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Stages of type 1 diabetes

Author: Dr Sorin Ioacara, MD, PhD
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Discover here: When does type 1 diabetes start? | Stage 1

The stages of type 1 diabetes are generally little known to both patients and doctors. The very concept of staging type 1 diabetes is a notion that has gained more shape only in the last 10-15 years. The diagnosis of type 1 diabetes is not very difficult in a child with a blood glucose of 400 mg/dl (22.2 mmol/l). If the child has been drinking a lot of water and urinating a lot for the last two weeks, things are even more straightforward.

However, our discussion refers to the possibility of diagnosing type 1 diabetes many years before this hyperglycemic moment, when the child is perfectly healthy.

There are four stages in the natural course of type 1 diabetes:

  1. Stage 1 – autoimmunity, asymptomatic, normoglycemia
  2. Stage 2 – autoimmunity, asymptomatic, prediabetes
  3. Stage 3 – autoimmunity, symptomatic, hyperglycemia
  4. Stage 4 – type 1 diabetes evolving for a long time

You can get the diagnosis of type 1 diabetes in any of these stages of evolution.

The stages of type 1 diabetes begin with the second specific antibody

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The stages of type 1 diabetes can begin only at least a few months after birth. Diabetes that starts in the first six months of life is never type 1 diabetes, but neonatal diabetes. At birth, you already have a constellation of genes, which can pose a low, medium or high risk for type 1 diabetes. These genes will then be present for the rest of your life. However, they are not enough to trigger the disease.

The primary cause of type 1 diabetes triggers autoimmunity

The risk of developing type 1 diabetes varies widely in the population. Current evidence is much better for risk factors acting after birth.

The cause of type 1 diabetes is that it can trigger the immune system’s response against pancreatic beta cells. It is very likely that initially, this response of the immune system is not constant, but in waves. The immune system attacks the pancreatic beta cells for a specified period. Then, a break will follow and so on.

The mechanisms of progression to type 1 diabetes differ from its cause

Gradually, the attack of the immune system becomes permanent, without periods of pause. The cause can sometimes disappear quickly after the initial aggression. Thus, only the mechanisms of progression to type 1 diabetes remain active in the long term, not its primary cause.

Current technology does not allow direct detection of immune system damage in the Langerhans Islands, which harbour the pancreatic beta cells. At least not in the living man.

Pathologic examination reveals pancreatic beta cells. It is usually done on the deceased patient or if at least one pancreas fragment is surgically removed. Pancreatic biopsy is extremely risky. That’s why it can’t be a routine option.

An indirect method of highlighting the attack of the immune system against pancreatic beta cells is the dosing of specific antibodies. The presence of a single antibody is not sufficient to diagnose the stage 1 of the type 1 diabetes.

The risk of type 1 diabetes in the presence of a single antibody is about 10%. The stages of type 1 diabetes start from the moment the second specific antibody appears.

Type 1 diabetes, stage 1

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The diagnosis of stage 1 of the type 1 diabetes involves the detection of at least two of the four specific antibodies. Also, all blood glucose levels must be within the normal range, including glycosylated hemoglobin. The particular symptoms of type 1 diabetes are not present at this stage. This is the real onset of type 1 diabetes.

Stage 1 of type 1 diabetes usually lasts for several years, sometimes even decades. Rarely, progression to stage 2 can be made quickly in just 1-3 months.

Most children (90%) who have a clinical onset of type 1 diabetes (stage 3) by the age of ten could have been diagnosed with stage 1 of the type 1 diabetes before the age of five. Once in stage 1, type 1 diabetes is a self-sustaining disease.

He will progress to stage 2, 3 and 4 no matter what we attempt to do. The interventions tried so far could only slow down the progression, not stop it.

Of great interest is the use of a drug, called teplizumab, in an attempt to slow the progression to stage 3. A recent study showed a doubling of the time required to reach stage 3 of type 1 diabetes (clinical onset).

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