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Is type 1 diabetes an autoimmune disease? – Type 1 Diabetes Mellitus

Type 1 diabetes, also known as Juvenile diabetes, is a chronic condition in which the pancreas produces little or no insulin leading to high blood sugar levels. Insulin is a hormone that allows sugar to enter cells through the body to produce energy. Importantly, this disease usually appears during childhood or adolescence, but it can develop in adults.

Within this text, you will find answers to some of the most common questions: which children are at risk, at what age it occurs, and many others. Before reaching that point, there will be brief explanations about the basic concepts of the disease.

By reading this article, you will obtain critical insights about Type 1 diabetes, such as who is likely to develop the disease, its warning signs, and the complications. Also, the answer to the question; is type 1 diabetes an autoimmune disease? Please continue reading to get pearls on this specific topic by the hand of a doctor.

What is an autoimmune disease?

An autoimmune disease is a medical definition for whatever condition that rises from a malfunction of the immune system that ends up attacking its own body.

Usually, the immune system protects us from harmful foreign germs. This is possible thanks to not only one immune cell but many that are in the body, each one with a specific function.

The immune cells are in the blood, organs, and specific immune places called “lymphoid organs.” They recognize foreign particles and germs and attack them with distinctive proteins called “antibodies” and by a strong binding and release of substances that disrupt the germs’ wall, finally destroying them.

The core cell is the lymphocyte, which can be either B or T cells—these commands all the immune responses that keep us healthy most of the time. However, when these cells start recognizing our own proteins or cells. They will attack them. Hence, at that point, is where the autoimmunity begins.

Moreover, there are many autoimmune diseases. Thyroid disease is a perfect example of this. For example, there is a type of autoimmune thyroid disease in which there will be an antibody destroying the thyroid gland. Therefore, it will cause hypothyroidism, which is a decrease in the function of the gland.

Also, there is the Grave’s disease, another thyroid disorder. Still, in this case, the antibody will stimulate a receptor in the thyroid gland that will cause its hyperfunction that ends up in hyperthyroidism. Interestingly, both diseases produce exactly opposite outcomes, and they are autoimmune conditions. The difference is that in this one without destroying anything.

Another classic example is rheumatoid arthritis. In this disease, the body produces antibodies that recognize and attack the joint surfaces causing its swelling. This will lead to joint pain and deformities in the long run.

What is type 1 diabetes?

Diabetes is a condition in which the blood glucose level (blood sugar) is high. Type 1 diabetes mellitus occurs explicitly due to an autoimmune response that destroys the cells in the pancreas that are in charge of producing the insulin hormone.

This hormone plays a essential rol in reducing the blood sugar levels (and fats). Therefore, when missing, it will cause a severe impairment in the body’s metabolism.

Is type 1 diabetes an autoimmune disease?

Type 1 diabetes mellitus is an autoimmune condition where there are infiltration and destruction by lymphocytes of the pancreatic islet, which harbors the cells that produce the insulin in the pancreas.

This is autoimmunity in its purest form. The immune cells start to wrongly recognize these pancreatic cells as a threat to the body, so attacks and destroy them. As the cells are destroyed, the insulin production begins to decrease, and with it, the capacity of down-regulate blood sugar in the body.

Sadly, islet autoimmunity or destruction of the pancreatic tissue manifests with symptoms only when 80 to 90% of the cells are destroyed. At that moment is when the blood glucose starts to skyrocket, causing the symptoms, complications, and eventually, doctors diagnose it.

Moreover, in nearly 90% of the patients with this condition, antibodies are circulating in the blood that is supposed to protect from foreign and harmful molecules but instead recognize and attack pancreatic islet cells. The most common of them is the GAD antibodies. GAD is an enzyme, glutamic acid decarboxylase, which is specifically found in the pancreatic beta cells that in the pancreatic islet are the ones secreting the insulin.

It is important to note that, in some way, autoimmune diseases mean that there is an ill system, which is not functioning right. Therefore, its impact can be in many spheres. In light of this, type 1 diabetes mellitus tend to occur more in patients with other autoimmune diseases. This will include some that I mentioned earlier in the autoimmune disease explanation as:

At what age does type 1 diabetes occur?

Type 1 diabetes can occur at any age. It can emerge from very early in life to mid-life, from 30 to 40 years old. It is an autoimmune disease that can happen anytime. However, the most common ages of onset go from 5 to 20 years old, with a peak between ten and fourteen years old. These patients tend to debut with diabetic ketoacidosis, which is a severe complication of the disease. This happens this way because most of those patients did not know they had it. Therefore, by not having symptoms, there is no diagnosis and the disease progress until its complications manifest. It is at this moment when, finally, the diagnosis comes through.

In patients of 30 to 40 years old, the disease receives the name of Latent Autoimmune Diabetes in Adults or LADA, but it is not so common. Although there is a genetic factor, viral infections play a role in the history of the disease. Children with other autoimmune diseases or viral infections, like infections by Enterovirus, may develop this disease in the early stages of life.

Which children are at risk of having this condition?

Type 1 diabetes represents a challenge for scientists as they do not know with certainty what causes it. However, genetics plays a significant role in the development of this disease. It is difficult to know who is at real risk or at what age there is an increased risk. The following represent the risk factors for the development of this disease:

  • Age: Being a disease that majorly affects children, the sole fact of being under 20 years old represents a risk for developing this disease.
  • Familiar History: Having one or both parents or a sibling with type 1 diabetes increases the risk of developing this particular disease. This is a major risk factor in the development of the illness as genetics may induce the autoantibodies’ apparition. Mothers who have gestational diabetes during pregnancy (diabetes while pregnant) may produce type 1 diabetes in their children as well.

One theory is that viral infections in the early stages of life may induce type 1 diabetes. Several of these infections correlate with the development of this disease, with Enterovirus being one of the most common infections. In fact, people with recent onset of the illness have traces of enteroviral infection on the beta cells in the Pancreas. Despite that, nowadays, this hypothesis remains tough to prove, some vaccines for this disease target the Enterovirus for this purpose.

Moreover, other theories may include the timing of the first introduction of food and gestational events. These are theories that do not have current validation through studies as they are not conclusive. But a combination of all of these environmental factors may trigger the apparition of the first autoantibody. Children with Celiac Disease may as well develop type 1 diabetes as both of them are autoimmune diseases.

Can adults develop type 1 diabetes?

Yes, adults can develop a subtype of type 1 diabetes as it can be a latent autoimmune disease. This entity receives a specific name, Latent autoimmune diabetes in adults or LADA. It is a disorder in which, despite the presence of islet antibodies at diagnosis, the progression of autoimmune beta cell failure is significantly slower.

Importantly, these patients do not require insulin at least during the first six months after the diagnosis of diabetes. This is one of the three primary criteria for making a diagnosis of the disease. The other two are adult age of onset (being over 30 years old) and having the presence of islet antibodies. Measuring the real number of cases by this disease is very hard for scientists as they do not agree while making the studies. However, there are significant reports that indicate that LADA is the most common form of adult-onset autoimmune diabetes. 

Many of the patients with type 2 diabetes, at least 10%, are positive for LADA. The outcome of this disease has no significant differences with type 2 diabetes. Untreated diabetes may lead to further complications that involve organs like heart, small blood vessels (Microvasculature), and eyes, among others.

Is type 1 diabetes caused by diet?

Type 1 diabetes is a chronic autoimmune disease in which there is insulin deficiency resulting in high blood sugar levels. It has many risk factors that may induce its development; however, diet and lifestyle habits are not the main among them, unlike type 2 diabetes. For the risk factors, age, genetics, and exposure to a trigger in the environment, such as a virus, play a significant role in developing this disease. It is a disease that currently affects over 1 million people in the United States. The annual rate of new cases is 19 new cases per 100.000 people among children younger than ten years and 18 per 100.000 among those ten years or older. 

The pancreas is the organ in charge of the production of insulin. This hormone allows sugar to enter the cells and produce energy. The beta cells of the pancreas are in charge of the making of insulin. In type 1 diabetes, there is an autoimmune disorder in which the immune system attacks these cells lowering insulin production. Almost all of these patients have circulating islet cell antibodies, and the majority also have anti-insulin antibodies. The lack of insulin leads to a rise in the glucose levels circulating in the blood. These patients are dependent on insulin injections for life.

Type 2 diabetes mellitus, on the other hand, is a condition in which the diet can induce the disease. This disease has many risk factors, but diet plays a major role. Constant food consumption with high levels of fats and sugar, plus the lack of activity, may lead to insulin resistance, which characterizes type 2 diabetes. Although it is a disease most common in adults, more children are developing this disease earlier in life due to obesity and unhealthy lifestyle habits.

Can type 1 diabetes be triggered by stress?

Several studies have theories that link the stress with the apparition of autoimmune diseases like Type 1 Diabetes. Within the human body exists a system whose name is “Hypothalamic-Pituitary-Adrenal Axis”; it interconnects the brain with other organs through hormones.

When a stressful event happens, the brain, through this system, releases hormones that will activate specific responses within other organs in the body to later be shut down by the same system.

If there is chronic psychological stress, the regulation of this system will not work correctly. This can trigger an immune response that can lead to insulin resistance, and it can trigger autoimmune diseases. However, scientists need to do more research on this topic to have a specific explanation of how this happens and prevent it.

What are the signs and symptoms of type 1 diabetes?

Type 1 diabetes is a disease that may go silent for years without any symptoms or signs. But when these symptoms and signs appear, they can appear relatively suddenly and may include the following:

  • Frequent and increased urination
  • Being more thirsty than normal
  • Bed-wetting during the night in children who do not wet the bed.
  • Extreme hunger
  • Fatigue and weakness
  • Irritability and mood swings
  • Blurred vision
  • Weight loss without explanation
  • Nausea

Despite these diabetes symptoms, it is not uncommon for these patients to debut with diabetic ketoacidosis symptoms. You will read thoroughly about that life-threatening situation in the complication section.

These patients usually do not know they suffer from this particular disease. That is why it is vital to check a child’s blood sugar every time they visit the doctor.

What are the complications of type 1 diabetes?

Diabetes is a disease with a wide variety of complications that may go from acute to chronic, depending on the blood sugar levels. This disease may affect several organs through the body, including the heart, kidneys, and even eyes. The following list contains the acute and chronic complications of this disease.

Acute complications

  • Hypoglycemia: It is a situation in which there are low blood sugar levels. This happens when the balance of diabetes medication, food intake, and physical activity is not right. It is a complication that can occur quickly, so it is crucial to act soon as well. Low blood sugar can happen when the patient takes more insulin than he or she needs, drinking alcohol on an empty stomach, or missing a meal. People with this condition may develop a hypoglycemic shock.
  • Hyperglycemia: Unlike hypoglycemia, hyperglycemia happens when blood glucose levels rise and become too high. This occurs when patients miss a dose of medication and are unwell from an infection. Daily stress affects them or meals with high carbohydrates content. People may not experience any symptoms as their blood glucose levels are slightly elevated, but as they raise symptoms may include: Being very thirsty, headaches, frequent urination, and tiredness.
  • Diabetic Ketoacidosis (DKA): It is a critical condition because of the severe lack of insulin in the body. The body cannot use sugar for energy and uses fat instead of releasing ketones into the bloodstream. It is a dangerous complication, and it needs quick medical attention. This condition makes the blood acidic and causes neurologic symptoms. These patients may present confusion, passing out, blurred vision, slow speech, and sleepiness, among others. It is most common in patients with type 1 diabetes. Still, it can also happen in patients with type 2 diabetes. Being ill with urinary tract infection, lung infection or others, missing doses, surgical procedures, and high blood levels without control and treatment leads to this complication. 

Chronic complications

  • Microvascular complications: Affection of small blood vessels in this disease may lead to further complications. It can affect nerves, kidneys, and eyes. Patients can develop diabetic retinopathy, a condition that blurs vision, and it is a severe and frequent complication. They can also develop nerve damage, and in combination with circulation problems, a diabetic foot can happen. In light of this, patients have to check their feet every day for any blister or cut that they see but are not feeling. This disease can affect kidneys as well, causing kidney disease. This will alter the normal filter function they have on the body. Therefore, there would be abnormal amounts of protein from the blood, leaving the body through the urine.
  • Macrovascular complications: Type 1 diabetes can affect as well as medium and large arteries. People with this condition may experience acceleration in atherosclerosis or plaques in the blood vessels. People with diabetes and atherosclerosis often have as well high blood pressure that can lead to coronary artery disease or strokes. This complication is the leading cause of death in patients with diabetes. This is why it is imperative to diagnose the disease early and pay attention to early symptoms.
  • Infections: Patients with this disease tend to develop infections; the most common are urinary tract infections or skin infections. If untreated, these infections may lead to severe conditions and even death.

How is type 1 diabetes diagnosed?

To make a diagnosis of type 1 diabetes in children, there are several tests which may include the following:

  • Random blood sugar test: Being the primary screening test for type 1 diabetes, the physician takes a blood sample at a random time. With this blood sample, the doctor asks for sugar levels, and depending on the results, may ask other tests.
  • Glycated hemoglobin (A1C) test: indicates the child’s blood sugar level for the past three months. This is the test where the doctors may know if a patient is not following the treatment and diet right.
  • Fasting blood sugar test: Very similar to the random blood sugar test. However, for this one, the doctor asks the patient to skip dinner the day before and take the sample in the morning.

If results indicate that the blood sugar levels are high, the doctor may suggest other tests to distinguish between prediabetes, type 1 diabetes, and type 2 diabetes. These additional tests include:

  • Blood tests to check for antibodies, most common in type 1 diabetes.
  • Urine or blood tests to check for the presence of ketones, which also suggests type 1 diabetes rather than type 2 diabetes.

Can type 1 diabetes go undiagnosed for years?

Not quite, although type 1 diabetes has a congenital factor, it cannot go undiagnosed for years. The onset of type 1 diabetes is quick, as it can take weeks rather than years. Scientists do not precisely know what triggers the expression of autoantibodies. Asides from the genetic factors, environmental factors, and viral infections can trigger this disease.

When the whole process begins, the immune system targets the beta-cells of the pancreas, and symptoms show up in weeks. Developing type 1 diabetes is a life-threatening disease that, if left untreated for a vast amount of time, may lead to death. Patients tend to develop warning signs as excessive hunger, being very thirsty, and frequent urination. The sole exception for this is LADA, as it is a slowly progressive disease, and it can go undiagnosed for years, but it is not so common.

Can type 1 diabetes go into remission?

It is complicated, but yes, type 1 diabetes can go into remission. Nonetheless, it is a phase of the disease. It is very interesting that when the disease makes spontaneous remission, in most of the cases, it happens shortly after the diagnosis of the disease, and insulin therapy begins.

Moreover, during this phase, the patient’s need for exogenous insulin declines by 50% and maintain near-normal metabolic control. In a few cases, some patients can achieve insulin independence as they produce enough insulin. 

Several studies show that when the remission phase occurs in 60% at 3 months, 40% at 6 months, and approximately 18% after 12 months. The occurrence of the remission phase is present in up to 80% of the children.

This suggests that there is some remaining function of the beta cells after the onset of the insulin treatment and probably reflects an attempt of beta cells regeneration. The duration of this stage varies from weeks to years, with an average of 7 months, and it is usually longer in patients older than 5 years.

Furthermore, studies also show that children with moderate/severe diabetic ketoacidosis at Type 1 Diabetes diagnosis are less likely to enter a partial remission phase. If they do, the phase is shorter.

Does type 1 diabetes affect life expectancy?

Yes, several studies show that type 1 diabetes affects the life expectancy of the patient. Still, the age of onset plays a major role. Patients who develop this disease between 0 to 10 years of age have a higher risk than the rest of them. These patients have four times the risk of dying early from any cause, and seven times the risk of dying from cardiovascular diseases. That is why managing diabetes from the early stages is critical. With the appropriate therapy and taking out risk factors, life expectancy may not be that low.

The average loss in life expectancy for these patients is approximately 18 years in women and 14 years in men. These patients are also 30 times more likely to develop coronary artery disease and 11 times more likely to have a stroke. This has a direct correlation with the chronic complications of diabetes. Macrovascular damages lead to further damage in arteries and atherosclerosis, making these patients more likely to suffer from heart diseases. To fight these statistics, asides from pharmacological therapy, doctors indicate changes in lifestyle and developing healthy habits. These include doing regular exercise, eating a healthy diet, and avoiding stressful events in daily life.

Are you having symptoms of this condition?

This tool is a type 1 diabetes symptoms checker. It gathers the most important signs, symptoms, and risk factors for this condition. Therefore, it would help in determining the likelihood of someone having this disease. Importantly, it is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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