What is Type 1 Diabetes?
Type 1 diabetes, also known as insulin-dependent diabetes, is an autoimmune disease in which the immune system attacks certain cells in the pancreas called beta pancreatic cells. These cells are responsible for producing insulin, a hormone that regulates blood glucose levels.
Glucose is a vital "fuel" for cells, providing essential energy for physiological processes such as regulating body temperature or the function of brain cells. Insulin is secreted when blood glucose levels are high. It acts by binding to receptors on the walls of the body's cells, activating the storage of glucose within them.
When 80 to 90% of beta pancreatic cells are destroyed, insulin is no longer produced in sufficient quantities: it can no longer regulate blood sugar levels. Glucose accumulates in the blood chronically, which has deleterious effects on the body.
How does diabetes manifest?
The symptoms related to Type 1 diabetes are abrupt. The excessive amount of blood glucose (hyperglycemia) resulting from the lack of insulin generally manifests as vision problems, excessive thirst, fatigue, abnormal hunger, weight loss, or frequent urination.
The signs of the disease progress when the condition is not managed: nausea, vomiting, and drowsiness may also occur.
What are the risk factors for developing Type 1 diabetes?
The risk factors for developing Type 1 diabetes are still unknown. However, it is known that the disease is associated with a combination of genetic predispositions and "environmental" factors.
What are the tests to diagnose Type 1 diabetes?
Analyzing blood sugar levels
Blood sugar level analysis, glycemia, allows for a very reliable diagnosis; however, it must be confirmed by a second blood test. Blood sugar levels vary depending on calorie intake and physical activity. When fasting, the normal blood glucose level is between 0.74 g/L and 1.06 g/L. Above 1.26 g/L on two measurements, the person is considered diabetic (above 2 g/L and in the presence of symptoms, a single measurement is sufficient to diagnose).
Measuring glycated hemoglobin levels
Today, monitoring the effectiveness of treatment in a patient relies on controlling blood levels of "glycated hemoglobin." Hemoglobin is a protein found in red blood cells that transports oxygen in the body.
Hemoglobin can also bind to glucose: it is then "glycated," reflecting the blood glucose level. A blood level of glycated hemoglobin (HbA1C) between 6 and 7% indicates balanced diabetes, for the 3 months preceding the test. The glycated hemoglobin level is thus measured when Type 1 diabetes is discovered to have a reference value for monitoring.
What is the management of Type 1 diabetes?
Non-drug treatment
First and foremost, adhering to a balanced diet combined with physical exercise is a crucial element of managing Type 1 diabetes.
Also among non-drug interventions, quitting smoking to prevent cardiovascular complications of the disease is important.
Medical management
The standard treatment for Type 1 diabetes is to administer the missing insulin through subcutaneous injections using a syringe or an "injection pen," or continuously with a "pump." The dose of insulin to be delivered varies throughout the day and must be regularly calculated by the patient before injection.
The patient is thus an integral part of the management: learning is necessary when implementing treatment so that they can administer injections on their own.
How are patients with Type 1 diabetes monitored?
Poorly controlled diabetes leads to a number of problems.
To prevent cardiovascular complications, blood pressure and blood lipid levels must be checked. Any potential kidney failure should be screened for. Feet should also be given special attention. Indeed, diabetes causes a loss of sensitivity to painful sensations: the patient can then injure themselves without realizing it. Feet should therefore be regularly checked for possible infection. An eye examination is also recommended about once a year, as well as regular monitoring of dental health.
What are promising research areas in Type 1 diabetes?
Several research areas are being pursued in the management of Type 1 diabetes.
Firstly, as mentioned earlier, it is about identifying risk factors for developing the disease to detect it earlier. This could open up new therapeutic avenues.
In terms of treatments, hopes are high for cell therapy. This involves harvesting, from patients, immature cells, i.e., cells with the ability to multiply and specialize into any type of adult cell. Transformed into pancreatic beta cells in the laboratory, these cells would be transplanted into patients to replace those destroyed during the disease.
Pancreas or beta cell transplants from donors are also being explored. However, a drawback is that this approach requires taking immunosuppressive drugs to avoid rejection. Nevertheless, this technique is being tested for the management of forms of diabetes that are difficult to balance.
Another approach under investigation is to stimulate the regeneration of pancreatic cells with specific molecules to restore normal insulin production.
The development of an "artificial pancreas" is also a research path. This is an insulin pump that, coupled with a glucose sensor, truly supplants the organ by continuously injecting insulin according to the body's needs and without the patient measuring blood glucose. Devices are currently being tested in France.
Another avenue lies in the use of drugs that would modulate the immune system so that it no longer attacks pancreatic beta cells: this is immunotherapy. This research is also ongoing and could yield results in the future.
Today, research is more mobilized than ever to better understand Type 1 diabetes, its causes, its mechanisms, and to develop effective treatments.