The Longer Answer:

Type 1 diabetes (T1D) is a chronic autoimmune disease caused by the destruction of pancreatic beta cells. It is characterized by the body’s inability to produce insulin, a hormone that is responsible for enabling glucose to enter cells to be used as energy. Without insulin, the body draws from fat and muscle to use as energy and the blood becomes acidic. In absence of this critical hormone, a person will get very sick and will eventually die.

Individuals living with T1D are dependent on exogenous insulin to stave off low blood glucose (hypoglycemia) and high blood glucose (hyperglycemia). If a person has taken too much insulin or has not consumed enough carbohydrates, the body enters hypoglycemia. Hypoglycemia can quickly become a medical emergency. A person entering hypoglycemia can experience confusion, dizziness, tremors, anxiety, rapid heartbeat, profuse sweating, and extreme hunger. Left untreated, hypoglycemia can become serious and can lead to seizures, coma, and ultimately death. Hyperglycemia can also become a medical emergency when the individual enters into diabetic ketoacidosis (DKA). As the liver breaks down fat to be used as energy, ketones are released. The rapid build-up of ketones results in DKA, a serious complication of hyperglycemia. DKA often occurs quickly, and the person experiencing DKA may present with confusion, nausea, dizziness, extreme fatigue, stomach pains, insatiable thirst, and personality changes. Severe hypoglycemia and DKA both require immediate medical intervention.

Hyperglycemia is also responsible for long-term health consequences, generally referred to as microvascular and macrovascular complications. Microvascular complications include diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. Diabetic retinopathy is a leading cause of blindness in Canada, and it can appear as early as five years after a T1D diagnosis. Microaneurysms occur in diabetic retinopathy, as does preretinal hemorrhages and retinal detachments. Diabetic neuropathy is seen in both peripheral and autonomic neuropathy, with peripheral resulting in tingling, burning, numbness, or of absence of reflex or temperature perception, and is a central cause of amputation. Autonomic neuropathy includes paralysis of stomach motility, pupillary disorders, uncontrollable bowel and bladder functions, and resting tachycardia. Diabetic nephropathy is the most common cause of kidney disease and is recognized as a leading cause of mortality in those living with T1D. Macrovascular complications result in coronary artery disease, the result of which is myocardial infarction. Complications to these large blood vessels also causes stroke and large vein vascular disease, resulting in poor limb circulation, infection, and ultimately may lead to amputation. Macrovascular complications show in vascular abnormalities, including plaque formation and stiffening of blood vessels. Cardiovascular and renal disease are the number one cause of death in persons with Type 1 diabetes.

The advancement of both immediate severe hypoglycemia and DKA as well as the advancement of long-term complications is largely preventable. The avoidance of short and long-term complications is dependent on how well a person can keep their blood glucose within a target range. Many variables can influence how frequently a person has low or high glucose. This includes, but is not limited to what food has been eaten and when, what type of exercise has been completed and when, the level of stress a person is experiencing, hormonal fluctuations that may be present, if illness is present and any number of other factors. This also depends greatly on the medical advice or supports received. The person may draw from a number of different health technologies that are available to help them meet their individual needs in glucose management. This includes the person’s preferred insulin, glucose monitoring devices, automated insulin delivery systems and hybrid or closed-loop systems, and hypoglycemia treatment technologies.