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: Autoimmunity plus normal glucose tolerance
People in this stage are those who have two or more Type 1 diabetes-associated islet autoantibodies but who have normal blood glucose levels. Islet autoantibodies are markers that appear when the beta cells in the pancreas are damaged. They appear long before Type 1 diabetes is actually diagnosed. These autoantibodies can be detected very early in life, and based on the findings of several studies, the lifetime risk of getting symptomatic Type 1 diabetes is close to 100% once two or more islet autoantibodies are detected in children who are at risk for Type 1.

Stage 2: Autoimmunity plus dysglycemia (abnormal glucose tolerance)
Stage 2 includes people who have islet autoantibodies but who also now have glucose intolerance (called dysglycemia) due to the loss of working beta cell mass. Glucose intolerance is identified by a fasting blood glucose level of 100 mg/dl or higher, a 2-hour glucose level of 140 mg/dl or higher after an oral glucose tolerance test, and/or an HbA1c level of 5.7% or higher. At this stage, the risk of developing Type 1 diabetes is 60% within 2 years and 75% in 4–5 years. HbA1c levels often increase 12–18 months before symptoms of Type 1 appear.

Stage 3: Symptomatic Type 1 diabetes requiring insulin therapy
The appearance of signs and symptoms of Type 1 diabetes signals stage 3. At this stage, insulin therapy must be started. Classic signs and symptoms include:

• Extreme thirst
• Frequent urination
• Feeling very hungry
• Sudden weight loss
• Extreme fatigue
• Blurry vision
• Cuts, sores, or infections that are slow to heal
• A fruity odor to the breath

Are you at risk?
Here are the risk factors for Type 1 diabetes:

Age: children between 4 and 7 and 10 and 14 years of age are at increased risk (Type 1 can occur at any age, however)
Family history: a parent or sibling with Type 1 slightly ups the odds of developing Type 1
Race/ethnicity: in the U.S,. whites are more likely to have Type 1 than other races/ethnicities
Viral infections: German measles, mumps, and coxsackie may be triggers
Genetics: the presence of certain genes signals a higher risk of developing Type 1
Geography: people living in northern climates are at higher risk than those living in southern climates
Other autoimmune conditions: Grave’s disease, multiple sclerosis, and pernicious anemia may increase the risk

What lies ahead?
This staging system will hopefully open up more clinical research and ultimately, the discovery and development of prevention therapies. Stay tuned!

One of the best ways to avoid having your blood sugar go dangerously low is to recognize the symptoms early. How can you improve your hypoglycemia awareness? Bookmark and tune in tomorrow to find out!