Type 1 Diabetes: The Basics
What even is Type 1?
T1D is an autoimmune disorder in which the beta cells of the pancreas stop working. This is a big deal because your beta cells make insulin, which is needed for your body to properly utilize carbohydrates. This is super dangerous and can cause a ton of long term and short term complications.
How is T1D different from all the other types of Diabetes
Most people only know about type 2 diabetes because that’s most of what we hear about in the news, but there are actually a bunch of different types of diabetes. All types of diabetes either affect the body’s ability to produce insulin, or properly utilize insulin. Let me break down the most common types for ya in a super over simplified way:
Type 1: Basically, the body can’t make insulin anymore because part of the pancreas stopped working. But other cells in the body still know what to do with insulin when its around.
Type 2: The pancreas still works fine (for now), but other cells in the body don’t know what to do with insulin when it’s there (insulin resistance).
Pre diabetes: Similar to type 2, but the cells still kinda sorta know how to interact with insulin so it’s not great but not bad enough to be labeled type 2 yet.
Gestational Diabetes: This is also similar to type 2, but it’s diagnosed during pregnancy.
Cystic Fibrosis related Diabetes: This is when CF related complications cause damage to the pancreas which stops insulin production (similar to type 1), and at the same time many of the medications used to treat the CF have the side effect of insulin resistance (similar to type 2). This is a super complex disease that basically combines both type 1 and type 2 together.
Chronic Pancreatitis Associated Diabetes: Having pancreatitis does a lot of damage to all different parts of the pancreas over time, including impairing the pancreas’s ability to produce insulin.
Latent Autoimmune Diabetes in Adults (LADA): This is another form of type 1 diabetes, but the onset is in adulthood and usually has a slow progression, leading doctors to often misdiagnose this condition as type 2 diabetes because it often looks like the pancreas is still producing insulin.
How do you treat T1D?
With insulin! Sounds easy enough, right? Wrong. Here’s the problem: our pancreases are super awesome at what they do! When functioning correctly, they’re able to give us the perfect amount of insulin exactly when we need it in response to how we’re eating, sleeping, moving, and feeling. It’s legit not possible for a human to be that precise. Ever. Here’s a list of 42 different things that affect blood sugar. Imagine trying to make a decision based on all of these different things at once… So yes, we have different types of insulin and all these cool technologies out there, but they’re not enough to function the way healthy beta cells would.
Wait, there’s more than one type of insulin?
Heck yeah! There’s actually 3 different categories, but we really only use two of them:
Short acting: this kind of insulin ”works” quickly and for only a short period of time after being injected (a few minutes-hours). It’s mostly used as needed throughout the day (with meals, for corrections, etc…)
Long acting: this kind of insulin “works” slowly and over a long period of time after being injected (12-24hrs). This insulin is taken once or twice a day and works in the background as what we call “basal” insulin.
NPH/mixed/70-30: This insulin is kind of a mix between the two, and honestly hardly anyone uses this anymore.
Insulin is expensive in the US and not always accessible in other countries. This is, obviously, super problematic as insulin is an absolute requirement for someone with type 1 diabetes to live.
Tell me about the technology!
Pumps: Insulin pumps are an alternative to injections as a way to receive insulin. Most of them look like an old school pager or iPod, they hold insulin, and are attached to the body via a tube (with the exception of the OmniPod, which is a tubeless pump) Important: while for some people having a pump makes their diabetes management easier, it’s not because the pump is automatic or just does it all for them! It’s really frustrating to most people who have pumps when you make that assumption. We’ll chat below about the pumps that are starting to trend toward automatic, but most pumps are simply just another way to hold and receive insulin, the user still makes all the decisions. Also note: only short acting insulin is used in an insulin pump!
Continuous Glucose Monitors (CGMs): A CGM is a device that has a tiny sensor inserted under the skin and is able to read blood sugars and transmit that information to a device like your smartphone. Although most still require at least a few calibrations via finger pricks, this is a way to reduce the number of finger pricks. These devices are also an awesome tool for many because they show blood sugar trends over time, which makes it easier to make decisions about how to treat a blood sugar!
Auto-Mode: there actually is one insulin pump currently that is designed to connect with a CGM and is able to make some decisions about insulin dosing automatically. I have heard mixed reviews so far, but I totally geek out over the technology that makes this possible!
Looping: This is a super unofficial (meaning this has NOT been FDA approved) diabetes management technology that uses an app and coding that several individuals with type 1 put together as a way to link your pump and CGM and have them work together similar to auto-mode described above. If you’re interested in learning more, there’s a great article and video from Beyond Type 1 on this topic.
Apps: There are hundreds of different apps that make all different aspects of diabetes management more accessible and seamless.
How does T1D affect relationship with food?
Honestly this could (and probably will be) and entire blog post in itself eventually. But essentially what it comes down to is how frequently and significantly T1D related decisions and thoughts affect what you do and how you feel about your food and your body. It’s kind of a mess, and one of the most perfect set ups for an eating disorder I could possibly imagine. If you feel like type 1 is seriously affecting your relationship with food or leading you to use disordered behaviors, let’s work together! You deserve better and I want to help!