Type 1 diabetes adult onset

Overview

Type 1 diabetes is an autoimmune condition where your body’s immune system mistakenly attacks the cells in your pancreas that make insulin. Insulin is a hormone that helps sugar (glucose) from food get into your cells to be used for energy. Without insulin, sugar builds up in your blood, which can cause serious health problems. Unlike type 2 diabetes, type 1 is not linked to lifestyle or weight. It can develop at any age, including in adults – this is sometimes called 'adult-onset type 1 diabetes' or 'latent autoimmune diabetes in adults (LADA)'.

Type 1 diabetes is less common than type 2. It affects about 1 in every 300 people in the UK. Adult-onset type 1 diabetes accounts for a significant number of new type 1 diagnoses in adults.

Type 1 diabetes can develop at any age, but there is a peak in childhood around age 10 to 14. Adult-onset type 1 diabetes can occur at any age in adulthood, often diagnosed between ages 30 and 50, but it can happen later too.

Symptoms

Common symptoms

• Excessive thirst (polydipsia)
• Frequent urination (polyuria)
• Extreme hunger (polyphagia)
• Unintentional weight loss
• Fatigue
• Blurred vision
• Slow-healing sores or cuts
• Frequent infections, such as thrush or urinary tract infections

Symptoms in children

• Same as common symptoms, plus bedwetting in a child who was previously dry at night
• Irritability or mood changes
• Rapid weight loss

Symptoms in older adults

• Symptoms may develop more slowly
• Confusion or dehydration, which can be mistaken for other conditions
• Persistent infections

Causes

Main causes

• Type 1 diabetes is an autoimmune disease. Your immune system attacks and destroys the insulin-producing beta cells in your pancreas.
• The exact trigger is unknown, but it likely involves a combination of genetic factors and an environmental trigger, such as a virus.

Risk factors

• Having a family history of type 1 diabetes (parent or sibling)
• Having certain genes (HLA types)
• Possible exposure to certain viruses, like enteroviruses
• Having other autoimmune conditions, such as coeliac disease or thyroid disease

When to see a doctor

See a doctor urgently if:

• If you have symptoms of diabetic ketoacidosis (DKA) or severe hypoglycemia, call your local emergency number immediately.
• If you have new-onset symptoms like excessive thirst, frequent urination, and unintentional weight loss, see a doctor urgently.

Book a routine appointment if:

• If you have persistent tiredness, blurred vision, or recurrent infections, make an appointment with your doctor.

Diagnosis

A healthcare provider will take your medical history, do a physical exam, and order blood tests to check your blood sugar and the function of your pancreas.

Tests that may be done

• Fasting blood glucose test
• Random blood glucose test
• HbA1c test (which shows your average blood sugar over the past 2 to 3 months)
• Autoantibody tests (to check for the immune attack on the pancreas; these help tell type 1 from type 2)
• C-peptide test (to see how much insulin your body is making)

What to expect at your appointment

A diagnosis of type 1 diabetes can be a shock, but your healthcare team will guide you. After diagnosis, you will learn how to check your blood sugar, give insulin (if needed), and manage your diet and activity. You will have regular follow-ups and access to specialists.

Treatment

The main treatment for type 1 diabetes is insulin therapy, because your body no longer makes its own insulin. The goal is to keep blood sugar levels as close to normal as possible to prevent short- and long-term problems.

Self-care at home

• Monitor blood sugar levels regularly using a glucose meter or continuous glucose monitor.
• Learn to count carbohydrates in meals to match your insulin doses.
• Adjust insulin for physical activity, illness, or stress as instructed by your healthcare team.
• Always carry fast-acting sugar, such as glucose tablets or sweets, in case of low blood sugar.

Medical treatments

Insulin is given by injection or an insulin pump. There are different types of insulin that work at different speeds: rapid-acting, short-acting, intermediate-acting, and long-acting. Your doctor will create an insulin plan that fits your lifestyle. Some people may also use new technologies like continuous glucose monitors and automated insulin delivery systems. Do not change your insulin dose or type without your doctor’s advice.

Living with this condition

Living with type 1 diabetes requires daily attention, but many people lead full, active lives. You will need to check your blood sugar several times a day, give insulin, and be mindful of what you eat and how active you are. Over time, these tasks become a natural part of your routine.

Lifestyle tips

• Carry a medical ID or wear a bracelet stating that you have diabetes.
• Have a plan for managing your blood sugar during exercise, travel, or when you are ill.
• Let friends and family know how to help you in an emergency.

Diet and exercise

There is no special 'diabetes diet'. You can eat a variety of foods, but you will need to learn how different foods affect your blood sugar and adjust your insulin accordingly. Carbohydrate counting is a useful skill. Exercise can help control your blood sugar, but you may need to adjust your insulin or have extra snacks to prevent lows. Talk to your healthcare team for personalised advice.

Mental health and emotional wellbeing

Managing a chronic condition like type 1 diabetes can be stressful. It's common to feel overwhelmed, anxious, or burned out. It's important to talk to your healthcare team if you are struggling. There is no shame in asking for mental health support. If you are in crisis, reach out to a crisis support service or call your local emergency number.

Prevention

Currently, there is no known way to prevent type 1 diabetes. Research is ongoing, but lifestyle changes do not reduce your risk.

Screening programmes

People with a family history of type 1 diabetes may be offered screening in research studies, but there is no routine screening for the general population.

Complications

If left untreated

• Without insulin treatment, blood sugar can become dangerously high, leading to diabetic ketoacidosis (DKA), which can be life-threatening.
• Over time, persistently high blood sugar can damage blood vessels and nerves, leading to heart disease, stroke, kidney disease, eye damage (retinopathy), nerve damage (neuropathy), foot problems, and increased infection risk.

Long-term outlook

With careful management and support from your healthcare team, most people with type 1 diabetes live long, healthy lives. Advances in insulin and technology make it easier to control blood sugar and reduce the risk of complications. It is a lifelong condition, but you can still do the things you love.

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