Text Copyright 2007 by Nancy Sculerati MD - all rights reserved
- Juvenile Diabetes
- Type 1 Diabetes
- Insulin must be injected or the cells that make it must be transplanted - in juvenile diabetes, now more often called Type I diabetes, the body cannot make enough insulin.
Painting by Warren Prosperi depicts the administration of insulin by the first “wandering nurses.” Commissioned by the Joslin Diabetes Center in Boston.
Back when diabetes mellitus ("high blood sugar") was first recognized as a distinct disease, it was juvenile diabetes that was described.
That's one reason that this disorder is called Type 1 diabetes, it was the first type identified. Those early case reports were all of children. Today, Type 1 diabetes is also recognized in adults. Not only that, but diabetes mellitis is no longer delineated according to the age of the patient, but instead by the cause of poor insulin activity. What makes diabetes Type 1, (rather than another kind of diabetes mellitus) is:
- Partial or complete failure of the body to make insulin - in Type 1, there is always a true and absolute insulin deficiency. In other types of diabetes mellitus insulin may have an abnormally low effect on the body, (usually described as the body's "insulin resistance"), the actual amount of insulin being produced is not diminished. In this type of diabetes, type 1, the actual supply of insulin is low or absent.
- Ordinarily, this is because the pancreas, a digestive gland that makes the hormone, insulin as one of many duties, has stopped insulin production.
- Most patients with type 1 diabetes develop the disease in childhood, but it may start at any age.
- The most common age of onset is between 7-15 years of age.
- Insulin must be given to people with Type 1 Diabetes, they cannot make enough of their own.
- Insulin was first used in clinical care in the first decades of the 20th Century, and became part of hospital practice in the USA in the 1920's.
- Giving type 1 diabetics the back the capability of making their own insulin is considered an ideal treatment, if permanent and complete, this would be a cure.
- By the last decades of the 20th Century, transplantation of the part of the pancreas, the islet cells, that secrete insulin began to be used as a remedy. Less than 2% of these transplants were successful. In 2000, a group of researchers in Canada came up with modified methods for transplant ( now nicknamed"The Edmonton Protocol"), and have had success rates near 80% for 1-year survival of the grafted insulin producing cells. Unfortunately, only about of patients continue to make adequate insulin for as long as 5 years. (Bromberg JS. LeRoith D. Diabetes cure--is the glass half full?[comment]. [Comment. Editorial. Historical Article] New England Journal of Medicine. 355(13):1372-4, 2006 Sep 28.)
Typical Findings in Type 1A
- HLA alleles
Is it possible for a person to have more than one type of diabetes at once? Yes, there are overweight people who are and have the insulin resistance that is part of Type 2 diabetes, and also have Type 1A diabetes caused by auto-antibiodies to the insulin producing islet cells in the pancreas.
- It is not thought that the one has anything to do with bringing on the other, instead each is viewed as arising as an independent entity; two bad cards dealt in the same hand, so to speak.
- Alemzadeh, R and WyattBehrman, D: Chapter 583 – Diabetes Mellitus. in Nelson Textbook of Pediatrics, 17th ed. Copyright © 2004 Saunders, An Imprint of Elsevier
- Mitka M. Poor patient adherence may undermine aim of continuous glucose monitoring. [News] JAMA. 298(6):614-5, 2007 Aug 8.
- Cody D. Infant and toddler diabetes. Archives of Disease in Childhood. 92(8):716-9, 2007 Aug.
- JDRF:Juvenile Diabetes Research Foundation International
- Non-profit organization - offers free newsletters, on-line and in-person patient support groups, raises money for research, awards grants to scientists, offers education
- DiabetesKIDSandTEENS.com
- Part of the Diabetes Australia New South Wales website