Blame it on the beta cells
Written by Karen Jameson, Registered Nurse, Credentialled Diabetes Educator
As health professionals, we have seen a variety of terms to describe type 1 diabetes over the years. For a long time, it was referred to as ‘juvenile diabetes’ because it was the most common type of diabetes among children, teens and young adults. The diagnosis was often between the ages of 12 months to 15 years. We now realise that type 1 diabetes can affect all ages, and the name evolved to ‘insulin-dependent diabetes Mellitus’ (IDDM) and eventually ‘type 1 diabetes’ in the 1990s.
The onset of diabetes in children is often sudden. One to two weeks of high glucose levels symptoms (increased thirst, urination and tiredness) leading to diabetes ketoacidosis (DKA). However, in adults, the destruction of beta cells can be gradual. As a result, it could be misdiagnosed.
Beta cell destruction
We often tell our clients that developing type 1 diabetes is not their fault. However, one of the most common questions from parents of newly diagnosed children is how they can rejuvenate the beta cells so we can cure diabetes.
Type 1 combines a genetic predisposition and a stressor in the environment. This combination starts the autoimmune destruction of the beta cells that produce insulin.
For those that have a high risk of developing type 1 diabetes, we know that:
- Those with a family history of type 1 have a 15-fold risk of potentially developing diabetes
- Most people with type 1 diabetes produce autoantibodies years before seeing high glucose levels and needing to go onto insulin.
- It can take a few weeks to a few years for the beta cells to be destroyed.
- The symptoms of high glucose levels (increased urination, thirst, and tiredness) usually occur when 90% of the beta cells are damaged.
The three stages of type 1 diabetes:
- Stage 1 – The appearance of two or more islet autoantibodies marks the start of autoimmune destruction of the beta cells. Glucose levels are within the target range.
- Stage 2 – The appearance of multiple islet antibodies, raised glucose levels, and more beta cells are damaged, but no symptoms
- Stage 3 –The majority of beta cells are destroyed and symptomatic, and a diagnosis of type 1 diabetes is confirmed
Individuals who know they are at risk could delay the onset if they are in stage 2. Stage 2 is linked with nearly a 100% lifetime risk of progression of type 1 diabetes and a 75% risk of developing the condition within five years. So how do we identify those that are at risk?
Screening for autoantibodies
- Screening aims to identify children in the early stages of type 1 diabetes before the autoimmune attack has progressed and signs and symptoms, or DKA, have developed.
- Early diagnosis through screening can reduce the trauma experienced by families and individuals. It also provides immediate and lifelong health benefits for the child and the family.
In Australia, there are currently two types of diabetes screening programs.
Type 1 screen
This program offers antibody testing to children and young adults to determine if they are at risk of developing type 1 diabetes. People who are found to test positive are monitored closely, and if they develop type 1 diabetes will be started on insulin early to avoid serious illness. Find out more at type1screen.org
Population screening
The Type 1 Diabetes National Screening Pilot aims to find the best way to screen those who do not have a relative with type 1 diabetes.
Most children will receive a negative screening test result. This result means they do not have markers of type 1 diabetes in their blood and do not currently have type 1 diabetes.
Screening is free, simple, quick and safe. A simple finger prick in children ages 2, 6 and 10 can identify early-stage type 1 diabetes. Find out more at kidsdiabetesscreen.com.au
Introducing Immune therapy to delay the onset of type 1 diabetes
Teplizumab (brand name Tzield) has been approved by the US Food and Drug Administration (FDA). It is the first drug approved for use in those with autoantibodies to delay the onset of type 1 diabetes.
- Teplizumab is an immunotherapy drug that binds to specific immune system cells to deactivate the cells that attack insulin-producing cells. This would delay the progression to stage 3.
- Teplizumab is administered by intravenous infusion once daily for 14 consecutive days.
- Trials have shown that Teplizumab delays type 1 diabetes by about two years.
- It has yet to be available in Australia.
Who can benefit from immune therapy?
Teplizumab aims to delay the onset of type 1 diabetes in children (aged eight years and older) and adults in stage 2.
We know that beta cell failure can occur years before the diagnosis of type 1 diabetes. By screening early and reducing the symptoms of hyperglycaemia, we can decrease the rates of DKA. In addition, commencing immunotherapy will delay the onset of diabetes. This will provide an individual time to prepare for the diagnosis, prevent the onset of being very unwell with DKA, and provide more time for learning and understanding.