by Wesley W. Wilson, MD
NOTE: If you have any questions for “Ask the Doctor,” please send them to the Voice editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I’m the only one in my immediate family with type 1 diabetes. They still insist “I got it from eating too much sugar” (I was nine years old, then). Where does type 1 diabetes come from? Do doctors know yet?
A: Some details of the cause of type 1 diabetes remain unclear and unexplained; but I can tell you and your family it didn’t come from eating too much sugar. There is agreement that type 1 diabetes develops when the body erroneously produces antibodies to its own insulin-producing beta cells.
Antibodies are substances manufactured to protect us from attack by infectious agents. They are wonderful when they prevent polio, pneumonia, or tetanus, but not so great when they are somehow misdirected and attack our own bodies. A number of diseases are caused by such “autoimmune” processes. These include type 1 diabetes, some types of thyroid disease, and illnesses like rheumatoid arthritis and Lupus.
Somehow, these helpful substances can be misdirected, so they erroneously attack normal tissues. Faulty production of antibodies seems to be an inherited problem, and family members of a person with type 1 diabetes are at greater risk of developing type 1 disease than are the rest of the population.
It’s not a sure thing, however. First-degree relatives of a person with type 1 diabetes run about a 3.5 percent risk of developing type 1 disease themselves. So it’s not surprising you are the only person in your family with type 1 diabetes. If you had 100 brothers and sisters, the odds are that only about three or four would also have type 1 diabetes. That rate is much greater than for the general population. The exact mechanism of inheritance needs further research and study.
It is now possible to test for the antibodies that cause type 1 diabetes, so persons at a very high risk of developing the disease can be detected early, even before there is any abnormality of the blood sugar. The hope is that these individuals, who seem almost certain to develop type 1, can be identified and then some form of treatment can be used to protect their beta cells—and prevent type 1 diabetes from ever developing. I would encourage any person who has type 1 diabetes to tell all their relatives to contact the Type 1 Diabetes Trial Net Study by calling 1-800-HALT-DM1 (1-800-425-8361); Web site: www.diabetestrialnet.org. We need to have as many persons as possible involved in this important research trial to detect and hopefully to prevent type 1 diabetes.
We all need to get the word out that type 1 diabetes is not caused by “eating too much sugar,” and there is great hope for the future; but much more study needs to be done.