The Type 1 Diabetes Stages


HeConnection-Informed-Type 1 Diabetes StagesA common question at diagnosis is, “Could this have been coming on for a while?” The usual answer is, “No, Type 1 diabetes comes on very suddenly, in a matter of weeks, as the body’s beta cells suddenly die out under attack from the immune system. But it turns out they were wrong. Three type 1 diabetes stages have been identified and described.

JDRF and the American Diabetes Association, supported by other organizations in the field, recently put forth a new staging system for type 1 diabetes, where full-blown disease is characterized as stage 3, part of an extended autoimmune process that often starts in infancy. This fall, Dr. Richard Insel, JDRF’s Chief Scientific Officer, explained the classification system to a group of reporters, talking through the importance of early diagnosis, and the hope that diagnosing the disease at an earlier stage could lead to breakthroughs in stopping the beta-cell destruction process—essentially, stopping the disease before it starts.

Insel explained that stage 1 is when people test positive for multiple pancreatic islet auto-antibodies, meaning that the immune system has begun to attack the pancreas. If you are a sibling of a person with type 1 diabetes, you can get tested for these auto-antibodies, through TrialNet. (1) our children who do not have diabetes are tested every year, since siblings are at greater risk than others.

In stage 2, people start processing glucose differently. While people in stage 2 are not yet experiencing the classic signs of type 1 diabetes (weight loss, tiredness, excessive thirst and polyuria), if given a glucose-tolerance test, their blood sugar would rise more than normal. The HbA1c (a measure of average blood glucose level over a three-month period) might also start rising above normal.

The abstract for the 3 type 1 diabetes stages is: “Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association.” (2) 

Being able to diagnose diabetes early, before precipitous loss of beta cells catapults someone into full-blown disease is important for a few reasons.

  • Right now, many children (46%, according to one study, of children in Colorado) are not diagnosed until they are in DKA (diabetic ketoacidosis), a condition that is fatal if not caught in time.
  • The later in the disease process someone is diagnosed, the more beta cells have already been destroyed. One of the things researchers are looking into is whether having more beta cells at diagnosis leads to better outcomes in terms of glucose control and long-term complications from the disease. The hope is that researchers will figure out a way to stop the progression to full-scale disease while patients are still in stage 1 or 2; right now, this idea is being tested through clinical trials, including a couple of studies conducted by TrialNet. (3)

Type-1-Diabetes-StagesResearchers have gained an understanding of these pre-symptomatic type 1 diabetes stages through the TrialNet data, and through studies including TEDDY (The Environmental Determinants of Diabetes in the Young), which for the past decade has been collecting data from 400,000 children genetically at risk of developing T1D.

Insel described how these studies have helped change our idea of when the disease begins – and when you’d have to intervene to keep it from developing.

“One of the things we know from TEDDY, which I don’t think we appreciated ten years ago, is that with childhood onset of type 1 diabetes, the autoimmune process begins very early in life,” Insel said.

People who develop T1D as children have already developed their autoantibodies during the first 2-3 years of life, with peak incidence at nine months of age. This is why any efforts to head off the disease need to happen early, perhaps as a vaccine in infancy.

While someone who tests positive for one autoantibody may never develop the disease, someone with multiple autoantibodies has a much greater lifetime risk. As Insel explained it: “The more autoantibodies you have, the more aggressive the autoimmune destruction is… the faster your rate of progression.” Another factor in speed of progression is the age you are at the onset of autoantibodies, or stage 1. In other words, while a very young child might progress from stage 1 to stage 3 in a matter of months, an adult might progress over a period of years or decades.

Lori Laffel, M.D., M.P.H., Chief, Pediatric, Adolescent, and Young Adult Section at Joslin Diabetes Center says “The overall goal is to try to develop approaches that can preserve residual beta cell function, but that means we have to identify risk for type 1 diabetes before substantial amounts of beta cells have been irreversibly destroyed by the immune system. If this earlier stage can be identified with certainty, there can be interventions earlier in the process when there are greater amounts of functioning beta cells to preserve, rather than at the current stage of diagnosis when the overwhelming majority have been destroyed or damaged”

“Or even if you do progress to type 1 diabetes, you may progress with ongoing residual beta cell function which makes management of type 1 diabetes easier for the future,” says Dr. Laffel.

What would you do differently if your child tested positive for multiple autoantibodies months or years before their diagnosis? Or, if difficulty regulating blood sugar levels was confirmed by an HbA1c test?  While there is nothing proven yet to stop the autoimmune attack, #VeryLowGlycemic and low #InsulinDemand foods may help preserve as many remaining beta cells as possible. That’s why we do what we do.

Here’s hoping that someday all kids will be diagnosed at stage 1, and that they won’t progress to type 1 diabetes as we know it today.

Health-e-Solutions comment: Glad to see the stages recognized even by the mainstream diabetes organization now, and acknowledging that early intervention might preserve remaining beta cells. This is what we believe happened with our two boys with type 1 diabetes. Thanks to our great doctors, we caught it early. Thanks to my great wife, we made lifestyle changes and developed #TheRomanDiet to reduce #InsulinDemand and focus on #VeryLowGlycemic foods, among other things.

We’d like to see you have success. Contact us today to schedule a consult. Or purchase our video workshop course and get on the road today toward better health, and to #ControlBloodSugarNaturally. People who have followed our natural, healthy lifestyle solutions have:

Health-e-Solutions Framework of H.O.P.E.Type 1 Diabetes Stages

  • Decreased their HbA1c percentage
  • Reduced or eliminated insulin requirements,
  • Reversed symptoms and complications
  • Improved insulin sensitivity
  • Improved fasting and post-prandial blood glucose levels
  • Increased c-peptide secretion and insulin production
  • Decreased or eliminated insulin antibodies
  • Normalized their weight

(* results may vary)

With our #FrameworkOfHOPE, we help you establish a lifestyle foundation that may stop or reverse disease progression and complications naturally, and reduce InsulinDemand and other medication requirements. Get off the roller coaster of high and low blood sugars, and get on the rolling plains of normal, control.