Type 1 Diabetes
There are two main forms of Type 1 Diabetes: Juvenile Onset and Latent Auto-‐Immune Diabetes of the Adult (LADA). About 5-‐10% of diabetes is Type 1, although in the world-‐wide diabetes epidemic, Type 1 cases are also increasing.
Juvenile onset diabetes means that the T1DM occurs generally in people 1-‐25 years old. LADA tends to occur in adults older than 35 years old, oftentimes from age 40-‐60 years old, but any age typically over 30 years old is possible.
This type of diabetes is due to auto-‐immunity, which means that a person’s own immune system cells attack and destroy their beta cells in their pancreas, the cells that produce and secret insulin into the body.
There are many risk factors for developing Type 1 diabetes, but in reality, we are not really sure why any particular patient develops it. Some risk factors include:
- Genetics—A person does need the genes for Type 1 to develop it. We’re not sure why those genes turn on, and why they do it when they do. What is interesting is that 80% of children of a parent with T1DM do not develop T1DM.
- Early introduction to gluten and dairy (and food in general)—There are some studies showing that early introduction in infants to gluten, dairy, and food overall may initiate Type 1 diabetes, but many people eat those foods and do not develop diabetes. In a patient with Celiac disease, avoiding gluten may indeed prevent the development of Type 1 diabetes. A concern is that a protein on the beta cell may look closely like a protein in gluten or the dairy molecule, so if the body is reacting to the food, it may get confused and then attack the same looking protein on the beta cell, destroying it. That is called “molecular mimickry.”
- Exposure to a virus—There is this “perfect storm” idea in T1DM, that a person has the genes, they have been turned on, perhaps they are sensitive to gluten or dairy, and the immune system is starting to react to the food antigens. When the person gets infected with a virus, such as a cold or flu, the immune system is activated to fight off that infection, and is then equally activated, mistakenly, to attack the beta cells. It is true that some patients do recall getting a virus weeks or two months before the onset of their T1DM, but it is by no means a scenario that happens to every T1DM patient.
- Low Omega-‐3 oils and Vitamin D3—Studies have shown that giving Omega-‐3 and Vitamin D3 to infants reduces their risk of developing T1DM. Being low in B vitamins and Vitamin E may also increase risk.
- Environmental toxins—Environmental toxins, in our air, food and water, have been shown to induce auto-‐immunity in people.
- Dysbiosis—Imbalances in the human intestinal micriobiome has association with increasing the risk of developing an auto-‐immune condition, including T1DM.
The T1DM patient at presentation is usually lean, and even losing weight. He may be urinating frequently, eating frequently, drinking frequently, have fatigue, mood swings, and blurred vision. There may be a fungal infection especially in the genital areas. It comes on very strongly typically in pediatric patients and parents usually figure things something is very wrong with their child within days or a few weeks.
It is easy to diagnose T1DM—significantly elevated glucose levels are typical, usually above 300 mg/dL, and positive T1 diabetic antibodies are usually seen.
LADA is oftentimes misdiagnosed in adults, as unfortunately many physicians are not aware of it. Any adult with diabetes is naturally considered to be a T2DM patient, even though they may be lean or normal weight, eat right, and exercise regularly. Around 15-‐20% of Adult T2DM patients are actually LADA patients, and all lean patients, who exercise and no family medical history of T2DM should be tested for LADA.
LADA may come on aggressively, like a Juvenile onset picture, but it may also come on slower. Being misdiagnosed with T2DM is confounding to the patient and she may as a result be prescribed improper medication as a result. In lean T2DM patients astounded at their diagnosis, having GAD-‐65 measured can immediately diagnose LADA and get the patient on the right treatment path.
Although many T1DM pediatric patients require insulin upon diagnosis, some LADA patients may or may not require insulin. Using comprehensive integrative medical care can help initiate a “honeymoon period” for pediatric patients, where injecting insulin is no longer required, as their pancreas seems to recover. A honeymoon period can last weeks, months, or years, but nearly every child will need insulin when puberty begins. In LADA patients the medical practitioner will need to analyze each patient individually to see when insulin is needed.
Type 1 diabetes is associated with other auto-‐immune diseases: Celiac Disease, Hashimoto’s or Grave’s disease, and Addison’s disease. These should be monitored yearly through lab work.
The goals for Type 1 diabetes patients include:
- Excellent glucose control—A1C 5.5% or less
- Education of comprehensive integrative care—the Eight Essentials
- Teach excellent use of insulin for better glucose control without high and low glucose levels throughout the day.
- Prevent, stabilize and heal diabetic complications
- Reduce auto-‐immunity to help prevent other auto-‐immune conditions from developing.
- Feel supported by medical practitioner, family, work environments.
The LCDA is devoted to educate all patients with Type 1 regarding everything associated with Type 1.