Type 1 Diabetes — “Four Key Players”

Joseph R. Anticaglia MD
Medical Advisory board

Deaths in the United States due to diabetes have exceeded 100,000 for the years 2020, and 2021. The CDC reports, “37.3 million” Americans of all ages have diabetes. “And the percentage of adults with diabetes increased with age, reaching 29.2% among those aged 65 years or older.”

The body breaks down sugars from our diet into glucose which the cells need to produce energy. The hormone insulin allows glucose to enter the cells of the body.

Type 1 Diabetes is a chronic disease in which the pancreas, the organ located behind the lower part of the stomach, loses its ability to produce any insulin.

Type 2 Diabetes happens when the body’s cells fail to respond to insulin. They’re insensitive to insulin. The cells shut their door , and don’t allow insulin to enter.

If you have diabetes, glucose is not being properly metabolized (processed), and it is found in high concentration in the blood and urine. Untreated, this condition over time can lead to heart and blood vessel damage, kidney failure, eye problems, nerve damage and potentially lower extremity amputation.

Four Key Players in Diabetes

  1. Glucose
    The body needs the fuel, the energy of glucose in its cells so that the heart, nerves, and other organs and tissues can function normally. Food and the liver supply the cells with glucose, but it cannot enter the cell without the help of insulin.
  2. Insulin
    Insulin is the hormone secreted by the beta cells of the pancreas that lowers the amount of glucose in the blood. Insulin circulates in the bloodstream and is the key that unlocks the cells allowing glucose to enter with the fuel they need.
  3. Glucagon
    This hormone is secreted by the alpha cells of the pancreas. It is the inverse of insulin. When there is too much circulating glucose in the bloodstream, insulin lowers the level of glucose in the blood. When there is not enough glucose circulating in the blood, glucagon raises the level of glucose in the blood.
  4. Liver
    If you have hyperglycemia, too much sugar in the blood, the liver will take the excess glucose and store it as glycogen. If the level of glucose is too low, hypoglycemia, the hormone glucagon will send a message to the liver to break down glycogen in the liver to glucose, and release it into the blood.

NIDDK People with type 1 diabetes need to take insulin every day.

Type 1 Diabetes is an autoimmune disease, meaning the person’s immune system mistakenly attacks the insulin producing cells of the pancreas. As a result, the pancreas doesn’t make any insulin. This lack of insulin causes a buildup of blood glucose (hyperglycemia) and in the urine (glycosuria). Glucose must have insulin for it to enter the body’s cells. Insulin is the key that unlocks the doors allowing glucose to enter the body’s cells.

Type 1 diabetes was commonly called “Juvenile” diabetes because the condition was diagnosed in children and young adults. People with type 1 diabetes require insulin shots every day. This insulin dependent diabetes can develop at any age, but in the U. S., most occur in children between four and fourteen years of age.

The CDC reports approximately 1.6 million Americans are living with diagnosed Type 1 Diabetes requiring daily insulin shots. This includes about 210,000 youngsters less than twenty years of age. The signs, and symptoms vary and can appear suddenly.

Signs and Symptoms

Type 1 diabetic patients can experience increase thirst, frequent urination, blurred vision, feeling tired, and unintended weight loss. Children might experience nighttime bed-wetting who previously did not have this problem. Lab tests report a high concentration of glucose in the blood, and urine.


The exact cause of type 1 diabetes is unknown. Ninety five per cent of the time an autoimmune reaction destroys the insulin producing beta cells in the pancreas. A person’s genetic makeup, and environmental factors have been considered as possible causes contributing to this disease.


Blood Glucose tests are used to diagnose diabetes, in particular, the AIC. Other blood tests include the fasting and random glucose tests.

  • A1c test — done any time No need to fast. Measures the average blood glucose level over the past two to three months.
  • Fasting Glucose test — usually done in the morning. Nothing to eat or drink for 8 hours prior to the test.
  • Random Glucose Test — done any time No need to fast.

Complications — Emergencies

Two complications are:

  • Ketoacidosis
  • Hypoglycemia.

Ketoacidosis (DKA) is a life-threatening emergency. With an extremely high level of glucose in the blood, the person’s glucose doesn’t enter the cells. In this situation, the body uses fats for energy. The problem happens when fats break down and form excess, toxic acids called ketones. The person must go to the emergency room for treatment if he experiences chest pain, abdominal pain, nausea and vomiting to avoid becoming unconscious.

Hypoglycemia, or low blood sugar. is another life-threatening emergency that requires immediate treatment. Dietary habits, and exercise are considerations in calculating insulin dosage Injecting too much insulin can cause a dramatic drop in blood sugar leading to a hypoglycemic coma.

People may feel anxious, complain of being tired, having a headache, and a tingling sensation of the lips or tongue. They look pale and sweaty and may complain that their “heart is racing.” They need sugary foods or drinks into their system as quickly as possible. If symptoms are not reversed, they need to be taken to the emergency department for treatment.

With ketoacidosis the goal is to bring down the level of glucose in the blood; with hypoglycemia the

Objective is to “up” the level of glucose in the blood.


People with type 1 diabetes must take insulin every day. In addition, they need to follow a healthy life-style, eat a healthy diet on a regular schedule, and home test their blood glucose level. If a person’s routine eating and exercise schedule has changed, they’re obligated to do home testing more frequently.

If you are a parent with a child with T1D, close consultation with your physician is mandatory. One needs to understand how to prevent, and manage complications , such as hypoglycemia..

Type 1 diabetes is a chronic, autoimmune disease that attacks and destroys the beta cells of the pancreas. This condition develops quickly, and usually affects children, and young adults under the age of twenty. People with this disease do not, cannot make insulin. They require daily insulin injections, or the use of an insulin pump to survive. Symptoms can appear suddenly, and can be life-threatening. Currently, no one knows how to cure or prevent this disease. But the outlook is good for those who monitor their blood glucose level, manage their insulin dosage, regulate their diet, and exercise, and control the stress in their lives.


  1. NIDDK — National Institute of Diabetes and Digestive and Kidney Diseases; Type 1 Diabetes; July 2017
  2. Centers for Disease Control and Prevention. National Diabetes Statistics Report website. https://www.cdc.gov/diabetes/data/statistics-report/index.html. January 18, 2022
  3. CDC National Diabetes Statistic Report, 2020
  4. Joseph R. Anticaglia, MD; Continuous Glucose Monitoring (CGM) How It Can Prevent Low Blood Sugar Emergencies; Doctor’s Column, HC Smart, 2020
  5. Melissa F. Brereton et al; Alpha-, Delta- and PP-cells; J Histochem Cytochem. 2015 Aug; 2015


NIDDK — National Institute of Diabetes and Digestive and Kidney Diseases

Hyperglycemia — high concentration of glucose in the blood plasma

Glycosuria — high concentration of glucose in the urine

Diabetes Mellitus is a disease in which the body loses its ability to produce or respond to insulin causing abnormal carbohydrate metabolism, hyperglycemia, and glycosuria (diabetes -go through, siphon, mellitus — sweet).


If you have large swings in your blood glucose levels, your doctor might advise you to consider continuous glucose monitoring or getting an insulin pump.

Diabetes type 2 is scheduled to be the subject of a future article.

This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.