The Three Different Stages of Type 1 Diabetes

Diabetes is broadly classified into Type 1 and Type 2 diabetes. Individuals with type 2 diabetes usually have a pre-diabetic state which is the time when people have to adopt a healthy lifestyle to prevent or delay the onset of diabetes.

However, until now, this was not the case with Type 1 diabetes. In fact, when diabetes was diagnosed in a young person, especially with DKA (diabetic ketoacidosis), and the onset was abrupt, the person would get a label of Type 1 Diabetes.

However, now we know that Type 1 Diabetes does not develop all of a sudden. It has three different stages.  These three different stages of Type 1 Diabetes have been identified to target it before the disease manifests itself.

The three different stages of Type 1 Diabetes Mellitus:

Unlike Type 2 Diabetes Mellitus where insulin resistance is the primary problem, individuals with Type 1 Diabetes do not usually have Insulin resistance.

Autoantibodies are formed against one’s own pancreatic islet cells which destroy the insulin-secreting cells resulting in absolute or relative insulin deficiency.

Patients develop symptoms of high blood glucose levels when 80 – 90% of the pancreatic Beta Cells are lost [Ref]. Some patients may present earlier (in times of stress) even when 50% of the cells are functioning.

The three different stages of Type 1 Diabetes are identified to formulate drugs so as to prevent the beta-cells from immune-mediated injury.

Tzield (Teplizumab-mzwv) injection, a CD3-targeted antibody, has already been approved for the treatment of Stage 2 Type 1 Diabetes in adults and children older than 8 years of age.

Stage 1 Type 1 Diabetes:

Stage 1 of type 1 diabetes mellitus is characterized by:

• The presence of two or more autoantibodies directed against the islet cells that are associated with the development of Type 1 Diabetes.
• The blood sugars at this stage are normal, and
• The individuals do not have any symptoms of diabetes or high blood glucose.

These individuals have a 100% risk of developing Type 1 Diabetes during their lifetime. The risk of developing Type 1 Diabetes after 5 years is about 44%.

At 10 years, the risk of developing Type 1 diabetes is estimated to be around 70%.

Stage 2 Type 1 Diabetes:

This is the stage when the islet cells are depleted to the extent that blood glucose starts rising in the plasma. However, at this stage, the individual is still asymptomatic since some islet cells of the pancreas are compensating for the cells that are lost.

This stage can be considered “Prediabetes for Type 1 Diabetes” people. It is characterized by:

• The presence of two or more autoantibodies directed against the islet cells that are associated with Type 1 Diabetes.
• Dysglycemia or impaired glucose tolerance: The blood glucose may fall in the ranges of:
  • FBS: 100 – 125 mg/dl
  • BSR: 140 – 199 mg/dl
  • A1C: 5.7 – 6.4 %

At this stage, the risk of developing Type 1 diabetes in five years is about 75%. The lifetime risk of T1DM is 100%.

Stage 2 is the stage when metabolic parameters start to become abnormal. The risk of heart, kidney, nervous system, and eye diseases is increased.

Stage 3 Type 1 Diabetes:

Stage 3 of Type 1 Diabetes can be considered as full-blown Type 1 Diabetes. Patients at this stage have autoimmunity, impaired blood glucose, and are symptomatic.

Symptoms of Type 1 Diabetes may include:

• Excessive thirst, hunger, and frequent urination
• Abdominal pain, nausea, drowsiness
• Weight loss

This is the stage when the person has to control his/her blood glucose with insulin and work on his diet and exercise routine to prevent complications such as kidney disease and retinopathy.

Summary of the 3 different stages of Type 1 Diabetes Mellitus:

The three different stages of Type 1 Diabetes Mellitus can be identified:

• Testing for autoantibodies against islet cells:

The three islet cell-directed antibodies are GAD65, IA-2, and/or ZnT8. The presence of any two indicates that the person is at risk and is labeled as Stage 1 of Type 1 Diabetes.

Autoantibodies are present in all three stages of Type 1 Diabetes.

• Testing for blood glucose:

Blood glucose is normal in stage 1 of Type 1 Diabetes. Both stage 2 and stage 3 of Type 1 Diabetes are characterized by dysglycemia.

The blood glucose may fall within the ranges set for “Prediabetes” as mentioned above.

• Asking for symptoms:

When the person develops symptoms of diabetes, along with elevated blood glucose and the presence of autoantibodies, this is Stage 3 Type 1 Diabetes.

All symptomatic patients with Type 1 Diabetes have stage 3 diabetes.