📘 What is type 1 diabetes?

Yes, type 1 diabetes mellitus is indeed an autoimmune disease. This means that your own immune system, which normally protects you from infections, mistakenly attacks the beta cells in your pancreas (the ones that produce insulin). It's as if your internal police force turned against healthy cells in your body.

The autoimmune process unfolds gradually, sometimes over many months or years, until over 70% of beta cells are destroyed. After this level of destruction, your endocrine pancreas can no longer produce enough insulin to control blood glucose, especially since some of the remaining beta cells temporarily stop their secretion.

Type 1 diabetes is not 100% inherited from parents. You can inherit a genetic predisposition to this disease (a higher risk). If one of your parents has type 1 diabetes, your risk is approximately 3-6%, compared to 0.4% in the general population (10 times higher). It's important to understand that you don't inherit the disease itself, but rather a greater vulnerability to harmful environmental factors.

For diabetes to develop, in addition to risk genes, certain environmental factors must also intervene (certain viral infections, major stress, etc.). That's why, even if you have an identical twin sibling who develops type 1 diabetes, you only have a 50% chance of developing the disease (which is not insignificant!).

You're told you have insulin-dependent diabetes because without insulin brought from outside, your cells cannot use glucose from the blood for energy, and you cannot survive. It's like having a car for which you've lost the keys. You have gas in the tank, but it's useless if you can't start it.

Unlike type 2 diabetes, where the pancreas still produces insulin but the body doesn't use it efficiently, in type 1 the production is almost completely stopped. That's why you depend 100% on insulin brought from outside. You cannot take a break from treatment even for a day.

Type 1 and type 2 diabetes are completely different diseases, although both lead to increased blood glucose. In type 1, your immune system destroys the cells that produce insulin, and you have almost no insulin of your own. In type 2, you produce insulin, but one unit of insulin doesn't have the effect it should. Your body has become more resistant to its effects. That's why more insulin is needed to achieve the same effect.

Type 1 usually appears relatively suddenly, especially in children or young people, and immediately requires insulin treatment. Type 2 develops slowly, usually in overweight adults, and can initially be treated with pills and lifestyle changes. You cannot prevent type 1 diabetes, but type 2 can often be prevented through healthy diet and physical exercise.

Type 1 diabetes most frequently occurs in children and adolescents, with two main peaks: between 4-6 years and between 10-14 years. Approximately half of cases are diagnosed before age 16. However, don't be fooled by the old name "juvenile diabetes." The disease can appear at any age, including at 70 years old.

In recent years, doctors are diagnosing more and more cases of type 1 diabetes in adults, after 30-40 years of age. If you're an adult and were recently diagnosed, you might have a form called LADA (latent autoimmune diabetes in adults), which progresses more slowly than the classic childhood-onset form.

Type 1 diabetes represents approximately 5-10% of all diabetes cases worldwide, being much rarer than type 2 diabetes. The incidence (new cases per year) varies geographically, being higher in Nordic countries (Finland has the highest rate in the world with 60 cases per 100,000 children per year) and lower in Asia.

The frequency of type 1 diabetes increases by approximately 3-4% annually globally, for reasons not yet fully elucidated - environmental factors, viral infections, changes in intestinal microbiota, or early exposure to certain foods are theories being investigated. Although traditionally considered a childhood disease, now 50% of new cases occur in adults. The disease affects boys and girls equally, with an incidence peak between 5-7 years and another around puberty (10-14 years).

Your pancreas no longer produces insulin because the immune system has destroyed most of the beta cells in the islets of Langerhans. These are the only cells in the body capable of producing this vital hormone (insulin). The autoimmune attack is like a fire that gradually consumes the insulin factory in your body, until almost nothing functional remains.

The destruction process can last months or years before the first symptoms appear. When you finally became visibly ill, over 70% of beta cells were already destroyed. The rest of your pancreas functions normally. It produces digestive enzymes and other hormones, but the ability to produce sufficient insulin is permanently lost.

At the time of diagnosis, you probably still have 30% of functional beta cells, and preserving them is important. The most effective way to protect them is maintaining the best possible glycemic control from the beginning. High blood glucose levels are toxic to remaining beta cells and accelerate their destruction.

Researchers are testing various treatments to preserve residual function, including immunomodulatory medications. None are yet approved for routine clinical use after the clinical onset of the disease. What you can do now is take your insulin according to your doctor's recommendations, carefully monitor your blood glucose, and avoid long periods of hyperglycemia.

Currently, type 1 diabetes cannot be permanently cured. Once beta cells are destroyed, they cannot regenerate naturally. Insulin treatment is not a cure, but a replacement therapy that you must continue for life. It's like wearing glasses. They improve your vision, but they don't cure your eyes.

Researchers are working intensively on potential cures, including beta cell transplants, artificial pancreas, and cell regeneration therapies. Some of these technologies are promising and could become reality in the next 10-20 years. Until then, with current technology and careful management, you can have a long and happy life with type 1 diabetes.