Type 1 diabetes is a chronic medical condition in which the pancreas (an organ within the abdomen) does not make enough or any insulin, leading to high blood sugar (hyperglycemia). It may also be called juvenile diabetes, insulin-dependent diabetes, or childhood-onset diabetes.

Type 1 diabetes is an autoimmune process that leads to destruction of insulin-producing cells in the pancreas. This process takes place over many months or even years. Due to inherited genetic factors, some people are more likely to develop Type 1 diabetes than others; however, environmental factors, such as viral infections, also play a role and affect the development of the disease. People with type 1 diabetes develop antibodies that attack cells in the pancreas, causing less insulin to be made. Insulin is important because it helps sugar (glucose) get into other cells to provide energy for crucial body functions. If no insulin is available, the sugar stays in the blood, leading to high blood sugar. Chronically elevated blood sugar can cause significant problems such as poor vision or blindness, numbness, pain, or tingling of the extremities, cardiovascular disease, gastrointestinal issues, poor wound healing, kidney failure, and more frequent and serious infections. Poorly controlled type 1 diabetes can also cause diabetic ketoacidosis, a serious and potentially deadly complication. About 2-3 out of 1,000 children will have type 1 diabetes.

Signs and symptoms of type 1 diabetes include:

• Excessive urination
• Excessive thirst
• Weight loss or poor weight gain
• Irritability
• Headache
• Abdominal pain
• Bedwetting
• Drowsiness
• Fungal skin infections
• Nausea and vomiting
• Blurry vision

More information is available in our Type 1 Diabetes module in the Diagnostic Criteria section.

Type 1 diabetes can be diagnosed in several different ways. Blood tests can be performed to measure fasting or random sugar levels, and a hemoglobin A1c test can measure sugar levels over the prior 3 months. In the case of type 1 diabetes, these lab tests are often significantly elevated. Blood and urine tests can also check for ketones, a by-product from cells that are not getting enough sugar due to low insulin. Having too many ketones from diabetes can lead to diabetic ketoacidosis. Further testing may be done to identify genetic risk factors, the types of antibodies present in the body, and whether other body organ systems are affected.

With treatment, better control of elevated blood sugar levels can be achieved. Better sugar control is associated with better outcomes and can help reduce the risk of long-term complications. Poorly controlled sugar levels are associated with cardiovascular disease (heart attacks, strokes), kidney failure, nerve damage (peripheral neuropathy), damage to the eyes (diabetic retinopathy), foot ulcers, infections, and even death.

The risk of developing type 1 diabetes is significantly elevated in close family members of a patient with type 1 diabetes. However, although close monitoring is justified, testing family members without symptoms is not routinely recommended.

Insulin is the mainstay for treatment of Type 1 diabetes. Insulin helps to control the amount of sugar in the blood and helps the sugar get into the cells. Different foods and amounts of foods can change sugar levels, so balancing the amount of insulin with the right amounts and types of foods is important. Being active, exercising, and stress will also affect how much insulin is needed. Routine monitoring for complications with the primary care provider and other specialists is a key aspect of preventative treatment.

The family can help the child eat healthily, get the right amount of exercise, and help watch for signs of problems and complications. Younger children will need more help monitoring blood sugar levels and taking insulin. Regular check-ups with the medical home clinician and other specialists will be important in controlling type 1 diabetes and monitoring for complications and other associated diseases. Other illnesses and medications can affect blood sugar levels, and insulin amounts may need to be changed if blood sugar levels change. Anxiety and depression can happen as children deal with the stress of eating differently than their friends, taking medications more often, and other challenges of living with type 1 diabetes. Support groups may be helpful for the child or family.

Although the names are similar, type 1 and type 2 diabetes are 2 different conditions. Type 1 diabetes is typically caused when the immune system attacks the body’s insulin-producing cells. Type 1 diabetes is more commonly diagnosed in young children and early adolescence. People with type 2 diabetes develop insulin resistance and, over time, can also develop low insulin levels. The body still produces insulin, but it’s unable to use it effectively. Type 2 diabetes is more common in older children and adolescents; however, rates are increasing in younger children. If untreated, type 1 and type 2 diabetes can lead to similar symptoms.