What is type 1 diabetes? Type 1 diabetes is an autoimmune disease that requires lifelong treatment. This type of diabetes affects around ten percent of all diabetes cases in adults worldwide. The good news is that with the right treatment, people affected by this type of diabetes can still live an active and fulfilling lifestyle!
Type 1 diabetes usually has nothing to do with an unhealthy lifestyle and obesity – as is the case for type 2 diabetes. Type 1 diabetics’ immune systems attack their pancreas, which is then no longer able to produce the vital hormone insulin. Those affected must therefore be treated with insulin for the rest of their lives.[1, 2]
In this article, you will find out exactly what insulin is and why your body needs it. You can also read about type 1 diabetes symptoms, how type 1 diabetes is diagnosed, and what type 1 diabetes treatment options are available. You will also discover answers to commonly asked questions about what risk factors there are and what role nutrition plays in type 1 diabetes.
What Is Type 1 Diabetes?
You have probably heard that there are different types of diabetes. We distinguish between type 1 diabetes and type 2 diabetes. The two types are triggered by different factors and are also treated in different ways.
Type 1 diabetes an autoimmune disease, whereby your immune system attacks and destroys your own pancreatic cells. One of the important functions of the pancreas is to produce insulin, a vital hormone that is mainly responsible for regulating our blood sugar levels. It transports sugar from our blood into our body’s cells, so that each individual cell is supplied with energy. Without insulin, our cells would virtually starve; almost no body cell can perform its functions without the hormone.
This attack on the immune system means that the pancreas produces less and less insulin. Eventually, it stops producing it altogether. When the amount of insulin in your body has significantly decreased, this triggers type 1 diabetes –usually suddenly.
Type 1 Diabetes Versus Type 2: What’s the Difference?
Type 2 diabetes is also a pancreatic disease, but it typically develops over a long period of time. An unhealthy lifestyle, but also a genetic predisposition can increase your risk of developing the disease.
With type 2 diabetes, the role of insulin in the body gradually becomes less effective. Insulin becomes increasingly less able to transport sugar from the bloodstream into the individual cells of the body and thus less able to lower blood sugar. This is known as insulin resistance.
You can cure type 2 diabetes by changing your lifestyle – for example, by exercising more and losing weight. This is not possible with type 1 diabetes.[5, 6]
For an overview of the differences between diabetes type 1 and 2, see our article on diabetes mellitus.
Type 1 Diabetes Risk Factors: Who’s Often Affected?
A predisposition to type 1 diabetes can be inherited. If both parents suffer from type 1 diabetes, the child’s risk is quite high. If only one parent has type 1 diabetes, the child is less likely to be affected by the disease. Only about ten out of 100 people with a hereditary predisposition actually develop type 1 diabetes.
Researchers therefore suspect that, in addition to genetic predisposition, other type 1 diabetes risk factors contribute to the onset of type 1 diabetes. Experts assume that nutrition in infancy, early infections with Coxsackie viruses (which cause hand, food, and mouth disease), and various environmental factors also have an influence. It is not possible to say exactly which environmental influences have an impact on the development of the disease, as research on this is still ongoing.
Did you know that the risk of developing type 1 diabetes can now be determined in newborns by means of a genetic test? This makes it possible to identify children whose risk of developing type 1 diabetes is greater than ten percent by their sixth birthday. Clinical trials are currently underway with the aim of preventing type 1 diabetes from developing in young people at risk.
What Are Typical Type 1 Diabetes Symptoms?
The onset of diabetes type 1 disease can make itself known in various ways. Type 1 diabetes can appear suddenly within a few months, but it can also develop quite slowly over a long period of time. The first signs and symptoms of diabetes type 1 are:
- a very high urge to urinate,
- a significantly greater feeling of thirst, and
- an unwanted loss of weight.
If you notice these typical type 1 diabetes symptoms, you should consult a doctor.
What Is Ketoacidosis?
When blood glucose levels suddenly become very high, experts call this “ketoacidosis.” Symptoms include nausea, vomiting, changes in consciousness, and difficulties breathing. In this ever happens to you, you should immediately call 911.[4, 7]
How Is Type 1 Diabetes Diagnosed?
To diagnose type 1 diabetes, our blood’s sugar concentration is the most important factor. The following measurements are used for this:
- HbA1c (long-term blood glucose value)
- Fasting plasma glucose test (FGT)
- Oral glucose tolerance test (OGTT)
Why Is HbA1c Measured?
A long-term blood sugar value HbA1c determines your blood sugar concentration over the last two to three months. A blood sugar (HbA1c) test is performed by taking a blood sample. If the HbA1c value is greater than or equal to 48 mmol/mol or 6.5 percent, this indicates diabetes. If the measured value is less than 39 mmol/mol or 5.7 percent, you can safely rule out diabetes.
If a HbA1c value is between these two values, a fasting blood glucose value is usually also determined. To find out more about normal blood sugar levels, read our dedicated Health Portal article.
What Is Fasting Plasma Glucose?
You can also determine your fasting plasma glucose value by a blood test. Here, however, it is important that you have remained fasting for at least eight hours beforehand, i.e. that you have not eaten anything. A value greater than or equal to 126 mg/dl or 7.0 mmol/l indicates diabetes.
What Can a Oral Glucose Tolerance Test Tell Me?
The oral glucose tolerance test provides you with information about how well the sugar from your food is absorbed by your body cells. This test plays a minor role in detecting type 1 diabetes. It is more commonly used to detect type 2 diabetes.[4, 6]
Type 1 Diabetes Treatment: What Can I Do?
Type 1 diabetes treatment is composed of different elements. The most important is insulin therapy. In addition, nutritional consultations with experts to learn about monitoring your own glucose levels are recommended. You should also consider asking for emotional support from experts, family, and friends, so that you can better adjust to your new lifestyle.
What Does Insulin Therapy Do?
If you have been diagnosed with type 1 diabetes, lifelong insulin therapy is unfortunately unavoidable. In insulin therapy, you are injected with insulin to compensate for your body’s lack of its own insulin. In other words, you undergo this form of type 1 diabetes treatment to regulate your blood glucose levels yourself.
Carrying out insulin therapy in your everyday life is not without its difficulties. You need to take many different factors into account, such as your personal insulin requirements, how the food you eat impacts your daily insulin requirement, and how you inject yourself with insulin. That’s why certain specialized practices or clinics, for example, offer special training courses that you should attend at the start of insulin therapy.
In general, there are two forms of insulin therapy:
- conventional insulin therapy (two injections a day at fixed times)
- intensified insulin therapy (several injections a day at flexible times)
Depending on the form of insulin therapy chosen, you inject a specific type of insulin. Which insulin therapy is right for you may depend, for example, on your individual lifestyle, but you can make your decision together with your doctor.
What Is a Basal Bolus Regimen?
Basal bolus therapy is often recommended for type 1 diabetics. This is a form of intensified insulin therapy during which several insulin injections are administered per day. The injections are not given at fixed times, as with conventional therapy, but are based on the current blood glucose level, the amount of food eaten, and physical activities.
With basal bolus therapy, you receive a long-acting insulin that covers your basic insulin needs and a short-acting insulin that you inject flexibly at your meal times. This allows for better blood glucose regulation and a flexible as well as active lifestyle. If you use an insulin pump to supply your body with insulin, only short-acting insulin is administered throughout the day.[7, 8]
How Much Insulin Is Needed per Day?
Type 1 diabetics suffer from an absolute insulin deficiency. This means that your body produces little or no insulin. Type 1 diabetes treatment is based on how much insulin your own pancreas still produces and how much would be normal in non-diabetic people.
Insulin sensitivity – that is, how well insulin is absorbed by the body’s cells – is individual and must also be taken into account. In addition, the following factors must be considered:
- BMI (body mass index)
- Physical activity
- Other diseases
- Intake of medication
- Daily food intake
Does Diet Affect Type 1 Diabetes?
Diet plays a crucial role in insulin therapy for type 1 diabetes. Above all, those affected should be able to assess how what they eat affects their insulin levels.
It is particularly important to know how high the carbohydrate, fat, and protein content is in certain foods. The proportion of carbohydrates, for example, is measured in bread units. These provide an orientation of how high the insulin dose should be before or after a meal. Nutritional coaching, which is an important part of type 1 diabetes treatment, teaches you how to best change your diet.
How Much Is a Bread Unit?
One bread unit corresponds to 12 grams of carbohydrates. A thin slice of white bread corresponds to exactly 1 bread unit. For foods such as cheese, fish, meat, and also most types of vegetables, no bread unit needs to be calculated, as they contain hardly any carbohydrates.
You should calculate bread units for the following foods in order to know your insulin dose:
- Cereals and grains such as pasta, bread, rice, and flour
- Vegetables such as pumpkin, parsnip, beet, corn, potatoes, sweet potato, and turnip
- Legumes such as lentils, beans, and chickpeas
- Soy products such as drinks and yogurt
- Sugary desserts
To start with, you should weigh the foods and calculate the bread unit before each meal. Over time, you will get a feel for how many bread units are in which foods. This just takes some time and patience.
This is how you calculate the bread unit of a food:
(carbohydrate content per 100 grams ÷ 100) × (amount consumed in grams ÷ 12) = bread unit
For example: You want to determine the bread unit for a slice of wholemeal bread (30 grams). The bread has a carbohydrate content of 40 grams per 100 grams. The calculation then looks like this:
(40 ÷ 100) × (30 ÷ 12) = 1 bread unit
If you want to calculate the bread units for a sandwich with butter, ham, and cucumber, you only have to calculate the bread units for the bread. The other ingredients contain little to no carbohydrates and will therefore not impact your the insulin dose.
Is a Special Diet Necessary for Diabetes?
A special diet is generally not necessary for type 1 diabetes. The general recommendations for a healthy diet apply: Eat plenty of fresh vegetables, fruit, and whole grains, and generally eat a diet rich in fiber. Fiber ensures that blood sugar rises only slowly after a meal and thus helps to regulate blood sugar better.
Alcohol consumption should be kept to a minimum, with a maximum of 10 grams of alcohol per day – a recommendation that also applies to non-diabetics. For type 1 diabetics, drinking too much alcohol carries the risk of severe hypoglycemia during the night. This risk can be reduced by eating while drinking alcohol.[6, 7]
What Is Type 1 Diabetes – at a Glance
What Is Type 1 Diabetes?
Type 1 diabetes is an autoimmune disease. In this case, the immune system attacks the body's own cells of the pancreas, so that it can only produce little or no insulin.
If little or no insulin is produced, blood sugar levels rise sharply and can no longer be regulated by the body itself. Insulin therapy is then required.
What Are Typical Type 1 Diabetes Symptoms?
The first signs and symptoms of type 1 diabetes are a strong urge to urinate, a significantly greater feeling of thirst, and unwanted weight loss.
If the disease occurs suddenly and blood glucose levels rise sharply, experts refer to this as ketoacidosis. This results in symptoms such as nausea, vomiting, and difficulties breathing.
In such a case, you should call the emergency services immediately.
How Do You Diagnose Type 1 Diabetes?
There are three different ways to diagnose type 1 diabetes, HbA1c (long-term blood glucose value), fasting plasma glucose (FGT), and an oral glucose tolerance test (OGTT).
What Forms of Type 1 Diabetes Treatment Are There?
Type 1 diabetes requires lifelong insulin therapy. This means insulin is injected daily to regulate blood glucose levels.
In type 1 diabetes, basal bolus therapy is often used. This is when the dose of insulin injected is calculated depending on what you eat.
 International Diabetes Federation (IDF), “Facts & figures,” available at https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html, accessed on May 11, 2021.
 Helmholtz Zentrum München, “Wie entsteht Diabetes Typ 1? - diabinfo.de,” available at https://www.diabinfo.de/leben/typ-1-diabetes/grundlagen/entstehung-und-risikofaktoren.html, accessed on April 20, 2021.
 K. W. S. Ashwell, Anatomie und Physiologie - Der menschliche Körper und seine Funktionen, 2016.
 Helmholtz Zentrum München, “Diabetes Typ 1 - diabinfo.de,” available at https://www.diabinfo.de/leben/typ-1-diabetes.html, accessed on April 20, 2021.
 Helmholtz Zentrum München, “Wie entsteht Diabetes Typ 2?” available at https://www.diabinfo.de/leben/typ-2-diabetes/grundlagen/entstehung-und-risikofaktoren.html, accessed on April 27, 2021.
 A. Neu und M. Kellerer, Diabetologie und Stoffwechsel - Praxisempfehlungen der Deutschen Diabetes Gesellschaft. Thieme Verlag, 2020.
 Deutsche Diabetes Gesellschaft, “S3-Leitlinie Therapie des Typ-1-Diabetes, 2. Auflage,” p. 109, 2018.
 Helmholtz Zentrum München, “Diabetes: Insulintherapie,” available at https://www.diabinfo.de/leben/behandlung/insulintherapie.html, accessed on May 4, 2021.
 Deutsche Diabetes-Hilfe e.V., “Wie werden Broteinheiten (BE) berechnet?” diabetesDE - Deutsche Diabetes-Hilfe, November 28, 2017, available at https://www.diabetesde.org/broteinheiten-berechnet, accessed on May 11, 2021.