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

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.

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.

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.

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.

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.

for more information about type 1 diabetes, visit diabetes canada .

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

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