Type 1 diabetes is an autoimmune condition that often develops earlier in life (though sometimes in middle-age) and is marked by the body’s inability to produce insulin, requiring lifelong insulin therapy.
What is Type 1 diabetes?
Type 1 diabetes (T1DM) is a chronic autoimmune condition in which the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is no longer able to produce insulin, a vital hormone that regulates blood sugar levels by allowing glucose to enter cells for energy. Without insulin, glucose builds up in the bloodstream, leading to high blood sugar (hyperglycaemia). Ketones which are used instead for energy then build up and can cause serious metabolic complications if not managed appropriately.
Living with type 1 diabetes requires daily insulin therapy, either through injections or an insulin pump, as well as careful monitoring of blood glucose levels, diet, and physical activity. With consistent management and medical support, people with type 1 diabetes can lead full, active, and healthy lives as demonstrated by the numerous athletes and popular persona who live with T1DM
Type 1 diabetes occurs when the pancreas stops producing insulin, preventing glucose from entering cells and causing it to build up in the bloodstream.
What is the difference between Type 1 and Type 2 diabetes?
Although both type 1 and type 2 diabetes involve problems with insulin and result in high blood sugar levels, they are fundamentally different in terms of cause, development, and treatment approach.
Aspect
Type 1 Diabetes
Type 2 Diabetes
Cause
Autoimmune destruction of insulin-producing beta cells
Insulin resistance combined with a gradual decline in insulin production
Onset
Sudden and usually in childhood or adolescence but can occur in middle-age.
Gradual and typically in adults over 40, but increasingly seen in younger individuals
Insulin Production
None, as the body cannot produce insulin
Insulin is produced, but the body becomes resistant to it over time
Risk Factors
Genetic predisposition and possible environmental triggers
Complicated inheritable genetic factors and lifestyle factors such as poor diet, physical inactivity, obesity, and family history
Symptoms
Rapid onset of symptoms like excessive thirst, weight loss and, fatigue
Symptoms may develop slowly and can go unnoticed for years
Treatment
Requires lifelong insulin therapy from the time of diagnosis
Often managed initially with lifestyle changes and oral medications; insulin may be required later
Prevention
Cannot be prevented at this time
Largely preventable or delayed through lifestyle interventions
Type 1 diabetes is an autoimmune condition that leads to an absolute insulin deficiency, whereas type 2 diabetes is primarily a metabolic disorder involving insulin resistance. While type 2 diabetes may be delayed or even reversed in some cases through lifestyle changes, type 1 requires continuous insulin therapy from the outset.
What causes Type 1 diabetes?
Type 1 diabetes is caused by an autoimmune response in which the body’s immune system mistakenly identifies insulin-producing beta cells in the pancreas as harmful and destroys them. This destruction significantly reduces or completely halts the production of insulin, the hormone essential for regulating blood sugar levels.
Genetic susceptibility — certain genes, especially those related to the human leukocyte antigen (HLA) system, increase the likelihood of developing type 1 diabetes. However, not everyone with these genes develops the condition, which indicates that genetics alone are not enough to cause it. Type 1 diabetes is usually not inherited from parents.
Environmental triggers — viral infections such as enteroviruses, including Coxsackievirus, have been implicated as possible triggers. These infections may alter immune function or mimic pancreatic cells, leading the immune system to attack its own tissues. Dr. Dinesh found many of his patients having a preceding viral illness a few weeks prior.
Autoantibodies — individuals who develop type 1 diabetes often show the presence of autoantibodies, proteins made by the immune system that target the pancreas, years before symptoms appear. Screening for these markers can help identify those at higher risk.
Other factors under study — ongoing research is exploring additional potential contributors, including gut microbiota, early-life diet, and exposure to certain toxins or stressors, though these associations are not yet fully established.
Type 1 diabetes is not caused by lifestyle choices, diet, or physical inactivity. It cannot be prevented, and there is currently no cure. However, early diagnosis and appropriate medical care can help manage the condition and prevent complications.
How common is Type 1 diabetes in Singapore?
Type 1 diabetes (T1D) is less prevalent in Singapore compared to Type 2 diabetes, yet its incidence is increasing and poses significant health challenges. According to the Type 1 Diabetes Index by JDRF (2022), approximately 4,100 individuals are currently living with T1D in Singapore.
Notably, the prevalence of T1D is increasing at an annual rate of 6.6%, which is higher than the 4.3% annual increase observed for Type 2 diabetes.
This rising trend is concerning due to its impact on life expectancy and quality of life. The same index estimates that individuals with T1D in Singapore lose an average of 21 healthy years of life due to complications and suboptimal access to care. Moreover, it is projected that 280 lives in Singapore could have been saved with earlier diagnosis and better access to insulin and monitoring technologies.
What are the symptoms of Type 1 diabetes?
The symptoms of type 1 diabetes often develop rapidly over a few days or weeks, especially in children and adolescents. Because the body can no longer produce insulin, blood glucose levels rise quickly, leading to a range of noticeable physical and behavioural changes.
Common symptoms include:
Excessive thirst (polydipsia) — a constant need to drink water due to high blood sugar causing dehydration. Dr Dinesh has noticed that there is a thirst for carbonated drinks and fruit juices (High-sugar drinks)
Frequent urination (polyuria) — the body tries to flush out excess glucose through the urine.
Unexplained weight loss — despite normal or increased appetite, the body starts breaking down fat and muscle for energy as Insulin is an anabolic hormone (weight gain) and its absence causes weight loss
Extreme fatigue — without insulin, glucose cannot enter cells, leading to low energy levels.
Increased hunger (polyphagia) — the body craves energy as it cannot use glucose effectively.
Blurred vision — high blood sugar levels can cause swelling in the eye lens, leading to vision changes. This is initially reversible.
If left untreated, type 1 diabetes can lead to a serious condition called diabetic ketoacidosis (DKA) — where the body produces high levels of ketones, leading to nausea, vomiting, abdominal pain, and even coma.
Recognising these symptoms early is crucial. If you or your child are experiencing several of these signs, seek medical attention promptly.
Who is at risk of Type 1 diabetes?
Type 1 diabetes most commonly affects children, adolescents, and young adults, which is why it was previously known as “juvenile diabetes.” However, it is now well established that type 1 diabetes can develop at any age, including in adults in their 30s, 40s, or even later. A form of the condition called Latent Autoimmune Diabetes in Adults (LADA) is often misdiagnosed as type 2 diabetes due to its slower onset. Dr. Dinesh comments that the typical individual with LADA was diagnosed with type 2 diabetes and does very well on just one medication (usually metformin) before the diabetes suddenly deteriorates or the individual is suddenly hospitalised with high sugar levels. The pancreatic destruction is insidious and symptoms appear after many years.
While the condition can occur in people of all ethnicities and backgrounds, certain factors may increase susceptibility:
Geographic and ethnic patterns — Type 1 diabetes is more common in people of European descent and in countries such as Finland and Sweden, though cases are rising globally, including in Asia.
In Singapore and other parts of Asia, the incidence remains lower than in Western countries but is steadily increasing, with more diagnoses now seen in both children and adults. Early recognition of symptoms and appropriate diagnosis are essential, regardless of age, to begin insulin therapy and reduce the risk of complications.
How is Type 1 diabetes diagnosed?
Type 1 diabetes is diagnosed through a series of blood tests that assess blood glucose levels and detect specific markers that confirm the autoimmune nature of the condition. Because the onset can be sudden, early and accurate diagnosis is essential to prevent serious complications.
Key diagnostic steps include:
Fasting blood glucose test — measures blood sugar after at least 8 hours without eating. A reading of ≥7.0 mmol/L (126 mg/dL) suggests diabetes.
Random (non-fasting) blood glucose test — a blood sugar level of ≥11.1 mmol/L (200 mg/dL), along with symptoms such as thirst or fatigue, may indicate diabetes.
HbA1c (glycated haemoglobin) test — reflects average blood sugar levels over the past 2–3 months. A result of ≥7% supports a diagnosis of diabetes.
Autoantibody testing — specific to type 1 diabetes, these tests detect antibodies that attack insulin-producing cells, such as GAD, IA-2, and insulin autoantibodies. Their presence confirms an autoimmune cause.
C-peptide test — a C-peptide test measures how much insulin the body is producing. Low levels suggest that the pancreas is no longer making enough insulin, consistent with type 1 diabetes.
In some cases, especially when the diagnosis is uncertain — such as in adults where LADA (Latent Autoimmune Diabetes in Adults) is suspected — a combination of tests is used to distinguish type 1 from type 2 diabetes.
What are the treatment options for Type 1 diabetes in Singapore?
Managing Type 1 diabetes requires a lifelong commitment to replacing insulin and carefully monitoring blood sugar levels. At The Metabolic Clinic, we take a comprehensive and individualised approach that supports every aspect of daily life with diabetes.
Insulin therapy for Type 1 diabetes
Since the body can no longer produce insulin, replacement through external insulin is essential. Most individuals require:
Multiple daily injections (MDI) — a combination of long-acting insulin (basal) and rapid-acting insulin (bolus) taken before meals.
Insulin pump therapy — delivers insulin continuously through a small device worn on the body, allowing for greater flexibility and tighter control. These pumps can now connect seamlessly to continuous glucose monitoring systems (explained below) such that patients do not need to prick their fingers anymore.
Blood sugar monitoring
Frequent glucose checks are key to preventing both high and low blood sugar levels. This can be done using:
Finger-prick blood tests — typically 4–8 times daily, especially before meals and bedtime.
Continuous glucose monitoring (CGM) — sensors placed under the skin provide real-time glucose data, trends, and alerts, making adjustments easier and more precise.
Regular HbA1c tests are also done every 3–6 months to assess long-term glucose control.
Diet and nutrition for Type 1 diabetes
Managing food intake is essential in Type 1 diabetes. Because insulin dosing depends on carbohydrate intake, people with Type 1 diabetes are taught:
Carbohydrate counting — estimating carbs in meals to calculate insulin doses accurately.
Balanced nutrition — a focus on whole grains, lean proteins, fibre, and healthy fats helps stabilise blood sugar levels and support overall health.
Glycaemic index awareness — knowing which foods cause slower or faster glucose rises can aid better meal planning.
Exercise and physical activity
Regular exercise improves insulin sensitivity and cardiovascular health. However, it also affects glucose levels, so personalised plans are important. We provide guidance on:
Adjusting insulin and food intake before, during, and after activity
Preventing hypoglycaemia during prolonged or intense exercise
Choosing safe and enjoyable activities that support long-term health
Education and emotional support
Living with Type 1 diabetes involves daily decision-making and emotional resilience. We provide:
Structured diabetes education — for both newly diagnosed individuals and those needing refresher training
Support for families and caregivers — especially important for children and adolescents
Psychological support — coping with the emotional demands of chronic illness through counselling or peer support when needed
Regular reviews and complication screening
Type 1 diabetes requires ongoing follow-up to monitor for long-term complications. This typically includes:
HbA1c testing every 3–6 months
Annual kidney function tests, cholesterol screening, and eye and foot exams
Type 1 diabetes is a lifelong condition that requires daily insulin therapy, regular blood sugar monitoring, and ongoing lifestyle adjustments. It can affect both children and adults, often presenting with sudden symptoms such as excessive thirst, fatigue, and weight loss. However, with early diagnosis and the right support, people with Type 1 diabetes can live full, active lives.
At The Metabolic Clinic, we provide thoughtful and personalised care for individuals living with Type 1 diabetes. Schedule a consultation with us today for tailored medical care, clear guidance, and ongoing support to help you manage your condition with confidence.
Frequently Asked Questions (FAQs)
Can Type 1 diabetes be prevented?
Currently, Type 1 diabetes cannot be prevented. It is an autoimmune condition where the body’s immune system attacks insulin-producing cells. Ongoing research aims to find ways to prevent or delay its onset.
Is there a cure for Type 1 diabetes?
There is no cure for Type 1 diabetes at this time. Management involves lifelong insulin therapy and lifestyle adjustments. Research is ongoing to explore potential cures in the future.
Can I stop taking insulin if I change my diet?
No, individuals with Type 1 diabetes require insulin regardless of dietary changes. While a healthy diet helps manage blood sugar levels, it doesn't eliminate the need for insulin.
What is the “honeymoon phase” in Type 1 diabetes?
The “honeymoon phase” refers to a period shortly after diagnosis when the pancreas still produces some insulin, leading to reduced insulin needs. This phase is temporary and varies in duration.
Are there different types of insulin?
Yes, there are various types of insulin, including rapid-acting, short-acting, intermediate-acting, and long-acting. The choice depends on individual needs and treatment plans.
Can exercise help control Type 1 diabetes?
Yes, regular physical activity can improve insulin sensitivity and help manage blood sugar levels. However, it’s important to monitor blood sugar before, during, and after exercise to prevent hypoglycemia.
Can adults develop Type 1 diabetes?
Yes, while commonly diagnosed in children and adolescents, Type 1 diabetes can develop at any age, including adulthood. Adult-onset Type 1 diabetes is sometimes misdiagnosed as Type 2 diabetes.
What is diabetic ketoacidosis (DKA)?
DKA is a serious complication of Type 1 diabetes resulting from extremely high blood ketone and sugar levels. It requires immediate medical attention and is characterised by symptoms like nausea, vomiting, and rapid breathing.
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