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doctor's orders: 'we’ve dramatically reduced the rates' of complications with type 1 diabetes

modern interventions like the use of insulin and treating cholesterol and blood pressure have made amputations, blindness, cardiovascular disease and heart failure less common, says dr. ronald goldenberg.

by karen hawthorne
published feb 06, 2023
last updated aug 10, 2023
read time 6 minute read
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read time 6 minute read
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'people can expect to live a normal life' with type 1 diabetes
"treatment of type 1 diabetes is not just about the insulin, but also how to monitor blood glucose, because that’s changed dramatically over recent years," dr. ronald goldenberg to healthing. getty images
if you have type 1 diabetes, your body doesn’t produce insulin, the necessary hormone that helps control the level of glucose or blood sugar in your bloodstream and send it to your cells for energy. over time, without treatment and management of the disease, it can cause serious complications like heart disease, vision loss and kidney damage. diabetes canada says that one in three canadians is living with diabetes or the early stages of diabetes, pre-diabetes, and is not aware of it. and about 10 per cent of people living with diabetes have type 1 diabetes, which requires taking insulin by injection or and insulin injection pump device. type 1 typically develops in kids and adolescents, but it can also happen in adults.
healthing spoke with dr. ronald goldenberg, an endocrinologist at the lmc diabetes & endocrinology clinic in thornhill. he has treated diabetes patients for more than 30 years.

what is type 1 diabetes?

dr. goldenberg: this is an autoimmune condition which is caused by the immune system basically attacking the beta cells in the pancreas — the cells responsible for insulin production. so when you get damage to these cells, the pancreas can no longer produce insulin and you become profoundly insulin-deficient which results in type 1 diabetes.

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what are the signs of type 1 diabetes?

dr. g: [without insulin managing blood sugar in your bloodstream], you can’t take up glucose into the cells and you get a whole host of signs and symptoms. people start developing increased production of urine and increased frequency of urination that leads to dehydration and then increased thirst. and because the body is actually losing glucose, it’s almost like a state of starvation and you get weight loss. this condition is also associated with the production of ketones because the body needs a source of energy. if you can’t use glucose, your body turns to burning fat and the production of ketones. you can develop a condition called ketosis and when it gets very severe, you get what they call ketoacidosis, which is a life-threatening condition that people often have when they first get diagnosed with type 1 diabetes.
these symptoms are short in duration, like a few weeks, and then the individual gets assessed either at a hospital or by their physician and they get diagnosed. but there’s another scenario which is not as common where they may have a little bit of thirst and urination, minor weight loss, but less traumatic symptoms. these sometimes can persist and progress very slowly over many, many months, so that’s a bit more difficult to recognize.

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how do people develop type 1 diabetes? what are the risk factors?

dr. g: because it’s an autoimmune disease, it’s caused by antibodies in the body that damage the beta cells of the pancreas. there can be a genetic predisposition for developing these antibodies. but interestingly, many individuals who develop type 1 diabetes have no family history of type 1 diabetes. so, since type 1 diabetes is increasing over time, some research suggests there are environmental triggers that affect the autoimmune process. cow’s milk as opposed to breast milk for infants might be one of the triggers because breastfed babies have a lower rate of type 1 diabetes in childhood compared to early ingestion of cow’s milk, for example.

are there lifestyle choices that can help prevent type 1 diabetes?

dr. g: the way things are going for prevention of type 1 diabetes is to recognize patients who have the antibodies that ultimately cause type 1 diabetes by screening people with a family history, for example, and finding that they have the antibodies years before they even get an elevated blood sugar. then we treat them with pharmacological agents that target the immune system and protect the beta cells.
there’s no doubt that certain lifestyle interventions can make it easier to control blood glucose, like reducing, simple carbohydrates and simple sugars. people with diabetes can eat sugar and carbohydrates, but it’s probably a bit easier to prevent glucose spikes if you have some reduction in simple sugars and refined carbohydrates. exercise provides a general health benefit, so we recommend a mix of aerobic and resistance training exercises which can be helpful in preventing cardiovascular disease and helping blood pressure. one of the important things in managing type 1 diabetes is not just controlling the glucose, but treating all risk factors for cardiovascular disease because that’s a long-term complication.
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many people who develop type 1 diabetes have no family history of type 1 diabetes. getty
many people who develop type 1 diabetes have no family history of type 1 diabetes. getty

how is type 1 diabetes generally treated?

dr. g: the cornerstone of management is insulin replacement. insulin is missing in the body, so we have to replace insulin and we try to do it in a physiological fashion — as best we can to mimic how the pancreas would produce insulin minute to minute, hour to hour, day to day. we’re just past the 100-year anniversary of the discovery of insulin, and some things have come a long way. before insulin was discovered, people with type 1 diabetes would basically die. now they’re living with this condition for many, many decades. that’s unmasked the fact that they are at risk of long-term complications of high blood sugar, so [that means] damage to the eyes, the nerves, the kidneys and also cardiovascular complications.
if you can try to normalize blood glucose, you can prevent or delay diabetes complications. so there are two ways that we can do this in type 1 diabetes. one is to give multiple daily injections of longer-acting or basal insulin, usually once a day, and then giving rapid-acting insulin before every meal to prevent the blood sugar from rising after eating. so these individuals are treated with four injections a day typically.
the other way is with an insulin pump that delivers rapid-acting insulin continuously throughout the day by a continuous infusion, a catheter that’s placed under the skin. then you supplement insulin at meals to prevent the rise in blood sugar after meals. now we have what we call hybrid closed loop insulin pumps which will communicate with a continuous glucose monitor device to automatically deliver insulin throughout the day. and the individual with diabetes learns to take extra insulin with each meal.
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treatment of type 1 diabetes is not just about the insulin, but also how to monitor blood glucose, because that’s changed dramatically over recent years. we’ve gone from self-monitoring of blood glucose by doing finger pricks to continuous glucose monitoring. it’s improved the quality of life of people with diabetes dramatically because you can get a continuous profile of your glucose.

what’s one piece of advice for someone with type 1 diabetes?

dr. g: i think people with type 1 diabetes now should be very optimistic about their future. years ago, it was very discouraging living with type 1 diabetes, worried about long-term complications and living with the day-to-day fear of hypoglycemia [low blood sugar that can make you shaky, anxious and light-headed]. now with modern management, people can expect to live a normal life, except for doing certain things that people without diabetes don’t have to pay attention to. one is monitoring your blood glucose and taking your insulin by pump or multiple daily injections, and two is paying a little more attention to a healthy lifestyle.
when i first started practising, we would see people with diabetes ravaged by complications, whether it is the amputations or blindness, cardiovascular disease, heart failure. and now with modern interventions, and not just insulin, but treating cholesterol and blood pressure, we can prevent these complications. it’s been very gratifying that we’ve dramatically reduced the rates of these severe complications.
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for more information about type 1 diabetes, visit diabetes canada.
 
karen hawthorne is a toronto-based writer.
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karen hawthorne
karen hawthorne

karen hawthorne worked for six years as a digital editor for the national post, contributing articles on health, business, culture and travel for affiliated newspapers across canada. she now writes from her home office in toronto and takes breaks to bounce with her son on the backyard trampoline and walk bingo, her bull terrier.

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