weren’t over weight.I got it first,I’m the oldest and then my sister got it.There is a 17 month age difference between us and then years later my Dad got type 1 diabetes as well.My nephew who is 11 years old was diagnosed when he was 9 so in my case its in the blood… :)

    Posted by Jonna |
  8. When first diagnosed w/ Type 1 26 years ago & being 26 yrs. old, my internist’s theory was that a virus had attacked my pancrease rendering it no longer producing insulin. I had had a cold 2 weeks prior to the textbook symptoms: thirsty, hungry, urinating frequently & losing 20 lbs. w/o dieting. No family history for at least 2 generations that we know of.

    Posted by Teri |
  9. I was 38 years old when I was diagnosed with T1.
    I lead an active life, ate well and was not at all overweight. My doc told me that becoming T1 was probably related to a childhood trauma or illness that compromised my immune system. I do have a nephew that became T1 as a child and several half siblings that are T2 but their mother had it and they are both overweight. I really don’t know what to believe as far as the cause.

    Posted by Laurie |
  10. I think all of the above are contributing factors. It’s hard to say what is more important because so many factors contribute to creating a diabetogenic environment. Because the cause is not simple, it cannot be simple to correct it.

    I do think the “easy blame game” played by the media and many who do not understand the complexity is also damaging, adding a great deal of social and self-recrimiationstress to the stress of simply having diabetes.

    Posted by Beth |
  11. While taking a sociology class in college a few years back, a remark was made that comes to the forward in this subject. The shells we have been shootng in the mideast conflicts are made of depleted uranium which can cause damage to the pancreas as well as birth defects. It has been hypothesized that it has travelled the weather patterns across the globe. Great Britain has detected it which at first makes sense as they are close until you realize that the weather patterns move from west to east and it would have to travel the globe in order to get to them. Just a suggestion that came to mind.

    Posted by Cheri |
  12. I have staunchly believed that my son’s Type I diabetes was triggered by an impure vaccination when he was 2 years old. Yes, we discovered later that there was a genetic link from some generations past. However, and more importantly, there were three (3) of the two-year olds in our small town clinic diagnosed within a six month period. Those statistics are a bit too great to be “random”. I believe that the vaccine contributed to the onset of their type I diabetes.

    Posted by MJ |
  13. Is the surge larger in younger or older persons, or equally? Many of the suggested causes would have a different level of possible causation depending on the age of the diabetic.

    And what about the change in our sleep patterns? TV, internet, cell phones, shift work, larger metropolitan areas with increased noise and artificial light, and other factors have changed our sleep patterns. Is there a connection between changing sleep patterns and Type 1 & 2, younger & older diabetics?

    I was diagnosed at 50 after a lifetime of healthy living, first as a T2, and later as an adult onset T1. Physically active and a well balanced diet throughout, I followed the lessons learned as a national level athlete in high school and college. I had none of the typical risk factors. But three weeks after having surgery I started experiencing the classic diabetes symptoms. I lost a lot of weight, going from the middle of the Body Mass Index to being under-weight. Blood-work confirmed the diagnosis 5 weeks after the surgery.

    After getting everything stabilized I wanted to know why. Why me, and why at that time? The initial thought was the surgery. But as time has gone by, other possible factors have been introduced. I had dealt with high levels of stress at times. I had long periods of less than optimal amounts of sleep. In my late 40’s I changed to a job where I had to get up at 3:30AM six days per week. And while I ate healthier than most Americans, I was still subject to the same chemicals and contaminants as everyone else.

    In the end, I doubt we will find any narrow bands of risk, or single events associated with the disease. Rather, there will be multiple factors in each case.

    Posted by BJ |
  14. My son was diagnosed with Type 1 at the age of 21.
    He had broken his thumb,did not know it was broken, and it healed wrong.Then he started losing weight and had the other symptoms. After he was diagnosed, people asked me if he had had a trauma.I believe a trauma not treated correctly,can trigger diabetes, as all the pancreas cells are depleted trying to heal it.The disease is not in my family,so genetics did not play a part in it.

    Posted by Carol |
  15. I was diagnosed with type1 twenty years ago at the age of 24, after having just gotten over the flu (virus) and moving to a new city for my new job (major stresses). I was weight training pretty heavily at the time and likely consumed a quart of milk each day. Can’t fight the data.

    Posted by Brent |
  16. I was diagnosed with type 1 in 1956 while in the hospital with measles and pneumonia. My doctors through the years have believed that the measles virus led to my type 1 diabetes. Their theory is that the antibodies built to the measles virus then attacked the beta cells of the pancreas. There had also been a family history of type 1 diabetes in my maternal grandmother’s family.

    Posted by Connie Stuart |
  17. Thanks, everyone, for all the good diagnosis stories and thoughts. It seems most of the increase in Type 1 has been in young children. But T1 is also being diagnosed more in adults.

    As several people said, there are probably multiple causes. I neglected to mention viruses in the article, but viruses are blamed for many autoimmune diseases and certainly play a big role. But why does a virus trigger autoimmune disease in some people and not in others? Genetics plays some part, but statistically only about 20%.

    There’s still much we need to know.

    Posted by David Spero RN |
  18. Before I was diagnosed with type 1 diabetes at age 25 I spent 3.5 years in the Marines playing with Trichlorathane 1,1,1 an organic compound De greaser for air craft parts. Anyone have a similar incident. Type 1 diabetes is non existant in my Family tree.

    Posted by Tony |
  19. There is some research developing within the last decade about how the food of today that is more highly processed in the last couple of decades ( and full of toxins, pesticides etc..) that are high in simple carbs are causing autoimmune (even neuro-immune) diseases. The body is meant to handle certain stress loads but now gluten sensitivity, diabetes and allergies, chronic fatigue and fibromyalgia are all on the rise at epic proportions. Our ability to handle stress is significantly lower due to our poor food and poor diets. Obesity is common not rare. Adults do not need 6-12 simple carbs a day. Most eat at least that and rarely any leafy greens for example that contain things to prevent disease. When is the last time you’ve eaten organic arugula, swiss chard or kale?

    Posted by Chris Federspiel |
  20. I was 35, 5′3 and 104 lbs when I first was diagnosed with pancreatitis. Three years on-diabetes. The pancreatitis was triggered after a series of pesticide (rodenticides, specifically) treatments were applied at my office. As it turns out, one pesticide that is still allowed to be used by exterminators (though not sold to general consumers) is a pancreatic beta cell destroyer. Thus, in my case, it was a pesticide. Watch what you use, people. A lot of these chemicals are exceedingly dangerous and have effects that we do not fully appreciate. Now, I’m sitting and wondering when and if pancreatic cancer will strike. I feel like a sitting such thorugh no fault of my own. It’s not right, and I believe that the government should do far more to protect us from the legions of un and mis-regulated chemicals, particularly pesticides, which are designed to be toxic!

    Posted by K. Reid |

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